Organizing palliative care in the rural areas of Iran: are family physician-based approaches suitable?

Abstract

Hossein Jabbari,1 Saber Azami-Aghdash,2 Reza Piri,3 Mohammad Naghavi-Behzad,4 Mark JM Sullman,5 Saeid Safiri6,7 1Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; 2Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; 3Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; 4Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 5School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus; 6Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran; 7Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Introduction: The provision of palliative end-of-life care (P/EOLc) for patients, wherever they live, is an increasingly important service, particularly given the increasing rates of cancer and other life-threatening diseases in Iran. However, unfortunately, those living in the rural areas of Iran are greatly disadvantaged with respect to this type of care. Therefore, the present study explored the feasibility of organizing P/EOLc in the rural areas of Iran. Methods: In this qualitative study, two focus group (FG) discussions were held in Tabriz (Iran) with rural family physicians (FPs, n=23) and key P/EOLc stakeholders (n=13). The FG sessions were recorded, transcribed, and the transcriptions checked by participants before the data were subjected to content analysis. Results: While most FPs indicated that they did not have sufficient involvement in providing P/EOLc, they emphasized the necessity of providing P/EOLc through four main themes and 25 subthemes. The four main themes were labeled as “structures and procedures,” “health care provider teams,” “obstacles,” and “strategies or solutions.” Furthermore, according to the main themes and subthemes identified here, the key stakeholders believed that the Iranian health system and the FPs’ team have the potential to provide P/EOLc services in rural areas. Conclusion: The most feasible strategy for providing P/EOLc in Iranian rural areas would be to use the current health care framework and base the process around the FP. Keywords: palliative end-of-life care, rural areas, family physician team

Keywords

• Palliative End-of-Life care
• Rural area
• Family physicians