Dealing with terminal illness : policies and practices in an oncology setting : a study based at Sir Paul Boffa Hospital.

Abstract

The aim of this dissertation was to assess to what degree current policies and practices at Sir Paul Boffa Hospital are fulfilling patients' needs with respect to "palliative care"; and to recommend changes to improve the quality of service provided. The objectives stemming from this aim are to: • Identify current policies and practices at SPB • Assess the palliative care outcome of patients at the in-patient oncology wards and out-patients department within this same hospital • Gauge the quality of palliative care at SPB through the measurement of patient satisfaction, by quantifying the gap between patients' expectations of a good quality palliative care service and the actual service they are receiving • Propose a blue-print for challenge in the provision of quality care in dealing with the terminally-ill The null hypothesis linked with the third objective was that there is no difference between the patients' perspective of the service they are receiving and the service they expect to receive. The data collection involved a mixed method approach, with two questionnaires, namely the SERVQUAL questionnaire and the POS questionnaire administered to patients, and semi-structured interviews conducted with management and nursing staff at SPB. For quantitative results, the sample size was that of 48, while the numbers of interviews conducted was 10. Results showed that currently, palliative care services are covering three of the four main components of palliative care as found in the literature. Pain relief and symptom control, the first core component, is taken seriously by staff members, and consequently, pain levels recorded among the patients were deemed to be of an acceptable level. The importance of offering patients psychosocial support, the second component, seemed to be well recognised by management, although the services do not seem to be well integrated into the system. Spiritual care, the third component, is offered mainly from a Religious perspective. Advance Care Planning does not appear to be included in the current service. Patients reported varying degrees of discomfort with issues that should be addressed by palliative care. The greatest degree of discomfort seemed to stem from psychological issues such as anxiety and family's anxiety. This shortcoming can be addressed by enhancing the quality and availability of counselling and psychosocial support. Patient satisfaction was used to measure the gap between perceived and expected service, an important indicator of functional service quality. Here, the null hypothesis was rejected, since all the gaps were found to be statistically significant. However, the gender variable was not found to be an influencing factor. Clinic was found to be a significant predictor of pain and waiting time dimensions. The pain element could be explained by the stage of disease reached by in-patients, who experienced a significantly higher amount of pain, while waiting time was not found to be an issue with inpatients. A final discussion group held with SPB management proposed the introduction of a palliative care ward and a formal counselling service for patients, in order to improve the quality of palliative care services.