Advance Directives or Living Wills: Reflections of General Practitioners and Frail Care Coordinators in a Small Town in Kwazulu-Natal

Background: Living wills have long been associated with end-of-life care. This study explored the promotion of living wills by general practitioners (GPs) and frail care nursing coordinators who were directly involved in the care of the elderly in Howick; KwaZulu-Natal. The study also explored their views regarding the pro forma living will disseminated by the Living Will Society.Subjects: Seven GPs and three frail care nursing coordinators; 10 in total.Design: The design was qualitative in-depth interviews and analysis; using the Framework method.Results: Both doctors and nursing staff understood the concept of living wills and acknowledged that they were beneficial to patients; their families and staff. They were concerned about the lack of legal status of the living will. They felt that the pro forma document from the Living Will Society was simple and clear. Despite identifying the low level of living will usage among patients; doctors and nursing staff felt that third-party organisations and individuals should promote living wills to patients; rather than promoting them to patients themselves.Conclusion: GPs and frail care nurse coordinators were knowledgeable about living wills in general; and the Living Will Society pro forma document in particular. They valued the contribution that living wills make to the care of the elderly; as they benefit patients; their families; healthcare workers and the health system. They also valued the pro forma living will document from the Living Will Society for its clarity and simplicity. However; the GPs and frail care nursing coordinators viewed the living will process as patient driven. They viewed their main role to be that of custodians; and not advocates; of the living wills

Challenges Impacting on the Quality of Care to Persons Living with HIV/AIDS and other Terminal Illnesses with Reference to Kanye Community Home-Based Care Programme

HIV/AIDS has been found to be a challenging disease to humanity; its challenge spin-offs falling especially on to the caregivers of those infected and affected by the virus. This paper aims to discuss the challenges influencing the state of caregiving in the Kanye community home-based care (CHBC) programme in Botswana. The study was qualitative in design and explorative in nature; involving 82 primary caregivers in focus group discussions; and 5 CHBC nurses in individual interviews. Caregivers were found challenged by lack of community networks support; inadequate sanitary and care packages; poor shelter compromising privacy; inadequate income and food for their clients; inadequate care motivation as their volunteerism does not attract any payment; inadequate health personnel to offer psychosocial support like counselling; and an unconducive caring environment generally. Putting in place policies to redress caregivers' poverty; helping caregivers start income-generating projects; increasing community assistance and caregiving facilities are recommended as factors to address caregiver challenges

Medical Futility and End-of-Life Care

Acceptance of the concept of medical futility facilitates a paradigm shift from curative to palliative medicine; accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process. This should not be looked upon as abandoning the patient but rather as providing the patient and family with an opportunity to come to terms with the dying process. It also does not entail withdrawal or passivity on the part of the health care professional. In addition to medical skills; the treating physician is responsible for guiding this process by demonstrating sensitivity and compassion; respecting the values of patients; their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored

The medical profession in Uganda and palliative care

This paper discusses the problems which Hospice Uganda has been facing in treating terminally ill cancer patients and advising on the control of pain in AIDS patients since Sept. 1993