Krause Rene, Gwyther Liz, Olivier Jill
Division of Interdisciplinary Palliative Care and Medicine, University of Cape Town, Room 2.28, Falmouth Building, Observatory, Western Cape 7935, South Africa.
Division of Interdisciplinary Palliative Care and Medicine, University of Cape Town, Observatory, Western Cape, South Africa.
Palliat Care Soc Pract. 2024 Jan 8;18:26323524231219510. doi: 10.1177/26323524231219510. eCollection 2024.
Palliative care (PC) has been integrated to a limited extent in the South African healthcare system. Contextual factors may be a pivotal influence in this integration.
This study aims to explore contextual factors that are possibly influencing the integration or lack thereof in an academic teaching hospital (ATH).
A mixed-method study was conducted in a large ATH in South Africa.
The mixed methods were conducted in parallel and then merged. Findings were integrated to describe the contextual factors influencing PC integration, to develop a timeline of implementation and assess the probable influence of context on the integration process. The mixed-methods phases included a narrative review of published literature related to health systems, integration of health interventions and PC in teaching hospital settings; followed by interviews, documentary and routine data analyses. Semi-structured interviews with purposively sampled participants provided the qualitative data. Primary national, provincial and organizational documents expanded the contextual phenomena and corroborated findings. Routine hospital admission and mortality data was statistically analysed to expand further and corroborate findings. All qualitative data was thematically analysed using deductive coding, drawing from the aspects of the contextual dimensions of integration.
Enabling contextual factors for local PC integration were global and local advocacy, demonstrated need, PC being a human right, as well as the personal experiences of hospital staff. Impeding factors were numerous misconceptions, PC not valued as a healthcare priority, as well as limitations in functional elements necessary for PC integration: national and regional political support, leadership at all levels and sustainable financing.
The normative and functional contextual aspects interplay at macro, meso and micro levels positively and negatively. How stakeholders understand and value PC directly and indirectly impacts on PC integration. Strategic interventions such as mandatory education are required to ensure PC integration. The health system is dynamic, and understanding the context in which the health system functions is core to the integration of PC. This may assist in developing integration strategies to address PC integration and the transferability of these strategies.
姑息治疗（PC）在南非医疗保健系统中的整合程度有限。背景因素可能是这种整合的关键影响因素。
本研究旨在探讨可能影响一所学术教学医院（ATH）整合姑息治疗或缺乏整合的背景因素。
在南非一家大型学术教学医院进行了一项混合方法研究。
混合方法并行开展，然后合并。研究结果进行整合，以描述影响姑息治疗整合的背景因素，制定实施时间表，并评估背景对整合过程的可能影响。混合方法阶段包括对与卫生系统、教学医院环境中卫生干预措施和姑息治疗整合相关的已发表文献进行叙述性综述；随后进行访谈、文件和常规数据分析。对有目的抽样的参与者进行半结构化访谈，提供定性数据。国家、省级和组织的主要文件扩展了背景现象并证实了研究结果。对医院常规入院和死亡率数据进行统计分析，以进一步扩展和证实研究结果。所有定性数据均采用演绎编码进行主题分析，借鉴整合背景维度的各个方面。
促进当地姑息治疗整合的背景因素包括全球和当地的倡导、已证明的需求、姑息治疗作为一项人权以及医院工作人员的个人经历。阻碍因素包括众多误解、姑息治疗未被视为医疗保健优先事项以及姑息治疗整合所需功能要素的局限性：国家和地区政治支持、各级领导能力以及可持续融资。
规范和功能性的背景因素在宏观、中观和微观层面上相互作用，既有积极影响也有消极影响。利益相关者对姑息治疗的理解和重视程度直接和间接地影响着姑息治疗的整合。需要采取强制性教育等战略干预措施来确保姑息治疗的整合。卫生系统是动态的，了解卫生系统运作的背景是姑息治疗整合的核心。这可能有助于制定整合战略，以解决姑息治疗整合问题以及这些战略的可转移性。
