Structural Challenges of Providing Palliative Care for Patients with Breast Cancer.
BACKGROUND
To establish a palliative care system (PCS) in Iran, it is necessary to identify the potential barriers.


OBJECTIVE
This study aims to highlight the views of stakeholders to know the challenges of providing palliative care for women with breast cancer.


METHODS
Semi-structured in-depth interviews are used with purposeful sampling conducted in Tehran, Iran; from January to June 2015. Twenty participants were included in the study: nine patients with breast cancer and ten health-care providers. The interviews were analyzed using qualitative directed content analysis based on Donabedian model. Data credibility was examined using the criteria of Lincoln and Guba.


RESULTS
Based on the pattern of Avedis Donabedian model, two main categories were identified: (1) palliative care services in the health system still remain undefined and (2) lack of adequate care providers. The subcategories emerged from the main categories are: (1) Inexistent home care, (2) specialized palliative care being in high demand, lack of: (a) Rehabilitation program and guidelines, (b) treatment/training protocols, (c) inefficient insurance and out-of-pocket costs, (d) patient referral system, (e) nontransparency of job description, and (f) weakness of teamwork.


CONCLUSIONS
The findings of the study identify views and perceptions of patients as well as the health professionals around the challenges of providing palliative care. To establish a structured PCS, we need to meet the challenges and remove perceived barriers to, including but not limited to, building up knowledge and awareness of health professionals, educating professional, and developing updated, well-defined, and standard treatment protocols, tailored to local conditions.
Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Tahereh Alsadat Khoubbin
TA
Khoshnazar
Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Maryam
M
Rassouli
Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mohammad Esmaeil
ME
Akbari
Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Psychology, Islamic Azad University, Roudehen Branch, Roudehen, Iran.
Farah
F
Lotfi-Kashani
Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Syrus
S
Momenzadeh
Breast Cancer Research Center, ACECR, Tehran, Iran.
Shahpar
S
Haghighat
Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran.
Moosa
M
Sajjadi
Breast cancer; Iran; Palliative care; Qualitative research