Stellenbosch University Research Aims On Improving End-of-life Care For Patients And Their Families

Globally, hospital emergency centres are being flooded with patients in need of palliative or end-of-life care. This is also true for South Africa, where rising rates of cancer, hypertension, diabetes, HIV, and tuberculosis (TB) add to the number of patients requiring palliative care.

Optimising health systems and community home-based care could alleviate the pressure on emergency centres and make it easier for patients and their relatives to deal with a life-limiting illness.

This is according to a study published recently in the African Journal of Emergency Medicine.

​Conducted by Christopher Straeuli (from George Regional Hospital), Louis Jenkins (Stellenbosch University) and Nardus Droomer (University of Cape Town), the study describes how patients with life-limiting conditions add to the case load of an emergency centre in a regional hospital in the Western Cape. The researchers say there is a paucity of data on how many of these patients visit emergency centres and why.

“While there is a growing need for palliative care services in South Africa, without data to inform health systems of the actual case load in emergency centres, planning interventions to improve service delivery remains a challenge. Multiple visits by patients to emergency centres are a sign that palliative care is not up to scratch, resulting in significant distress for both the patient and their caregivers.”

To help address this issue, they used a palliative care identification tool which was developed for low-and-middle-income countries, to assess all the patients who entered the emergency centre in the regional healthcare facility over a three-month period. They captured the relevant information of these patients in an electronic database.

“Our study found that most patients who visited the emergency centre for palliative care needs were discharged home (55%), just over a quarter (26%) were admitted, while a small number (13%) died in hospital.

“Some patients visited the emergency centre because they needed, among others, urinary catheter replacements and medication. This is a function of the local primary health care facilities and therefore could potentially have been avoided.

“Others ended up in the emergency centre because their caregivers felt overwhelmed and found it difficult to provide continuous support.”

The researchers point out that pain and shortness of breath were the most common reasons for visits to the emergency centre. Cancer, neurological conditions, and HIV were the most frequent diagnoses, which together made up more than half of the cases. Patients with HIV and TB were significantly younger.

​The researchers say emergency centres in Africa are under-resourced and uncomfortable places for patients who need end-of-life care. “They are busy, noisy and overwhelming, usually without appropriate space for care of and consultation with the dying patient or to talk about end-of-life matters.”

They emphasise the need for more advocacy for well-functioning home-based palliative care to alleviate the pressure on emergency centres and to allow for better patient-centred palliative care.