Division of Radiation Oncology, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
Palliative Care Practitioners Association of South Africa, Stellenbosch, South Africa.
Z Evid Fortbild Qual Gesundhwes. 2023 Aug;180:25-28. doi: 10.1016/j.zefq.2023.06.001. Epub 2023 Jul 28.
South Africa (SA), an upper middle-income country, faces significant challenges, including severe inequality, poverty, high unemployment rates, unequal access to basic services, and a long history of human rights violations. It is a diverse nation with eleven official languages. The country also bears a heavy burden of communicable and non-communicable diseases, with many patients seeking healthcare services too late. Despite the pressing need, palliative care is still an emerging field in South Africa, with limited funding allocated for its integration. Advance Care Planning (ACP) is a recommended practice in SA for patients with serious illnesses while they are still in good health and can function independently. Non-Governmental Organizations (NGOs) in SA have played a significant role in integrating ACP planning within their settings through advocacy and training. ACP has been included in both formal academic training and training programs offered by NGOs. Additionally, research has been initiated to evaluate the acceptability and validity of the Serious Illness Conversation Guide within the cultural diversity and complexities of the SA context. Acceptance of ACP amongst SA healthcare workers and the public faces many challenges. Many South Africans still have a low level of trust and acceptance towards the public healthcare system. In many South African cultures discussing death and dying is considered culturally taboo. Traditional cultures interpret and apply the concept of individual autonomy differently. The philosophy of "Ubuntu", which translates to "I am because we are", is widely endorsed in the country, prioritising community needs over individual needs. It is, therefore, essential for healthcare professionals engaging in ACP conversations not to make assumptions about a person's preferences for communication, decision-making and care, based on external attributes. Instead, they should respectfully explore these preferences and be adaptable in their approach to ACP. The implementation of ACP in SA is still in its early stages, requiring further research to inform culturally sensitive approaches to advance care planning.
南非（SA）是一个中等偏上收入国家，面临着严峻的挑战，包括严重的不平等、贫困、高失业率、基本服务获取机会不均等以及长期存在的侵犯人权现象。它是一个多语言国家，有 11 种官方语言。这个国家还背负着传染病和非传染性疾病的沉重负担，许多患者求医过晚。尽管需求紧迫，但缓和医疗在南非仍然是一个新兴领域，用于其整合的资金有限。在南非，对于患有严重疾病但仍身体健康且能够独立生活的患者，预先医疗指示（ACP）是一种推荐的做法。南非的非政府组织（NGO）通过宣传和培训，在其环境中发挥了整合 ACP 规划的重要作用。ACP 已经被纳入正式学术培训和 NGO 提供的培训计划中。此外，还启动了研究，以评估在南非文化多样性和复杂性背景下，严重疾病对话指南的可接受性和有效性。ACP 在南非医疗保健工作者和公众中的接受程度面临诸多挑战。许多南非人对公共医疗体系仍然缺乏信任和接受。在许多南非文化中，讨论死亡被认为是文化禁忌。传统文化对个人自主权的理解和应用也存在差异。“Ubuntu”的理念，即“我因我们而存在”，在该国得到广泛认可，将社区需求置于个人需求之上。因此，参与 ACP 对话的医疗保健专业人员不应基于外在属性，对个人对沟通、决策和护理的偏好做出假设。相反，他们应该尊重地探讨这些偏好，并在 ACP 方法上具有适应性。ACP 在南非的实施仍处于早期阶段，需要进一步研究，以提供对文化敏感的预先医疗指示规划方法。
