Access to hospice care: multi-professional specialist perspectives in South Africa

Research addressing the nature of hospice referrals focuses primarily on the effect of late referral and the majority of studies are based in North America. Using health care professionals as key informants, the goal was to describe the hospice referral system used in the Western Cape Province of South Africa from the perspective of nursing sisters, medical doctors, and social workers. Semi-structured interviews with 29 such individuals were conducted at 15 rural, urban and peri-urban sites, exploring their perceptions towards, and experiences with, patient referral to hospice programmes. Interpretative descriptive design allowed for a comprehensive description of the referral process as well as an extension of the data based on the perspectives of the three stakeholder groups. The majority of hospice referrals originated from either community-based clinics or state hospitals. Three main themes, centring around the process of referring, (lack of) standardization, and (lack of) knowledge, arose from the analysis of the transcripts. An interpretation of the themes led to the development of a model describing the ideal hospice referral system for South Africa.