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Palliative care, including effective management of cancer pain, is recognised under international law as a human right. Pain management can and should be delivered from the time of cancer diagnosis. This care is inexpensive, safe and effective and can be delivered in a variety of settings including hospitals, outpatient clinics, residential hospices, nursing homes, community health centers and at home. However, cancer pain is frequently inadequately treated. and healthcare providers often feel insufficiently prepared to assess and manage cancer pain. The purpose of this guideline is to assist members of all healthcare professions in South Africa to optimise patient care within the limitations of their resources, aiming to reduce suffering while maintaining quality of life and dignity. The guideline has been endorsed by the following organisations: Gauteng Centre of Excellence for Palliative Care / Wits Centre for Palliative Care PainSA Hospice Palliative Care Association Palliative Treatment for Children – South Africa (PATCH-SA) University of Cape Town, FHS, Family Medicine Division South African Society of Clinical and Radiation Oncology (SASCRO) South African Society of Anaesthesiologists (SASA)

Palliative care, including effective management of cancer pain, is recognised under international law as a human right. Pain management can and should be delivered from the time of cancer diagnosis. This care is inexpensive, safe and effective and can be delivered in a variety of settings including hospitals, outpatient clinics, residential hospices, nursing homes, community health centers and at home. However, cancer pain is frequently inadequately treated. and healthcare providers often feel insufficiently prepared to assess and manage cancer pain. The purpose of this guideline is to assist members of all healthcare professions in South Africa to optimise patient care within the limitations of their resources, aiming to reduce suffering while maintaining quality of life and dignity. The guideline has been endorsed by the following organisations: Gauteng Centre of Excellence for Palliative Care / Wits Centre for Palliative Care PainSA Hospice Palliative Care Association Palliative Treatment for Children – South Africa (PATCH-SA) University of Cape Town, FHS, Family Medicine Division South African Society of Clinical and Radiation Oncology (SASCRO) South African Society of Anaesthesiologists (SASA)

Palliative care, including effective management of cancer pain, is recognised under international law as a human right. Pain management can and should be delivered from the time of cancer diagnosis. This care is inexpensive, safe and effective and can be delivered in a variety of settings including hospitals, outpatient clinics, residential hospices, nursing homes, community health centers and at home. However, cancer pain is frequently inadequately treated. and healthcare providers often feel insufficiently prepared to assess and manage cancer pain. The purpose of this guideline is to assist members of all healthcare professions in South Africa to optimise patient care within the limitations of their resources, aiming to reduce suffering while maintaining quality of life and dignity. The guideline has been endorsed by the following organisations: Gauteng Centre of Excellence for Palliative Care / Wits Centre for Palliative Care PainSA Hospice Palliative Care Association Palliative Treatment for Children – South Africa (PATCH-SA) University of Cape Town, FHS, Family Medicine Division South African Society of Clinical and Radiation Oncology (SASCRO) South African Society of Anaesthesiologists (SASA)

Introduction: Palliative care has the potential to improve the quality of life for children living with LL or LTC's and their families. However, in the South African context, little is known about the specific care needs of these children and the experiences of caregivers and health care workers during the child's stay at an intermediate / step down facility. Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and cross-sectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.

Background: In the last few decades, the increasing upsurge in HIV/AIDS and noncommunicable diseases such as heart disease, stroke and cancer as well as aging populations has given rise to the need for PC services in many countries globally, including Lesotho. However, available literature indicates gaps in PC development and integration in Lesotho. Aim: To explore the perceptions of health care workers regarding the need for PC services in three selected hospitals in Lesotho, with regards to knowledge of PC, the burden of care (especially to healthcare workers), existing PC services and policies which guide availability and access to PC medications. Objectives: (1) To explore selected health care workers' views on the burden of disease at the hospitals where they work and in Lesotho; (2) To identify knowledge, attitudes and beliefs on PC and linking that to the need for PC provision for patients diagnosed with life threatening conditions; including their families; (3) To determine which conditions in the HCWs' views qualify a patient to receive PC, and (4) To identify whether in the HCWs' views there is adequate development and provision of PC services in the hospitals where they work. Method: This study used a descriptive research design conducted within a qualitative approach. Individual semi-structured interviews were conducted with 12 research participants in three hospitals in Lesotho. Research participants included medical doctors, pharmacists, social workers and nurses. Data was recorded, transcribed verbatim and analyzed using thematic analysis. Results: Themes and sub-themes emerged from the data analysis: prevalent palliative care conditions, psycho-social support, referral criteria for palliative care services, palliative care challenges, poor infrastructure and lack of resources, accessibility and affordability of pain medication, and lack of palliative care policies and procedures. Conclusion: Although each hospital had a different pattern of views and challenges, the same reasons and issues were raised all of which suggests primarily that PC services were at low levels of operation, mostly unorganized and in many instances non-existent in Lesotho. The followings recommendations were presented: 1. Introduction of compulsory entry point education and Continuing Professional Development (CPD) for HCWs 2. Sensitization and advocacy for PC. 3. Adequate funding 4. Availability and accessibility of PC medications and 5. Policies promoting restrictions on prescriptions should be reviewed towards formulation new policies.

Introduction: Palliative care is a core component of comprehensive health care across a person's life span. South Africa is currently in the process of integrating palliative care into all levels of the health care system. Doctors play a vital role in providing these services, but misconceptions about palliative care and who should be providing it, may prevent these services from being offered. Aim: The aim of this study was to discover doctor's perceptions and the current provision of palliative care in a private hospital. Objectives: The objectives of the study were: (1) to explore doctors' experiences of pain and symptom management in palliative care; (2) to explore doctors' perceptions of palliative care, goals of care and teamwork in palliative care; and (3) to explore the doctors' provision of palliative care at the hospital. Methodology: This was a qualitative study using a grounded theory approach. Semi-structured interviews were conducted with 14 participants, made up of doctors in oncology, physicians, surgeons, a cardiologist, an intensivist, a hematologist and a general practitioner. Interviews were recorded, transcribed and an inductive process was used for data analysis which allowed for categories to emerge from the data. Results: Eight themes emerged from the data analysis: improving the quality of life; palliative care as a role for oncologists; late referrals to palliative care, views on the World Health Organisation analgesic pain ladder; morphine a controversial means of pain control; team approach; family involvement and spiritual care. Conclusion: Palliative care was seen as an important intervention for a dying patient, but by introducing these services so late, patients are not benefitting from all that palliative care has to offer. Doctors did not always have a good understanding of when and how to provide palliative care. The following recommendations were made: (1) further research to be conducted in more private hospitals; (2)engage with management and doctors to begin the process of offering more formalised palliative care services at the hospital; (3) networking with available palliative care services, (4) organising palliative care training and workshops and (5) palliative care awareness campaigns.

Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and crosssectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources, and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.

Background: Palliative care (PC) is considered a necessary component of care that needs to be integrated into the South African health care system, including hospitals. In South Africa there has been a growth in legislation and policy frameworks stating the need for and promoting the development of hospital based PC programmes, however, how hospitals implement these policies is still unknown. Aim: The aim of this study was to identify factors that influence integration of PC in state hospitals and develop implementation recommendations. Objectives: The objectives of this study were (1) To describe existing PC services in three state hospitals in the Western Cape as perceived by the PC team; (2) To identify prohibiting and promoting factors in the integration of PC services in the three hospitals; and (3) To elicit views of health care professionals on how challenges to integrating PC in a hospital setting could be addressed. Method: This was a qualitative study whereby individual semi-structured interviews were conducted with 17 key informants (five-seven at each hospital). To obtain perspectives from relevant professionals on an operational and management level, key informants included chief executive officers, nursing managers, PC programme managers, physicians, nursing sisters, pharmacists, and social workers. The data was recorded, transcribed and analysed through steps of thematic analysis. Results: A description of each hospital’s PC programme was provided. Prohibiting factors identified most frequently related to resource challenges (insufficient human resources, time for PC, infrastructure and funding), followed by the hospital culture (limiting attitudes and beliefs about PC), education and training (limited opportunity, time and funding), health care providers (lack of PC knowledge, communication and hierarchy), as well as patient, family, community, and policy factors. Enabling factors identified were mainly related to having adequate resources (PC champions, effective teamwork, infrastructure and financial support). Raising awareness of PC needs and benefits (using practical methods), education and training in PC (formal and informal training opportunities), support structures (self-care, management and government support), partnerships (networking), and community-based support were also identified as promoting factors. Conclusion: Recommendations generated from this study were as follows: (1) Conduct a needs assessment to determine the organisations’ readiness and needs for PC integration; (2) Identify PC champions who have an interest in PC and influence in the organisation; (3) Raise PC awareness by providing education and training opportunities, and making PC part of the hospital culture; (4) Ensure adequate amount and use of human and material resources for PC; and (5) Network and build partnerships with other organisations who already have PC services.