关键词: medical communication palliative care paternalism patient–provider relationship sub-Saharan Africa

来  源:   DOI:10.1089/jpm.2023.0501

Abstract:
Background: As a person nears the end of their life, culture and ethnicity increasingly drive preferences and priorities for care. Understanding these preferences and priorities is fundamental to health care professionals\' goals to respect decision making and support the individual throughout this phase of life. Across Africa, several countries are in the initial stages of implementing palliative care services in their burgeoning health care systems. Moving forward, it is imperative to consider cultural similarities and differences when compared with the Western world, where the field of palliative care evolved, to create a tailored palliative care approach that is consistent with African culture. In palliative care, understanding cultural preferences and priorities requires communication between the patient and the provider and is a crucial step toward a successful implementation in Africa. A paternalistic patient-provider relationship is the current leading model in sub-Saharan Africa.1 Aim: This narrative review explores the prevalence of paternalism and explores its appropriateness and necessity in the current application of palliative care in sub-Saharan African countries. Methods: This narrative review was conducted using four databases as well as hand searching of relevant articles sourced from references of already selected articles. A total of 730 articles were identified. Fourteen articles met the inclusion/exclusion criteria set for this narrative review. Results: In sub-Saharan Africa, the leading patient-provider relationship was determined to be paternalistic. Reasons for this were language, education, cultural norms and expectations, lack of time, and benevolence. Conclusions: The implementation of palliative care often relies on communication of patient desires and goals. Consideration is needed to determine how a provider can appropriately know these factors in a paternalistic relationship.
摘要:
背景:当一个人接近生命的尽头时,文化和种族越来越多地推动护理的偏好和优先事项。了解这些偏好和优先事项对于医疗保健专业人员的目标至关重要,即在整个生命阶段尊重决策并支持个人。在整个非洲,一些国家正处于在其新兴的医疗保健系统中实施姑息治疗服务的初始阶段。往前走,与西方世界相比,必须考虑文化的相似性和差异性,姑息治疗领域的发展,创建符合非洲文化的量身定制的姑息治疗方法。在姑息治疗中,了解文化偏好和优先事项需要患者和提供者之间的沟通,这是在非洲成功实施的关键一步。家长式的患者-提供者关系是撒哈拉以南非洲当前的主要模式。1目的:这篇叙述性综述探讨了家长式的普遍性,并探讨了其在撒哈拉以南非洲国家姑息治疗的当前应用中的适当性和必要性。方法:使用四个数据库以及从已选择的文章的参考文献中获取相关文章的手工搜索进行叙事回顾。共识别出730篇文章。14篇文章符合本叙述性审查的纳入/排除标准。结果:在撒哈拉以南非洲,主要的患者-提供者关系被确定为家长式。原因是语言,教育,文化规范和期望,缺乏时间,和仁慈。结论:姑息治疗的实施通常依赖于患者愿望和目标的沟通。需要考虑确定提供者如何在家长式关系中适当地了解这些因素。
公众号