Original Research

A Delphi study to guide the development of a clinical indicator tool for palliative care in South Africa

Rene Krause, Alan Barnard, Henriette Burger, Andre de Vos, Katya Evans, Lindsay Farrant, Nicki Fouche, Sebastiana Kalula, Jennie Morgan, Zainab Mohamed, Eugenio Panieri, Tasleem Ras, Peter Raubenheimer, Estelle Verburg, Kirsty Boyd, Liz Gwyther
African Journal of Primary Health Care & Family Medicine | Vol 14, No 1 | a3351 | DOI: https://doi.org/10.4102/phcfm.v14i1.3351 | © 2022 Rene Krause | This work is licensed under CC Attribution 4.0
Submitted: 23 November 2021 | Published: 19 May 2022

About the author(s)

Rene Krause, Department of Family Medicine and Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Alan Barnard, Department of Family Medicine and Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Henriette Burger, Department of Oncology, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
Andre de Vos, Department of Social Work, Groote Schuur Hospital, Cape Town, South Africa
Katya Evans, Department of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
Lindsay Farrant, Department of Family Medicine and Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town
Nicki Fouche, Department of Nursing, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Sebastiana Kalula, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Jennie Morgan, Department of Family Medicine and Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Zainab Mohamed, Department of Oncology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Eugenio Panieri, Department of General Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Tasleem Ras, Department of Family Medicine and Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Peter Raubenheimer, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Estelle Verburg, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Kirsty Boyd, Usher Institute, Primary Palliative Care, University of Edinburgh, Edinburgh, United Kingdom
Liz Gwyther, Department of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa


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Abstract

Background: The South African National Policy Framework and Strategy on Palliative Care (NPFSPC) recommends that when integrating palliative care (PC) into the health system, a PC indicators tool should be used to guide clinicians to recognise a patient who should receive PC. The policy document recommends ‘a simple screening tool developed for use in South Africa that would assist healthcare professionals (HCPs) to recognise patients who may have unmet palliative care needs’.

Aim: This research study sought to develop South African consensus on indicators for PC to assist clinicians to recognise a patient in need of PC.

Setting: The South African healthcare setting.

Methods: A Delphi study was considered suitable as a methodology to develop consensus. The methodology was based on the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies to ensure rigour and transparency in conducting and reporting. Six different Delphi rounds were used to develop consensus. Each round allowed participants to anonymously rate statements with predefined rating scales.

Results: Cognisant of the disparities in healthcare provision and access to equitable healthcare in South Africa, the expert advisory group recommended, especially for South Africa, that ‘this tool is for deteriorating patients with an advanced life-limiting illness where all available and appropriate management for underlying illnesses and reversible complications has been offered’. The expert advisory group felt that disease-specific indicators should be described before the general indicators in the South African indicators tool, so all users of the tool orientate themselves to the disease categories first. This study included three new domains to address the South African context: trauma, infectious diseases and haematological diseases. General indicators for PC aligned with the original Supportive and Palliative Care Indicators Tool (SPICT) tool.

Conclusion: The Supportive and Palliative Care Indicators Tool for South Africa (SPICTTM-SA) is a simple screening tool for South Africa that may assist HCPs to recognise patients who may have unmet PC needs.


Keywords

palliative care; indicator tool; Delphi study; trauma; infectious diseases; haematology

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