جودة حياة مرضى السرطان الفلسطينيين في غياب خدمات الرعاية التلطيفية
محمد حسين حماد خليف
MOHAMMAD HUSEIN HAMMAD KHLEIF
Background overall Quality of Life (QoL) is fundamental for both well and ill people. For the cancer patients it is a vital issue in the presence of this devastating condition that depletes all the resources on both the individual and community level. This study looked into the cancer patients QoL at the most difficult times of their lives. Cancer is the second leading cause of death in Palestine; 12.4% of all deaths (MOH, 2012). Most of the cases are diagnosed in late stage (Husseini et al, 2009), and very low levels of pain control and palliative care are available (AL-Sadeel Society website, 2012). Methods The aim of this study is to assess QoL domains scores and symptoms experience within the Palestinian culture. The study was carried out in the only three main settings available for treatment of cancer in the West Bank of Palestine. In-depth interviews with 10 cancer patients were done to reveal the uniqueness and any special concerns for Palestinian patients. And a cross sectional design studied 323 patients to reveal associated factors with QoL. The data collection tools were structured in-depthinterview questions and the QoL assessment tool of the European Organization for Research and Treatment of Cancer (EORTC QLQ C-30) to which socio demographic data were added. Findings Both qualitative and quantitative parts of this research were in harmony in representing the poor health related QoL (41.8%) of the cancer patients. The predictors of poor QoL were advanced stage of cancer (β= -0.3, p<0.001), poor economical condition (β= 0.19, p=0.001), low educational level (β= 0.12, p=0.04), and long duration of treatment (β= -0.11, p=0.04). As well, the generated qualitative themes supported these results; the main expressed needs of the cancer patients were financial aid, pain management, fully equipped healthcare facilities in their vicinity, availability of medications and qualified staff, eradication of stigmatization, communication and psychosocial support, health education, home nursing care, and palliative care.QoL functions were low and below half of the full function in most cases; physical (48.5%), role (48.8%), emotional (46%), cognitive (60.5%), and social (50%). Moreover, severe symptoms were experienced by cancer patients; fatigue (66.6%), pain (63%),insomnia (56.4%), appetite loss (45.3%), and financial difficulties (64.6%). These results were lower than other studies in the region, denoting difficult conditions of Palestinian patients with cancer. Conclusion Palestinian cancer patients are suffering from quite difficult conditions. These can be divided to two main streams; socio-economic factors of the patients, and inability of the healthcare system to early detect, diagnose, treat, and provide professional support, especially to advanced stages cancer patients. So, and for better QoL, there is desperate need for integrating palliative care services into the health care system in Palestine as quality improvement, cost-effective and economically efficient measure, and develops social welfare system. As well as, there is a need for early detection, and awareness and education for cancer patients and health care providers.
السياسات والاداره الصحية , Policies & Health Management