Barriers and facilitators in providing quality end-of-life care to patients with haematologic malignancies : the nurses’ perceptions

Abstract

The ‘cure culture’ present in a haematology oncology unit in Malta poses a challenge to end-of-life care provision for patients with hematologic malignancies. Extant literature focuses on the perceptions of medical practitioners regarding the non-referral of these patients to palliative care and the avoidance of end-of-life discussions. Yet, although nurses provide twenty-four hour care to these patients, there is a dearth of research regarding their perceptions of barriers and facilitators in quality end-of-life care provision for these patients. The aim of this paper is to explore the perceptions of Maltese nurses regarding barriers and facilitators in quality endof- life care provision for adult patients with haematologic malignancies in a haematology oncology unit in Malta. Five female nurses were recruited by purposive sampling and each participant was interviewed twice using semi-structured interviews. The data were transcribed verbatim. Two themes “Addressing the unique needs of each patient’ and “Obstacles to providing quality end-oflife care” were extracted. The first theme represents the nurses’ perceptions of facilitators necessary to provide quality end-of-life care namely, keeping the patient physically comfortable, ensuring that their spiritual needs are met, and working with patient concerns to enable closure. Conversely, the barriers perceived as hindering the provision of quality end-of-life care include the lack of patient privacy in the ward, the non-inclusion of nurses in care plan decision making, the provision of false hopes to patients, and care provision within a cureoriented ward culture. The findings demonstrate how end-of-life care with these patients should not be task and cure-oriented, but rather, should adopt a palliative modus operandi, that prompts care practices utilising a holistic and person-centred approach, with a focus on quality of life as opposed to quantity.