The pharmacological management of palliative care symptoms in haematology and oncology patients at Parirenyatwa Group of Hospitals (PGH) in Harare Zimbabwe
Introduction: Palliative care is the approach to the care of patients with life-threatening illnesses. An important part of this is the rational use of a pharmacological approach to relieve suffering by addressing the symptom burden of the patient. Palliative care symptoms contribute a great deal to the suffering of the patient and affects quality of life. Different studies across several countries on the palliative care symptoms have identified common symptoms with pain being the most frequent. The WHO Public Health Strategy for palliative care outlines four components: policy, education, implementation and drug availability. These components interlink and each one affects the others. The drugs used for palliative care symptoms should be classified as essential medicines and be available to all patients who need this treatment. Factors influencing the effective pharmacological management of palliative care symptoms include drug availability, policy and the approach of the prescribers. Studies have shown that developing countries rank low in the use of the essential palliative care drugs especially morphine. Aim: The aim of this study was to describe the prevalence of palliative care symptoms and the prescribing and administration patterns in oncology and haematology patients at PGH, as well as exploring the health workers' opinions on the pharmacological approach to these symptoms. Methods: A mixed method approach was used to qualitatively look at the health workers' responses using inductive thematic analysis and quantitatively obtain information on palliative care symptom management from the health workers and patient records. Results: Pain was the commonest palliative care symptom identified by health workers, and evident in the patient records. A list of other palliative care symptoms, and the frequency at which they occurred was compiled in this study. The health workers highlighted drug availability, palliative care education and need to engage some nurses in prescribing some of the palliative care drugs. Fewer than half of the patient records assessed as being in need of palliative care (N = 247) were given medications from the recognized palliative care drug list (N = 101). Conclusion: This study showed that essential medicines for palliative care symptoms are not easily available in Zimbabwe for various reasons that include cost, policy, education and training. Pain and other palliative care symptoms are not adequately managed. Therefore, palliative care is not yet integrated into the health care system in Zimbabwe as mandated by the WHO. Recommendations to improve palliative care symptom treatment are suggested.
palliative care symptoms, prescribing, availability, management, medicines/drugs, health workers
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