1
|
Aebischer Perone S, Nikolic R, Lazic R, Dropic E, Vogel T, Lab B, Lachat S, Hudelson P, Matis C, Pautex S, Chappuis F. Addressing the needs of terminally-ill patients in Bosnia-Herzegovina: patients' perceptions and expectations. BMC Palliat Care 2018; 17:123. [PMID: 30454032 PMCID: PMC6245800 DOI: 10.1186/s12904-018-0377-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many terminally ill patients in Bosnia-Herzegovina (BiH) fail to receive needed medical attention and social support. In 2016 a primary healthcare centreer (PHCC) in Doboj (BiH) requested the methodological and technical support of a local partner (Fondacija fami) and the Geneva University Hospitals to address the needs of terminally ill patients living at home. In order to design acceptable, affordable and sustainable solutions, we involved patients and their families in exploring needs, barriers and available resources. METHODS We conducted interviews with 62 purposely selected patients using a semi-structured interview guide designed to elicit patients' experiences, needs and expectations. Both qualitative and quantitative analyses were conducted, using an inductive thematic approach. RESULTS While patients were aware that their illnesses were incurable, they were poorly informed about medical and social support resources available to them. Family members appeared to be patients' main source of support, and often suffered from exhaustion and financial strain. Patients expressed feelings of helplessness and lack of control over their health. They wanted more support from health professionals for pain and other symptom management, as well as for anxiety and depression. Patients who were bedridden or with reduced mobility expressed strong feelings of loneliness, social exclusion, and stigma from community members and - occasionally - from health workers. CONCLUSIONS Our findings suggest a wide gap between patients' end-of-life care needs and existing services. In order to address the medical, psychological and social needs of terminally ill patients, a multi-pronged approach is called for, including not only better symptom management through training of health professionals and improved access to medication and equipment, but also a coordinated inter-professional, inter-institutional and multi-stakeholder effort aimed at offering comprehensive medical, psycho-social, educational and spiritual support.
Collapse
Affiliation(s)
- S Aebischer Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205, Geneva, Switzerland.
| | - R Nikolic
- Primary Health Care Center, Dom zdravja Doboj, Nemanjina 18, 74000, Doboj, Bosnia and Herzegovina
| | - R Lazic
- Primary Health Care Center, Dom zdravja Doboj, Nemanjina 18, 74000, Doboj, Bosnia and Herzegovina
| | - E Dropic
- Fondacija fami, Kralja Aleksandra 52, 74000, Doboj, Bosnia and Herzegovina
| | - T Vogel
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - B Lab
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - S Lachat
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - P Hudelson
- Transcultural consultation and interpretation, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - C Matis
- Geriatrics and community palliative care unit, Geneva University Hospitals, Avenue Cardinal-Mermillod 36, 1227, Carouge, Switzerland
| | - S Pautex
- Geriatrics and community palliative care unit, Geneva University Hospitals, Avenue Cardinal-Mermillod 36, 1227, Carouge, Switzerland
| | - F Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205, Geneva, Switzerland
| |
Collapse
|