title: Current state of palliative and end-of-life care in home versus inpatient facilities and urban versus rural settings in Africa.
abstract: OBJECTIVE
  Because palliative care in sub-Saharan Africa may not fit the style of delivery of palliative care in the global north, exploring the evidence can serve to reduce existing barriers and help streamline national policies that determine the optimal setting to implement formal palliative and end-of-life services.
  
  
  METHODS
  A search was conducted in Ovid MEDLINE®, PubMed, and Google Scholar databases using the search terms nursing care, terminal care, end of life care, palliative care, dying, death, hospice, opioids, morphine, Africa, sub-Saharan Africa, caregivers, and place of death. Eighty-seven relevant articles were found using the search terms. Of these, 22 matched inclusion criteria and were reviewed.
  
  
  RESULTS
  Opioid availability and distribution is best accessed at the inpatient level, and hence, pain and end-of-life symptoms are best managed at the inpatient level. Despite the great need, nurses' lack of prescription power in the home-based setting is a shortcoming. Home deaths have not been adequately studied, but research suggests that palliative care generally causes economic strain, psychosocial distress on family members, and increased risk of transmission of communicable disease. Hospice is understudied but shows favorable outcomes.
  
  
  CONCLUSIONS
  Funding and research need to focus on development of inpatient palliative and hospice care units in urban areas. In rural areas, the priority should be a home-based care model that involves nurses who are privileged to prescribe opioids and adjunctive medication therapies.
authors: School of Nursing, Yale University, New Haven, Connecticut.
authors: Jessica
authors: J
authors: Jang
authors: Mark
authors: M
authors: Lazenby
mesh_terms: D017954:Africa South of the Sahara; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006701:Home Nursing / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D010166:Palliative Care / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*; D019037:Urban Health Services / Q000706:statistics & numerical data*