Expanding the reach of palliative care to community-based home care programs.

This article describes a pilot project, run over a two-year period in the Eastern Cape province of South Africa. It was aimed at assessing the impact of a model of introducing a palliative care component and professional supervision of community caregivers on the quality of care given to people living with HIV/AIDS and their families. The use of the African Palliative Care Association African Palliative Outcome Scale as an assessment tool is outlined, and the challenges and outcomes encountered by the various role players are listed. The overall conclusion is that this model is a cost-effective way of increasing access to palliative care in resource poor settings.

Generating an African palliative care evidence base: the context, need, challenges, and strategies.

The enormous burden of progressive, incurable disease in sub-Saharan Africa is reflected in the epidemiology of cancer and HIV. However, there has been little research activity and evidence generated to inform appropriate and effective responses. A collaborative of clinicians, academics and advocates have been active in the design, delivery and reporting of research activities in African palliative care. Here, they report the methodological, ethical, logistic and capacity-based challenges of conducting research in the sub-Saharan context from their experience. A number of strategies and responses are presented.

Promoting the integration of quality palliative care: the South African Mentorship Program.

This article provides a brief outline of the HIV/AIDS situation in South Africa and the development of the Hospice Palliative Care Association (HPCA) as the background to an exploration of the changing face of palliative care in light of the demands of HIV/AIDS. It describes the South African Palliative Care Mentorship Program, including a description of the Integrated Community-Based Home Care (ICHC) model and its promotion of collaboration with the formal health care sector and other networking partners. The role mentorship played in its application to HPCA member hospices in response to the increasing demands of HIV/AIDS is outlined. The article also focuses on the development of provincial and regional mentorship capacity, the establishment of provincial palliative care development teams, the development of comprehensive palliative care standards, and the link between mentorship and accreditation. The key results of the promotion of the ICHC model and the effects of the mentorship program are highlighted, including possibilities for the expansion of the model beyond its original context in South Africa. The difficult issue of sustainability within an African context is also mentioned. In conclusion, there is a challenge to readers to explore the use of mentorship within their own palliative care settings.

Participation in treatment decision-making by women with early stage breast cancer.

OBJECTIVE: This study aimed to assess the way women treated for early stage breast cancer perceived the treatment selection process. The purpose was to understand more fully patients' experiences of the decision process and their preferences for participation in treatment decisions. SETTING AND PARTICIPANTS: The study informants were 40 women, treated at a teaching hospital in Sydney Australia, who were interviewed face to face 1 year after their first treatment for stage I or stage II breast cancer. METHODS: This study used a qualitative approach, based on the analysis of interview transcripts. The main areas covered were how the informants' treatment decisions were made and their preferences for participation in treatment decisions. Content and thematic analyses were conducted with findings presented using verbatim quotations for illustration. RESULTS AND CONCLUSIONS: Many of the informants who preferred not to participate in decisions also failed to recognize the need for value judgements (as well as medical expertise) in the decision-making process. Some informants believed they ought to be responsible for the consequences whilst others did not. Difficulties were identified in patient utilization of medical information for treatment decision-making, and also in establishing preferences for the risks and benefits of treatments where few patients had prior experience of the potential outcomes. The findings indicate that patient participation in treatment decision-making is a more complex issue than simply giving patients information and choices. Ways of enhancing patients' involvement in the treatment selection process are discussed.