Ofosu-Poku Rasheed, Owusu-Ansah Michael, Antwi John
Directorate of Family Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Int J Chronic Dis. 2020 Mar 15;2020:8432956. doi: 10.1155/2020/8432956. eCollection 2020.
Ghana's chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist palliative care services. This paper explores the factors influencing referral of patients with nonmalignant chronic diseases for specialist palliative care. A qualitative approach was used to explore these factors from eight (8) participants-four (4) physician specialists and four (4) next of kin of patients with advanced nonmalignant chronic illness. Individual face-to-face interviews were conducted using a semistructured interview guide. Interviews were audio-recorded and data coded, themes and subthemes were identified, and thematic analysis was done. Barriers and motivators identified were categorized as either related to physicians, institution, or family. Barriers to referral were perception of the scope of palliative care, medical paternalism, lack of an institutional referral policy, poor human resource capacity of the palliative care team, and lack of awareness about the existence of specialist palliative care service. Poor economic status of the patient and family, poor prognosis, previous interaction with the palliative care team, and an appreciation of patients' expectations of the healthcare system were identified as motivators for referral. The palliative care team must therefore increase awareness among other health professionals about their services and facilitate the development and availability of a clear policy to guide and improve referrals.
加纳的慢性病负担正在上升。慢性病管理临床护理的一个重要方面是提高患者及其家庭的生活质量，并帮助他们应对危及生命的疾病经历。专科姑息治疗服务有助于实现这一目标，尤其是在面临复杂的社会心理挑战和高症状负担的情况下。因此，尽可能多的患者能够获得现有的专科姑息治疗服务是很有必要的。本文探讨了影响非恶性慢性病患者转诊至专科姑息治疗的因素。采用定性方法，从八名参与者（四名内科专科医生和四名晚期非恶性慢性病患者的近亲）中探究这些因素。使用半结构化访谈指南进行个人面对面访谈。访谈进行了录音，并对数据进行编码，确定主题和子主题，然后进行主题分析。所确定的障碍和推动因素分为与医生、机构或家庭相关的因素。转诊障碍包括对姑息治疗范围的认知、医疗家长主义、缺乏机构转诊政策、姑息治疗团队人力资源能力不足以及对专科姑息治疗服务存在缺乏认识。患者及其家庭经济状况差、预后不良、之前与姑息治疗团队的互动以及对患者对医疗系统期望的理解被确定为转诊的推动因素。因此，姑息治疗团队必须提高其他卫生专业人员对其服务的认识，并促进制定和提供明确的政策，以指导和改善转诊。
