Structural Challenges of Providing Palliative Care for Patients with Breast Cancer

Using Patient-Centered Dissemination and Implementation Frameworks and Strategies in Palliative Care Settings for Improved Quality of Life and Health Outcomes: A Scoping Review

BACKGROUND

There is a need for patient-provider dissemination and implementation frameworks, strategies, and protocols in palliative care settings for a holistic approach when it comes to addressing pain and other distressing symptoms affecting the quality of life, function, and independence of patients with chronic illnesses. The purpose of this scoping review is to explore patient-centered D&I frameworks and strategies that have been adopted in PC settings to improve behavioral and environmental determinants influencing health outcomes through evidence-based programs and protocols.

METHODS

The five step Arksey and O'Malley's (2005) York methodology was adopted as a guiding framework: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results.

RESULTS

Only 6 out of the 38 (16%) included studies applied a D&I theory and/or framework. The RE-AIM framework was the most prominently cited (n = 3), followed by the Diffusion of Innovation Model (n = 2), the CONNECT framework (n = 1), and the Transtheoretical Stages of Change Model (n = 1). The most frequently reported ERIC strategy was strategy #6 "Develop and organize quality monitoring systems", as it identified in all 38 of the included studies.

CONCLUSION

This scoping review identifies D&I efforts to translate research into practice in U.S. palliative care settings. Results may contribute to enhancing future D&I initiatives for dissemination/adaptation, implementation, and sustainability efforts aiming to improve patient health outcomes and personal satisfaction with care received.

Caregiving Ability of Mothers of Children With Cancer: Qualitative Content Analysis

BACKGROUND

Childhood cancer confronts the child and the parents with considerable degrees of stress. Because caring for the child is mainly the role of the mother in most families, her ability to take care of the affected child is very important.

OBJECTIVE

To explore the caregiving ability of Iranian mothers who have children diagnosed with cancer.

METHODS

In this present study, which was conducted using the Directed Qualitative Content Analysis Method, 11 parents having children diagnosed with cancer and 5 professional caregivers working at the Department of Hematology and Oncology of Mofid Children Hospital in Tehran, Iran, were selected using purposeful sampling method. Data were collected through semistructured interviews. Data analysis was performed simultaneously with data collection using the Directed Content Analysis Approach.

RESULTS

Five main categories emerged, namely, care exhaustion, care confusion, spiritual conflict, care competence, and care preparedness that represent the beneficiaries' perception of the caring ability of Iranian mothers of cancer-afflicted children.

CONCLUSION

Study results revealed that the caregiving capacity of mothers nurturing cancer-stricken children can be evaluated across 5 domains, encompassing a spectrum of maternal requirements in child care. Improving these domains can elevate maternal caregiving proficiency, fostering self-care and enhancing care for the ailing child.

IMPLICATION FOR PRACTICE

A program can be developed based on the findings of the present study, in order to improve the caring ability of mothers of cancer-afflicted children, which results in improving the mother's care for her cancer-afflicted child.

Palliative care in the treatment of women with breast cancer: A scoping review

OBJECTIVES

Recent studies on the quality of life in women with breast cancer show a high prevalence of signs and symptoms that should be the focus of palliative care (PC), leading us to question the current role they play in addressing breast cancer. Therefore, the objective of this review is to map the scope of available literature on the role of PC in the treatment of women with breast cancer.

METHODS

This is a methodologically guided scoping review by the Joanna Briggs Institute and adapted to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist for report writing. Systematic searches were conducted in 8 databases, an electronic repository, and gray literature. The searches were conducted with the support of a librarian. The study selection was managed through the RAYYAN software in a blind and independent manner by 2 reviewers. The extracted data were analyzed using the qualitative thematic analysis technique and discussed through textual categories.

RESULTS

A total of 9,812 studies were identified, of which only 136 articles and 3 sources of gray literature are included in this review. In terms of general characteristics, the majority were published in the USA (35.7%), had a cross-sectional design (44.8%), and were abstracts presented at scientific events (19.6%). The majority of interventions focused on palliative radiotherapy (13.6%). Thematic analysis identified 14 themes and 12 subthemes.

SIGNIFICANCE OF RESULTS

Our findings offer a comprehensive view of the evidence on PC in the treatment of breast cancer. Although a methodological quality assessment was not conducted, these results could guide professionals interested in the topic to position themselves in the current context. Additionally, a quick synthesis of recommendations on different palliative therapies is provided, which should be critically observed. Finally, multiple knowledge gaps are highlighted, which could be used for the development of future studies in this field.

Palliative care delivery models: a systematic scoping review protocol

AIM

This scoping review will map out the evidence for palliative care delivery models in hospitals and the challenges of their application in practice from 2012 to 2022. A list of the predetermined MeSH terms will be used to search electronic databases for the relevant literature in English or Persian.

METHOD

The Joanna Briggs Institute Reviewer's guideline will be used to qualitatively appraise the identified reports and to assess their scientific rigour. Information about the introduced models will be summarised in extraction sheets and a narrative synthesis of the retrieved data will be performed and tabulated for benchmarking analysis. The findings will be applicable for evidence-informed policy-making in health systems and in response to palliative care unmet needs. The study results could also be accommodated in decision-making processes for the adoption of an integrated PalC model to achieve enhanced organisational performance in clinical settings.

Psycho-emotional recovery, the meaning of care in the process of providing palliative care to Iranian people with cancer: A grounded theory study

AIM

Despite the significance of palliative care in treating people with cancer, the provision of this type of care in Iran is vague and unorganized. This research intends to explore the meaning of care in the process of providing palliative care to Iranian people with cancer and to develop a theory that would explain the phenomenon.

DESIGN

This is a qualitative study in nature and Corbin and Strauss' Grounded Theory approach was used for data analysis.

METHODS

Data was collected through semi structured interviews that were held with 21 participants who have had experiences in receiving and providing palliative care. The study was conducted in April to December 2019 in palliative care centres of Tehran. Sampling first started purposefully and moved to theoretical once concepts began to emerge from the data. Comparative and continuous data analysis was undertaken using Corbin and Strauss' (Basics of qualitative research: Techniques and procedures for developing grounded theory, Sage, 2015) approach.

RESULTS

Main concerns of care providers in providing palliative care was to reduce the affliction and anxiety of patients by understanding the difficult state of patient and psycho-emotional recovery was identified as the core category, which was performed via three critical strategies: building emotional connection, reinforcing positive mindset and having a core value in care.

Hospice care delivery system requirements

BACKGROUND

Hospice care is a perceived need in the Iranian health system.

AIM

This qualitative study is explaining the stakeholders' perception of what is required to develop a hospice care system for patients living with cancer in Iran.

METHODS

A total of 21 participants (specialists, policymakers, healthcare providers, cancer patients and family caregivers) were selected through purposeful sampling and interviewed in-depth in 2020. Interviews were analysed through directed content analysis.

FINDINGS

A total of 1054 codes, 7 categories and 21 subcategories were extracted. The requirements include the need to provide: multiple settings and diverse services; participatory decision making; integration into the health system; specialised human resources; an organised system of accountability; the preparation of the existing health system; and wider capacity-building in existing Iranian society.

CONCLUSION

It is essential that Iranian services create a participatory comprehensive care plan, utilise expert manpower, integrate hospice care into the existing health system and organise a system of accountability. Policymakers should focus on the preparation of the health system and capacity building in society.

Caregivers' Knowledge of and Attitude towards Palliative Care in Iran

BACKGROUND

Addressing the palliative care needs requires clinicians to have sufficient knowledge of and positive attitudes toward palliative care. The study aimed to determine nurses' and physicians' knowledge of and attitudes towards palliative care in Iran.

METHODS

This descriptive cross-sectional study was conducted in 2021 on 493 physicians and nurses, selected through convenience sampling. Three online questionnaires addressing caregivers' demographic and professional's questionnaire, Health Care Providers' Attitude toward PC Questionnaire, and Health Care Providers' Knowledge of PC Questionnaire were used. The data was analyzed in SPSS using correlational and descriptive statistics and regression analysis.

RESULTS

The mean score of attitude towards palliative care was 142.03 ± 11.35 and the mean score of palliative care knowledge, 19.47 ± 2.62. Considering the regression coefficients between these two mean scores (P-value = 0.001, b = 1.304), it can be inferred that knowledge is a good predictor of attitude. In addition, the mean scores of knowledge and attitude have a significant relationship with age, female gender, holding a master's or PhD degree, the need for formal education in the field of palliative care and the need to take a palliative care course.

CONCLUSIONS

The present study showed that Iranian nurses and physicians have a moderate level of knowledge and attitude towards palliative care. It is necessary to take measures in order to improve knowledge and attitude by holding retraining courses, theoretical and clinical training sessions and relevant seminars in short term, and also by integrating related topics into nursing and medical curriculums in long term.

Identifying unmet information needs of advanced cancer patients in Iran: An in-depth qualitative study

Background and Aims

One of the main vital needs for self-care in patients with advanced cancer is information need. Meeting this need has significant positive effects on improving their treatment and care. This study was conducted to identify the unmet information needs of patients with advanced cancer in Iran.

Methods

This exploratory study was performed from July to February 2021 in the Kerman University of Medical Sciences cancer treatment centers. Oncologists selected eligible patients by purposeful sampling method. Semistructured and in-depth interviews were conducted with selected patients to collect data. Interviews continued until data saturation. Each interview was audio-recorded and transcribed verbatim.

Results

In the interviews, 15 patients with advanced cancer ranging in age from 43 to 65 years participated. The most common type of cancer in women was breast (71.4%) and prostate (50%) in men. The two main categories of "types of unmet information needs" and "reasons for not meeting information needs" were extracted from the analysis of patient interviews, with six and four subcategories, respectively.

Conclusion

Cancer patients had a large number of unmet information needs. At the time of identifying the unmet information needs of cancer patients, the basic reasons for not meeting these needs should also be considered because cultural differences and social gaps in societies are inevitable.

Challanges of Meeting the Palliative Care Needs of Colorectal Cancer patients in Iran: A Qualitative Research

Background

Despite the high prevalence of Colorectal Cancer (CRC) in Iran and the need to pay more attention to the Palliative Care (PC) needs of patients with this disease, a few studies have previously examined the PC needs of them by gaining the patients', family members', and treatment team's views. This study aimed to investigate the challenges in the way of meeting the PC needs of CRC patients.

Materials and Methods

This study was a qualitative content analysis study conducted on 43 participants (including 15 patients, 20 health care providers, and eight family members) through purposive sampling and semi-structured individual interviews in Omid Educational and Medical Center and Iranian Cancer "Control Center (MACSA) in Isfahan from May 2020 to December 2021. Data analysis was performed simultaneously with data collection using conventional qualitative content analysis with the Graneheim and Lundman approach. In order to assess the trustworthiness of the obtained data, credibility, dependability, confirmability, and transferability criteria were used.

Results

Data analysis led to the production of 615 primary codes, 16 sub-categories, and five main categories. These five main categories included "Lack of facilities and equipment", "Lack of quality of services provided by the treatment team", "Insufficient financial support to the patient and family", "Insufficient psychological and emotional support from the patient and family", and "Inefficiency of the patient and community awareness process".

Conclusions

To improve the quality of care and increase patients' satisfaction with the provided services, it is recommended that policymakers should meet the challenges of the PC.

Psychometric Properties of the 'Patients' Perspective of the Quality of Palliative Care Scale'

Objectives

Palliative care is a basic human right for all patients suffering from progressive and excruciating pain, limitations in daily activities as well as requiring constant care. The development of palliative care is always associated with the physical, psychological, social and spiritual care quality level and requires continuous evaluation by the care-receiving patients. This study aimed to determine the psychometric properties of the patients' perspective of the quality of palliative care scale.

Materials and Methods

This methodological study was conducted on 500 patients with chronic diseases admitted to the hospitals affiliated in Golestan University of Medical Sciences, between 2019 and 2020. Participants were selected through stratified sampling through proportional allocation as well as considering the bed occupancy rate in the two referral hospitals of the university. According to Wild approach, we translated the original version of the scale the patients' perspectives of the quality of the palliative care scale with 35 items and eight subscales. Using exploratory and confirmatory factor analysis, the psychometric properties of the scale (i.e., initial reliability and face, content, convergent and construct validities) were assessed. The reliability of the scale was calculated by applying Cronbach's alpha coefficient, McDonald's omega coefficient and the Intraclass correlation coefficient (ICC). SPSS-16 and AMOS-24 software programs were used to analyse the data.

Results

Three items were omitted after assessing the initial reliability of the translated version of the perspectives of the quality of the palliative care scale using adjusted Cronbach's alpha. The qualitative face validity and impact score of the remaining items of the scale were confirmed by the target group. Meanwhile, a panel of experts confirmed the content validity ratio and content validity index. Convergent validity was approved by calculating the average variance extracted >0.5. Performing EFA led to the extraction of 7 subscales with 32 items. CFA and goodness of fit indices such as GFI = 0.98, CFI = 0.91, RMSEA = 0.048 and GFI = 0.97 confirmed the construct model by omitting three items. Hence, the Persian version of the patient's perspective of the quality of palliative care scale was finalised, including seven subscales with 29 items. ICC of >0.7 represented good reliability. Moreover, Cronbach's alpha and McDonald's omega coefficient confirmed the internal consistency of the scale.

Conclusion

Based on the findings of this study, the Persian version of the patients' perspective of the quality of palliative care scale is introduced as a valid and reliable scale. It can accurately indicate and predict the meticulous quality of such care in hospitalised patients and can be used in the cure and care assessments in the health system.

Current State of Palliative Care in Iran and Related Issues: A Narrative Review

BACKGROUND

Palliative research studies seem to be limited and disperse in Iran. The present study was therefore conducted to review and categorize the Palliative Care (PC) studies performed in Iran in terms of the research type, the type/focus of PC, the measured outcomes in interventional palliative studies and their related results, the disease type, and their geographical distribution.

MATERIALS AND METHODS

This narrative review was conducted in 2021 in which both Iranian and international databases including PubMed, Scopus, Web of science, CINAHL, ProQuest, Magiran, SID, Noormags, ISC were searched. The inclusion criteria were original articles conducted in Iran and results published in Persian or English journals ab initio in which PC was assessed as a variable (dependent or independent) or the main concept.

RESULTS

A total of 1096 articles were identified from which only 44 articles were reviewed. The research studies were mainly focused on cancer and majority conducted in Tehran. Majority of studies were quantitative-interventional leading to a variety of positive changes in dependent variables, including reduce in pain severity, change in life pattern, a good response to therapy, increase life expectancy, improve in dysphagia, improve quality of life, reduce patients' metastasis, and increase in nurses' self-efficacy.

CONCLUSIONS

The PC studies distributed across different fields and cities in Iran resulted to a number of positive outcomes for patients. More focused and robust research studies with different patients need to be conducted in this emerging field in Iran.

Assessing the compliance of educational curricula of selected disciplines with the content standards of cancer-related palliative care

BACKGROUND

Management of cancer complications requires the provision of palliative care as a comprehensive care by the main and trained members of this method of care. The aim of the present study was to assess the compliance of educational curricula of selected disciplines with the content standards of cancer-related palliative care.

MATERIALS AND METHODS

In this descriptive-comparative study, the content standards of palliative care for nurses, physicians, and social workers were identified based on the World Health Organization guideline and Oxford Textbook of Palliative Nursing. For this purpose, a separate checklist was prepared for the disciplines with different dimensions. Then the face and content validity of the checklists were checked. Finally, we examined the coordination between selected curricula available on the website of Education Deputy of the Ministry of Health, Treatment and Medical Education with the dimensions of the checklists.

RESULTS

All three curricula in most domains were relevant with the content standards, but there was the biggest education need in the areas related to the dimensions of "planning and educational," "educating physician in palliative care," and "considering patient preferences" in these disciplines.

CONCLUSIONS

To meet the educational needs, it is suggested to change some course topics, hold training courses, or joint workshops.

Lessons Learned from Countries That Have Introduced Palliative Care Services into Their National Health System: A Narrative Review

OBJECTIVE

This review aims at gaining a broad overview of national approaches about Palliative care (PC) implementation into health care systems in countries that have PC identified within their national policies and strategies.

METHODS

Paper searching was conducted using both peer-reviewed databases and gray literature sources covering governmental reports with PC strategies from 2000 onward. Articles published in English that cited at least 1 category of the WHO's public health PC model were included. Qualitative content analysis was used for data analysis and synthesis of findings.

RESULTS

Thirteen reports met the inclusion criteria. Education and appropriate policies were the most frequent strategies covered by all countries included. Under education; information about training health care providers was needed for the effective introduction of a PC program. Reviewing standards of care required to deliver PC effectively, and financial support for PC service development were considered the central policies needed. Furthermore, partnerships and collaborations across the health systems as well as providing care based on patients' needs were required for the provision of a PC program.

CONCLUSION

It is of the essence to learn from countries demonstrating enhanced PC practices before the implementation of a new PC program in a given country. Such practices could be used as a guide and to address barriers that may hinder the development of PC at a national level. Best practices can be achieved by focusing on educational and policy-based strategies through identifying patients' needs, assessing general public awareness, health care providers' knowledge and training as well as incorporating stakeholders' perspectives.

A Systematic Review on Barriers to Palliative Care in Oncology

The number of people with cancer and the need for palliative care among this population is increasing in the United States. Despite this growing need, several barriers exist to the utilization of palliative care in oncology. The purpose of this study was to synthesize the evidence on the barriers to palliative care utilization in an oncology population. A systematic review of literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, and Psych Info databases were used for the literature search. Articles were included if they: 1) focused on cancer, (2) examined and discussed barriers to palliative care, and c) were peer reviewed, published in English, and had an accessible full text. A total of 29 studies (8 quantitative, 18 qualitative, and 3 mixed-methods) were identified and synthesized for this review. The sample size of the included studies ranged from 10 participants to 313 participants. The barriers to palliative care were categorized into barriers related to the patient and family, b) barriers related to providers, and c) barriers related to the healthcare system or policy. The factors identified in this review provide guidance for intervention development to mitigate the existing barriers and facilitate the use palliative care in individuals with cancer.

Why oral palliative care takes a backseat? A national focus group study on experiences of palliative doctors, nurses and dentists

Aim

Poor oral care among frail older people at the end of life endangers quality of life. However, only few dying people have access to oral palliative care services. Therefore, this study aimed to investigate oral palliative care practices and referral patterns for palliative patients in the Brunei healthcare settings.

Design

An exploratory qualitative study.

Methods

Five focus groups were conducted among palliative care nurses (N = 7), palliative medicine doctors (N = 4), dentists (N = 6), oncologists (N = 4) and oncology nurses (N = 4). Verbatim was analysed using qualitative thematic analysis.

Results

Analyses revealed four distinct themes emerging as current oral palliative care assessment and referral practice in the Brunei healthcare settings: "taking a back seat," "opportunistic oral care," "they refused and refused" and "challenging healthcare resources and oral palliative care."

Comparison of The Hospice Palliative Care Delivery Systems in Iran and Selected Countries

Background: There is an increasing demand for Hospice Palliative Care (HPC) due to the aging population, increased incidence of cancer, and other chronic diseases, as well as recent advances in care and treatment. Objectives: The present study was conducted to examine the nature and structure of HPC services and to describe and compare them in the United Kingdom (UK), Canada, Australia, Japan, India, Jordan, and Iran to extract general conclusions and suggestions for developing HPC systems in Iran. Methods: In the current descriptive-comparative study, from 2018 to 2019, HPC delivery systems in the selected countries and Iran were reviewed based on the World Health Organization (WHO) guideline, and the similarities and differences among them were explained. Results: Developing the National HPC Program and its integration into the health system are important activities. The most common source of financing is donation. The services are mainly provided to patients with cancer. Human resource development includes curriculum reform, creating specialty, subspecialty disciplines, and holding training courses. Other activities include designing national guidelines, the free access to opioids, research development, the establishment of the national information network, and the quality control programs. Iran lacks any formal structure and program of HPC services and they are provided in a scattered and very limited manner as part of general palliative services. Conclusions: HPC services are in a mediate and low level in developed countries and Iran, respectively. Before the establishment of the HPC delivery system, a complicated range of economic, social, cultural, and political factors must be considered.

Palliative Care in the Health System of Iran: A Review of the Present Status and the Future Challenges

Objectives:

In the near future, the health system of Iran will face serious public health challenges means increase in the elderly population and the rate of chronic diseases. Therefore, it is anticipated that providing palliative care for chronic diseases will be one of the priorities of the country’s health system. The purpose of the present study was to explain the present status and the future challenges of providing palliative care in the health system of Iran and help policy-makers to create a future roadmap by presenting a picture of the present status.

Methods:

In this qualitative study, 17 semi-structured interviews were conducted with policy-makers, researchers, and managers of the centers providing palliative care in 2018-2019. Interviews were analyzed using directed content analysis based on the Public Health Strategy and framework analysis.

Results:

According to the WHO Public Health Strategy, palliative care challenges categorized in 13 subcategory and four main category include policy-making, program implementation, comprehensive education and drug availability.

Conclusion:

Providing palliative care that is currently dispersed in some centers does not meet the needs of chronic diseases. Establishing the palliative care system as one of the major goals of the health system of Iran is possible through reforming the fourfold structure of policy-making, implementation, education and drug availability. Therefore, it is suggested that authorities perform comprehensive and systematic management of challenges using foresight methods.

Perceived factors to providing palliative care for patients with cancer - a qualitative systematic review

Palliative care (PC) is one of the necessary cares given throughout a patient’s experience with cancer. The aim of this study was to identify the perceived factors to providing PC for patients with cancer. Our study was a systematic review of qualitative literature. To this end, electronic databases, including CINAHL, PubMed, PsycINFO, Ovid, and Web of Science as well as Persian databases were searched and qualitative studies on the role of PC in patients with cancer published between Jan 2008 and Dec 2017 were selected. Generally, 12 studies were reviewed. A thematic synthesis approach was used to analyze the data. Exploring the selected articles, the findings on the perceived factors to providing PC for patients with cancer were categorized into three themes, including organizational factors, ethical factors, and psychological factors. This qualitative systematic review expands our knowledge about factors influencing the provision of PC for patients with cancer. It is necessary for health system managers and caregivers to pay attention to all aforesaid factors in order to improve PC for cancer patients.

A Comparison of Symptom Management for Children with Cancer in Iran and in the Selected Countries: A Comparative Study

AIM

The aim of this study is to describe the experiences of other countries regarding the status of pediatric palliative care in the field of symptom management and to compare it with the current status in Iran to achieve an appropriate level of symptom management for children with cancer.

MATERIALS AND METHODS

This is a comparative study. The research population includes the palliative care systems of Jordan, England, Australia, and Canada, which were ultimately compared with Iran's palliative care system.

RESULTS

The results showed that in the leading countries in the field of palliative care, such as Australia and Canada, much effort has been made to improve palliative care and to expand its service coverage. In the UK, as a pioneer in the introduction of palliative care, a significant portion of clinical performance, education and research, is dedicated to childhood palliative care. Experts in this field and policymakers are also well aware of this fact. In developing countries, including Jordan, palliative care is considered a nascent specialty, facing many challenges. In Iran, there is still no plan for providing these services coherently even for adults.

CONCLUSION

Children with cancer experience irritating symptoms during their lives and while they are hospitalized. Regarding the fact that symptom management in developed countries is carried out based on specific and documented guidelines, using the experiences of these successful countries and applying them as an operational model can be useful for developing countries such as Iran.

Pediatric Palliative Care in Iran: Applying Regionalization of Health Care Systems

Background: Establishing palliative care services is a priority in the health system of Iran. Considering the necessity of integrating these services into the health system, this study aimed to explore the stakeholders’ perceptions about the provision of a conceptual framework for palliative care services for children with cancer according to the health system in of Iran. Methods: The present qualitative study was conducted through in-depth semi-structured interviews held with 29 participants including palliative care specialists, policy-makers, health care providers, the parents of children with cancer selected through purposive sampling, between August 2016 and February 2017. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed using MAXQDA10 software. Results: The codes extracted from interviews produced the main theme “ classes of palliative care services” with the two main categories “comprehensive care” including, strengthening family shelter, maintaining the child in a familiar environment, achieving stability and “establishing social justice” including, easy access to services, financial relief and quality care. Conclusion: Presenting a framework based on level of palliative care services, the findings of this study paves the way for integrating these services into Iranian health system.

Educational Needs on Palliative Care for Cancer Patients in Iran: A SWOT Analysis

BACKGROUND

By acceptance of palliative care as a part of health system of each country and due to increasing prevalence of cancer, special focus on stakeholder's educational needs is of vital importance so that palliative care services are improved and the quality of life of patients is enhanced. This study was conducted to explore the educational needs of stakeholders of palliative care for cancer patients in Iran.

METHODS

This qualitative study with 20 semi-structured interviews was conducted from August 2016 to February 2017 in Shohadaye Tajrish and Emam Khomeini Hospitals of Tehran. Participants were selected through purposive sampling and included cancer patients and their family caregivers as well as healthcare providers, experts and policy-makers. The data were analyzed through Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Statements of each main category of the study were summarized in SWOT categorizes.

RESULT

A total of 546 codes were extracted from the analysis of the interviews and four main categories and four subcategories were identified. The four main identified categories included: "academic education planning", "workforce education", "public awareness", and "patient and caregiver empowerment" that contained our subcategories as follows: "strengths", "weaknesses", "opportunities" and "threats" (SWOT).

CONCLUSION

Meeting the educational needs of the stakeholders of palliative care requires policy-makers to identify the factors leading to strategies that are based on the use of opportunities, the removal of weaknesses, and coping with the threats to which the organization is faced.

Palliative Care Policy Analysis in Iran: A Conceptual Model

BACKGROUND

Palliative care programs are rapidly evolving for patients with life-threatening illnesses. Increased and earlier access for facilities is a subject of growing importance in health services, policy, and research.

AIM

This study was conducted to explain stakeholders' perceptions of the factors affecting the design of such a palliative care system and its policy analysis.

METHODOLOGY

Semi-structured in-depth interviews conducted following purposive sampling of the participants. Twenty-two participants were included in the study. The interviews were analyzed using qualitative-directed content analysis based on "policy analysis triangle" framework.

RESULTS

The findings showed the impact of four categories, namely context (political, social, and structural feasibility), content (target setting), process (attracting stakeholder participation, the standardization of care, and education management), and actors (the Ministry of Health and Medical Education, health-care providers, and volunteers) in the analysis of the palliative care policies of Iran.

CONCLUSION

In the past 6 years, attention to palliative care has increased significantly as a result of the National Cancer Research Network with the support of the Ministry of Health. The success of health system plan requires great attention to its aspects of social, political, and executive feasibility. Careful management by policymakers of different stakeholders is vital to ensure support for any national plan, but this is challenging to achieve.