Pilime Sukoluhle, Ratshikana Mpho, Ojifinni Oludoyinmola, Ibisomi Latifat
School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada.
Wits Centre for Palliative Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
BMC Palliat Care. 2025 Jun 2;24(1):155. doi: 10.1186/s12904-025-01778-3.
The prevalence of chronic diseases among the South African population is increasing. The incidence of cancers is high and expected to double by 2030 while the HIV burden is disproportionately high. These are indicators of the need for palliative care services in the South African health system. While some palliative care service exists, there are challenges with availability and integration into routine services nationally. In Gauteng Province, CMJAH is one of two quaternary hospitals that provide palliative care services. We sought to find the barriers and enablers for the availability and integration of palliative care into routine services at CMJAH.
We used an exploratory qualitative research approach. Study sites were the internal medicine, surgical, and medical oncology departments, the palliative care unit, and the administration block at CMJAH. We interviewed four groups of personnel: the management of the four departments, previous and current staff in the palliative care unit, and hospital management staff. A hybrid of inductive and deductive coding was conducted, and the final codebook was developed using all the domains and selected constructs of the Consolidated Framework for Implementation Research (CFIR).
Barriers and enablers were categorised according to the domains of the CFIR. We found that individual characteristics such as knowledge and awareness of palliative care, adequate training, and positive attitude towards palliative care encourage the availability of services at a hospital. The availability of a budget for palliative care, a conducive environment for service provision, and management buy-in are also key determinants for palliative care. Poor planning, lack of implementation of the national policy framework and strategy for palliative care, and over-reliance on external donor funds are some of the hinderances for availability and integration of palliative care at a public hospital.
Despite the importance of palliative care, implementation is a challenge at CMJAH. The availability of a palliative care budget from relevant Government departments, and inclusion of some roles (navigators, spiritual chaplains) in the personnel structure for the Health Department are some of the ways through which availability and integration of the service can be improved across public hospitals in South Africa.
南非人群中慢性病的患病率正在上升。癌症发病率很高，预计到2030年将翻倍，而艾滋病毒负担异常沉重。这些都是南非卫生系统需要姑息治疗服务的指标。虽然存在一些姑息治疗服务，但在全国范围内，服务的可及性以及将其纳入常规服务方面存在挑战。在豪登省，CMJAH是提供姑息治疗服务的两家四级医院之一。我们试图找出在CMJAH将姑息治疗纳入常规服务的障碍和促进因素。
我们采用探索性定性研究方法。研究地点为CMJAH的内科、外科、肿瘤内科、姑息治疗科以及行政楼。我们采访了四组人员：四个科室的管理人员、姑息治疗科的前任和现任工作人员以及医院管理人员。采用归纳编码和演绎编码相结合的方式，并使用实施研究综合框架（CFIR）的所有领域和选定结构制定了最终编码手册。
根据CFIR的领域对障碍和促进因素进行了分类。我们发现，诸如对姑息治疗的知识和认识、充分的培训以及对姑息治疗的积极态度等个人特征有助于在医院提供服务。姑息治疗预算的可及性、有利于服务提供的环境以及管理层的支持也是姑息治疗的关键决定因素。规划不善、缺乏国家姑息治疗政策框架和战略的实施以及过度依赖外部捐助资金是公立医院姑息治疗可及性和整合的一些障碍。
尽管姑息治疗很重要，但在CMJAH实施仍是一项挑战。相关政府部门提供姑息治疗预算，以及在卫生部人员结构中纳入一些角色（导航员、心灵牧师），是改善南非公立医院服务可及性和整合的一些途径。
