Volume 24, Issue 3 (10-2021)                   jha 2021, 24(3): 9-21 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Mehrolhassani M H, yazdi_ Feyzabadi V, setayesh M, khajeh Z. Challenges of palliative care: A systematic review. jha 2021; 24 (3) :9-21
URL: http://jha.iums.ac.ir/article-1-3716-en.html
1- Associate Professor, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
2- Assistant Professor, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
3- Assistant Professor, Department of Persian Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran.
4- Msc, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. , z.khajeh@kmu.ac.ir
Abstract:   (2072 Views)
Introduction: Palliative care plays an essential role in improving the quality of life of patients suffering from chronic and incurable diseases; therefore, it seems necessary to remove barriers in improving palliative care. The present systematic review aims to describe the current status of palliative care, and determine the challenges of palliative care services.
Methods: In this systematic review study, we searched Scopus, Magiran,SID,Cochran,Embase, PubMed, Web of Science, and Google Scholar databases. Also, we retrieved articles published in English and Persian during 2000 to 2021. The keywords include "hospice care," palliative care," "health care," "terminal care," "end of life care," and palliative medicine". All retrieved articles were screened in three stages, namely review of titles, abstracts, and full texts. Meanwhile, we analyzed data based on the WHO 2018 framework and deductive-inductive approach.
Results: A total of 3497 articles were found. After reviewing these articles, we were able to selecte 48 articles. Data were extracted and categorized according to four functions, namely service delivery, stewardship, resources generation, and financing. Service delivery had four themes, and nine sub-themes; stewardship had two themes and five sub-themes; resource generation had three themes and nine sub-themes; and financing had one themes and three sub-themes.
Conclusion: Findings of the present study can help policymakers improve the infrastructure and resources, as well as processes of palliative care that can consequently lead to an improvement in the outcomes of palliative care. Also, solving the challenges of palliative care requires strengthening the health systems so that they will be able to design and implement appropriate policies
Full-Text [PDF 1170 kb]   (970 Downloads)    
Type of Study: Review | Subject: Health Services Management
Received: 2021/07/1 | Accepted: 2021/09/20 | Published: 2021/11/1

1. Schneider N, Walter U. Where do prevention and palliative care meet? A systematic literature study on the interfaces of two different health care sectors. Am J Hosp Palliat Care. 2007;24(2):114-8. [DOI:10.1177/1049909106296038]
2. Mardanihamooleh M, Borimnejad L, Seyedfatemi N, Tahmasbi M. Interpretation of palliative care concept, its barriers and facilitators using meta-synthesis. Modern Care Journal. 2015;11(4):316-29. [In Persian]
3. Ruhollahi M, Vandrajabpour M, Balibigloo M, Esfandiari A, Salari H, Hamouzadeh P, et al. Comprehensive National Cancer Support and Palliative Care Development Plan [Internet]. Iran: Assistance Health- Assistance treatment Cancer Office. 2013 [cited 2020 Feb 8]. Available from: https://cri.tums.ac.ir/wp-content/uploads/2017/09/cancer_pallative_care.pdf.
4. Hodgson C. Cost-effectiveness of palliative care: A review of the literature. Ottawa: Canadian Hospice Palliative Care Association; 2012.
5. World Health Organization. Palliative Care [Internet]. 2020 [cited 2020 Oct 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care
6. Iranmanesh S, Razban F, Tirgari B, Ghazanfari Z. Nurses' knowledge about palliative care in southeast Iran. Palliat Support Care. 2013 Jun;12(3):203-10. [DOI:10.1017/S1478951512001058]
7. Llobera J, Sansó N, Ruiz A, Llagostera M, Serratusell E, Serrano C, et al. Strengthening primary health care teams with palliative care leaders: Protocol for a cluster randomized clinical trial. BMC Palliat Care. 2017 Jul;17(1):1-8. [DOI:10.1186/s12904-017-0217-9]
8. Fjose M, Eilertsen G, Kirkevold M, Grov EK. "Non-palliative care" - a qualitative study of older cancer patients' and their family members' experiences with the health care system. BMC Health Serv Res. 2018 Sep;18(1):1-12. [DOI:10.1186/s12913-018-3548-1]
9. World Health Organization. definition of palliative care [Internet]. 2020 [cited 2020 Feb 8] Available from: https://www.who.int/health-topics/palliative-care
10. Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, et al. Evidence for improving palliative care at the end of life: A systematic review. Ann Intern Med. 2008 Jan;148(2):147-59. [DOI:10.7326/0003-4819-148-2-200801150-00010]
11. Ansari M, Rassouli M, Akbari ME, Abbaszadeh A, Akbarisari A. Palliative care policy analysis in Iran: A conceptual model. Indian J Palliat Care. 2018;24(1):51-7.
12. Al-Mahrezi A, Al-Mandhari Z. Palliative care: Time for action. Oman Med J. 2016;31(3):161-3. [DOI:10.5001/omj.2016.32]
13. Heydari H, Hojjat-Assari S, Almasian M, Pirjani P. Exploring health care providers' perceptions about home-based palliative care in terminally ill cancer patients. BMC Palliat Care. 2019 Aug;18:1-9. [DOI:10.1186/s12904-019-0452-3]
14. Hassankhani H, Rahmani A, Dehghannezhad J. Development of palliative care in cancer patients: A neglected necessity. Iran Journal of Nursing. 2018;31(115):1-5. [In Persian] [DOI:10.29252/ijn.31.115.1]
15. Yazdi-Feyzabadi V, Mehrolhassani MH, Zolala F, Haghdoost A, Oroomiei N. Determinants of risky sexual practice, drug abuse and alcohol consumption in adolescents in Iran: a systematic literature review. Reproductive health. 2019 Dec;16(1):1-0. [DOI:10.1186/s12978-019-0779-5]
16. Rassouli M, Sajjadi M. Palliative care in Iran: Moving toward the development of palliative care for cancer. American Journal of Hospice and Palliative Medicine. 2016 Apr;33(3):240-4. [DOI:10.1177/1049909114561856]
17. Jennings B, Morrissey MB. Health care costs in end-of-life and palliative care: The quest for ethical reform. J Soc Work End Life Palliat Care. 2011;7(4):300-17. [DOI:10.1080/15524256.2011.623458]
18. Hall S, Kolliakou A, Petkova H, Froggatt K, Higginson IJ. Interventions for improving palliative care for older people living in nursing care homes. Cochrane Database Syst Rev. 2011; (3):1-30. [DOI:10.1002/14651858.CD007132.pub2]
19. Meier DE. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q. 2011;89(3):343-80. [DOI:10.1111/j.1468-0009.2011.00632.x]
20. Khoubbin Khoshnazar TA, Rassouli M, Akbari ME, Lotfi-Kashani F, Momenzadeh S, Haghighat Sh, et al. Structural challenges of providing palliative care for patients with breast cancer. Indian J Palliat Care. 2016;22(4):459-66. [DOI:10.4103/0973-1075.191828]
21. Oishi A, Murtagh FE. The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, carers and health-care professionals. Palliat Med. 2014 Oct;28(9):1081-98. [DOI:10.1177/0269216314531999]
22. Strupp J, Romotzky V, Galushko M, Golla H, Voltz R. Palliative care for severely affected patients with multiple sclerosis: When and why? Results of a Delphi survey of health care professionals. J Palliat Med. 2014 Oct;17(10):1128-36. [DOI:10.1089/jpm.2013.0667]
23. Fukui S, Yoshiuchi K. Associations with the Japanese population's preferences for the place of end-of-life care and their need for receiving health care services. J Palliat Med. 2012 Oct;15(10):1106-12. [DOI:10.1089/jpm.2012.0034]
24. Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost‐effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2013 Jun; (6):1-279. [DOI:10.1002/14651858.CD007760.pub2]
25. Shirinabadi Farahani A, Rassouli M, Khanali Mojen L, Ansari M, Ebadinejad Z, Tabatabaee A, et al. The feasibility of home palliative care for cancer patients: The perspective of Iranian nurses. Int J Cancer Manag. 2018 Aug;11(8):1-8. [DOI:10.5812/ijcm.80114]
26. Bahador RS, Nouhi E, Jahani Y. The study of palliative care and its relationship with quality of life in patients with chronic heart failure in 2014-2015. Journal of Clinical Nursing and Midwifery. 2017;5(4):35-46. [In Persian]
27. Ziehm J, Farin E, Schäfer J, Woitha K, Becker G, Köberich S. Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals. BMC Health Serv Res. 2016 Aug;16(a):1-10. [DOI:10.1186/s12913-016-1609-x]
28. Hatamipour K, Rassouli M, Yaghmaie F, Zendedel K, Alavi Majd H. Spiritual needs of cancer patients: A qualitative study. Indian J Palliat Care. 2015;21(1):61-7. [DOI:10.4103/0973-1075.150190]
29. Gardiner C, Gott M, Ingleton C, Hughes P, Winslow M, Bennett MI. Attitudes of health care professionals to opioid prescribing in end-of-life care: A qualitative focus group study. J Pain Symptom Manage. 2012 Aug;44(2):206-14. [DOI:10.1016/j.jpainsymman.2011.09.008]
30. Hökkä M, Melender H-L, Lehto J, Kaakinen P. Palliative nursing competencies required for different levels of palliative care provision: A qualitative analysis of health care professionals' perspectives. J Palliat Med. Forthcoming 2021. [DOI:10.1089/jpm.2020.0632]
31. Shi H, Shan B, Zheng J, Peng W, Zhang Y, Zhou X, et al. Knowledge and attitudes toward end-of-life care among community health care providers and its influencing factors in China: A cross-sectional study. Medicine (Baltimore).2019 Nov;98(45):1-8. [DOI:10.1097/MD.0000000000017683]
32. Schmid W, Rosland JH, Von Hofacker S, Hunskår I, Bruvik F. Patient's and health care provider's perspectives on music therapy in palliative care - an integrative review. BMC Palliat Care. 2018 Feb;17(1):1-9. [DOI:10.1186/s12904-018-0286-4]
33. Ridley J, Dance D, Pare D. The acceptability of humor between palliative care patients and health care providers. J Palliat Med. 2014 Apr;17(4):472-4. [DOI:10.1089/jpm.2013.0354]
34. Patel AA, Walling AM, Ricks-Oddie J, May FP, Saab S, Wenger N. Palliative care and health care utilization for patients with end-stage liver disease at the end of life. J Clin Gastroenterol Hepatol. 2017 Oct;15(10):1612-9. [DOI:10.1016/j.cgh.2017.01.030]
35. Bui T. Effectively training the hospice and palliative medicine physician workforce for improved end-of-life health care in the United States. Am J Hosp Palliat Care. 2012 Sep;29(6):417-20. [DOI:10.1177/1049909111429325]
36. Ghazi-Mirsaeed SJ, Moghimkhan F. Information behavior of patients with cancer in palliative care in Tehran city, Iran. Health Information Management. 2018 Aug;15(3):120-5. [In Persian]
37. Cruz-Oliver DM, Malmstrom TK, Roegner M, Yeo G. Evaluation of a video-based seminar to raise health care professionals' awareness of culturally sensitive end-of-life care. J Pain Symptom Manage. 2017 Oct;54(4):546-54. [DOI:10.1016/j.jpainsymman.2017.07.023]
38. Brown CE, Jecker NS, Curtis JR. Inadequate palliative care in chronic lung disease. An issue of health care inequality. Ann Am Thorac Soc. 2016 Mar;13(3):311-6. [DOI:10.1513/AnnalsATS.201510-666PS]
39. Chang E, Hancock K, Harrison K, Daly J, Johnson A, Easterbrook S, et al. Palliative care for end-stage dementia: A discussion of the implications for education of health care professionals. Nurse Educ Today. 2005 May;25(4):326-32. [DOI:10.1016/j.nedt.2005.02.003]
40. Bogetz JF, Root MC, Purser L, Torkildson C. Comparing Health Care Provider-Perceived Barriers to Pediatric Palliative Care Fifteen Years Ago and Today. J Palliat Med. 2019 Feb;22(2):145-51. [DOI:10.1089/jpm.2018.0367]
41. Patel K, Masi D. Palliative care in the era of health care reform. Clin Geriatr Med. 2015 May;31(2):265-70. [DOI:10.1016/j.cger.2015.01.003]
42. Yoshida S, Miyashita M, Morita T, Akizuki N, Akiyama M, Shirahige Y, et al. Strategies for development of palliative care from the perspectives of general population and health care professionals: A japanese outreach palliative care trial of integrated regional model study. Am J Hosp Palliat Care. 2015 Sep;32(6):604-10. [DOI:10.1177/1049909114532341]
43. Haun MW, Estel S, Rücker G, Friederich H-C, Villalobos M, Thomas M, et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev. 2017Jun;6(6): 1-94 [DOI:10.1002/14651858.CD011129.pub2]
44. Heydari H, Hojjat-Assari S, Almasian M, Pirjani P. Exploring health care providers' perceptions about home-based palliative care in terminally ill cancer patients. BMC Palliat Care.2019 Aug;18(1):1-9. [DOI:10.1186/s12904-019-0452-3]
45. Heydari H. Home-based palliative care: A missing link to patients' care in Iran. Hayat. 2018;24(2):97-101. [In Persian]
46. Kuruvilla L, Weeks G, Eastman P, George J. Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives. Palliat Med. 2018 Sep;32(8):1369-77. [DOI:10.1177/0269216318777390]
47. Mok E, Lau KP, Lam WM, Chan LN, Ng J, Chan KS. Health-care professionals' perspective on hope in the palliative care setting. J Palliat Med. 2010 Jul;13(7):877-83. [DOI:10.1089/jpm.2009.0393]
48. Csikai EL, Bass K. Health care social workers' views of ethical issues, practice, and policy in end-of-life care. Soc Work Health Care. 2000;32(2):1-22. [DOI:10.1300/J010v32n02_01]
49. Sadhu S, Salins NS, Kamath A. Palliative care awareness among Indian undergraduate health care students: A needs-assessment study to determine incorporation of palliative care education in undergraduate medical, nursing and allied health education. Indian J Palliat Care. 2010 Sep;16(3):154-9. DOI: 10.4103/0973-1075.73645 [DOI:10.4103/0973-1075.73645]
50. Aghaei MH, Mohajjel Aghdam A, Bodaghi S, Azami Agdash S. Knowledge and attitude of nurses toward caring for end of life patients. Iran Journal of Nursing. 2017;30(107):74-82. [In Persian] [DOI:10.29252/ijn.30.107.74]
51. Pugh A, Castleden H, Giesbrecht M, Davison C, Crooks V. Awareness as a dimension of health care access: exploring the case of rural palliative care provision in Canada. J Health Serv Res Policy 2019 Apr;24(2):108-15. [DOI:10.1177/1355819619829782]
52. Zhou Y, Li Q, Zhang W. Undergraduate nursing students' knowledge, attitudes and self‐efficacy regarding palliative care in China: A descriptive correlational study. Nurs Open. 2021 Jan;8(1):343-53. [DOI:10.1002/nop2.635]
53. Borimnezhad L, Seyedfatemi N, Mardani Hamooleh M. Concept analysis of palliative care using rodgers' evolutionary method. Iran Journal of Nursing. 2014;26(86):1-15. [In Persian]
54. Singh GK, Davidson PM, Macdonald PS, Newton PJ. The perspectives of health care professionals on providing end of life care and palliative care for patients with chronic heart failure: An integrative review. Heart Lung Circ.2019 Apr;28(4):539-52. [DOI:10.1016/j.hlc.2018.10.009]
55. Kogan AC, Sadamitsu K, Gaddini M, Kersten M, Ellinwood J, Fields T. Engaging primary care physicians to refer patients to home-based palliative is challenging and complicated. Palliat Med Rep. 2020 Nov;1(1):259-63. [DOI:10.1089/pmr.2020.0009]
56. Pakseresht M, Baraz S, Rasouli M, Reje N, Rostami Sh. A comparative study of the situation of bereavement care for children with cancer in Iran with selected countries. International Journal of Pediatrics. 2018;6(2):7253-63.
57. Monterosso L, Ross-Adjie GM, Rogers IR, Shearer FM, Rogers JR. How well do we understand health care professionals' perceptions and needs in the provision of palliative care? A mixed methods study. J Palliat Med. 2016 Jul;19(7):720-7. [DOI:10.1089/jpm.2015.0421]
58. Saunders S, Weiss ME, Meaney C, Killackey T, Varenbut J, Lovrics E, et al. Examining the course of transitions from hospital to home-based palliative care: A mixed methods study. Palliat Med. 2021 Sep; 35(8): 1590-601. [DOI:10.1177/02692163211023682]
59. Fearon D, Kane H, Aliou ND, Sall A. Perceptions of palliative care in a lower middle-income muslim country: A qualitative study of health care professionals, bereaved families and communities. Palliat Med. 2019 Feb;33(2):241-9. [DOI:10.1177/0269216318816275]
60. Lijimol AS, Krishnan A, Rajagopal MR, Gopal BK, Booth CM. Improving access and quality of palliative care in Kerala: A cross-sectional study of providers in routine practice. Indian J Palliat Care. 2020;26(4):500-5. [DOI:10.4103/IJPC.IJPC_17_20]
61. Amroud MS, Raeissi P, Hashemi SM, Reisi N, Ahmadi SA. Investigating the challenges and barriers of palliative care delivery in Iran and the world: A systematic review study. J Educ Health Promot. 2021 Jul;10:1-7.
62. Stiel S, Heckel M, Wendt KN, Weber M, Ostgathe C. Palliative care patients' quality of dying and circumstances of death-comparison of informal caregivers' and health-care professionals' estimates. Am J Hosp Palliat Care. 2018 Jul;35(7):1023-9. [DOI:10.1177/1049909118756616]
63. Ehikpehae H, Kiernan J. The impact of the interprofessional health care team in palliative care. J Interprof Educ Pract. 2018 Jun;11:12-4. [DOI:10.1016/j.xjep.2018.01.001]
64. Hosseini A, Aramesh k. Ethical challenges of caring for children at the end of life. J Med Ethics. 2013;7(25):55-81. [In Persian]
65. Yazdi Feyzabadi V, Khajeh Z, Radmerikhi S, Mehrolhasani MH. The profile of health services delivery in the recent decade of iran's health system: An essential element in achieving universal health coverage. Iranian Journal of Epidemiology. 2018;13(5):166-9. [In Persian]
66. Mehrolhassani MH, Jafari Sirizi M, Poorhoseini SS, Yazdi Feyzabadi V. The challenges of implementing family physician and rural insurance policies in Kerman province, Iran: A qualitative study. Health and Development Journal. 2012;1(3):193-206. [In Persian]
67. May P, Hynes G, McCallion P, Payne S, Larkin P, McCarron M. Policy analysis: Palliative care in Ireland. Health Policy. 2014 Mar;115(1):68-74. [DOI:10.1016/j.healthpol.2013.07.016]
68. Chaman R, Amiri M, Raei Dehaghi M. The national family physician and the quality of referral system.Payesh. 2012;11(6):785-90. [In Persian]
69. Kerr CW, Donohue KA, Tangeman JC, Serehali AM, Knodel SM, Grant PC, et al. Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership. J Palliat Med. 2014 Dec;17(12):1328-35. [DOI:10.1089/jpm.2014.0184]
70. Dunn EJ, Markert R, Hayes K, McCollom J, Bains L, Kahlon D, et al. The influence of palliative care consultation on health-care resource utilization during the last 2 months of life: Report from an integrated palliative care program and review of the literature. Am J Hosp Palliat Care. 2018 Jan;35(1):117-22. [DOI:10.1177/1049909116683719]
71. Bolhari J, Naziri Gh, Zamanian S. Effectiveness of spiritual group therapy in reducing depression, anexiety, and stress of women with breast cancer. Journal of Woman & Society. 2012;3(9):87-117. [In Persian]
72. Stiel S, Matthies DMK, Seuß D, Walsh D, Lindena G, Ostgathe C. Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference? J Pain Symptom Manage. 2014 Jul;48(1):26-35. [DOI:10.1016/j.jpainsymman.2013.08.018]
73. Ansari M, Rassouli M, Akbari ME, Abbaszadeh A, Akbari Sari A. Educational needs on palliative care for cancer patients in iran: A SWOT analysis. Int J Community Based Nurs Midwifery. 2018 Apr;6(2):111-24.
74. Pype P, Symons L, Wens J, Van den Eynden B, Stes A, Deveugele M. Health care professionals' perceptions towards lifelong learning in palliative care for general practitioners: A focus group study. BMC Fam Pract. 2014 Feb 19;15(36):1-11. [DOI:10.1186/1471-2296-15-36]
75. Yazdi Feyzabadi V, Ansari M, Amini Rarani M, Naghibzadeh Tahami A, Heydari A. Health team in primary health care: Facilitators and inhibitors of the effective function. Journal of Management and Medical Informatics School. 2014;2(1):66-74. [In Persian]

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2023 CC BY-NC 4.0 | Journal of Health Administration

Designed & Developed by : Yektaweb