Structural Challenges of Providing Palliative Care for Patients with Breast Cancer

Background: Breast cancer is the most common cancer among Iranian women.According to the recommendations of the World Health Organization (WHO), examining and managing the challenges of breast cancer patients is a pivotal care priority in palliative care.Palliative care, as one of the fundamental human right to improve the quality of life of the patient and the family, and the provision of universal care, is one of the foundations of this type of care of high complexity. Therefore, it seems that integration of such care in the health system of the country requires identification of the challenges and barriers in the structure of the health system of the country.The aim of this study was to determine the structural challenges of providing palliative care for patients with breast cancer.Method: A literature review conducted using Persian and English articles in OVID, SID, pubmed, google scholar, from 2010 to 2017 with keywords Palliative Care , Breast Cancer , Structural Challenges .There were 20 articles related to palliative care challenges, of which 12 were directly related to the subject of research, including 3 ovid studies, 4 studies on google scholar, 4 pubmed and 1 Persian article which was found in SID.Findings: A review of studies has shown that the inability to provide specialized services is due to the lack of appropriate manpower, the lack of referral systems and effective insurance services as some of the structural barriers to patient relief.The high cost of treatment makes it more difficult to access.Another problem is the shortage of nurses and the need for nurses to be educated and used by nurses as compared to specialized nurses.Another challenge is the poor knowledge of palliative care, including symptom management philosophy, patient care and lack of long-term training programs to strengthen professional staff.Also, the lack of attention to the issue of palliative care in the health system of the country is a challenge that can be changed by changing the views of policymakers, staff and health managers, strengthening the systemic approach and building the necessary infrastructure for the successful implementation of relevant programs.In Iran s health system, there is a lack of a comprehensive approach to patient care that has led to scattered planning;for example, discharge planning in Iran instead of a process is an event. Therefore, there is no interaction between service providers and the patient remains confused about the complexity of self-care.Palliative care requires the input of a wide range of services, and professionals need to communicate with each other to ensure continuity of care, such communication is often poor.Conclusion: Structural factors can be effective implementation of palliative care which can act as a facilitator or barrierfor establishing such a care.The lack of palliative care services based on the regionalization and referral system, as important structural challenges, resulting in increased care costs, seems to be a significant barrier to palliative care.

کلیدواژه ها:

Structure ، health system ، palliative care ، breast cancer