Barriers in implementing the dying patient law: the Israeli experience - a qualitative study
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EARCH ARTICLE
Open Access
Barriers in implementing the dying patient law: the Israeli experience - a qualitative study Avi Zigdon1*† and Rachel Nissanholtz‑Gannot1,2†
Abstract Background: Coping with end-of-life issues is a major challenge for governments and health systems. Despite pro‑ gress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel. Methods: Qualitative in-depth interviews using professionals and decision makers in the health-care and related sys‑ tems (n = 37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n = 10) and social workers (n = 10). Data was managed and analyzed using Naralyzer software. Results: Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers. Conclusions: This study highlights the role of the family doctor in end-of-life by training physicians in decisionmaking workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient’s access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues. Keywords: End-of-life, Palliative care, Physician, Law Background Coping with patients at the end of their lives is a major issue for governments and health systems in the developed world. The approach whereby every person has the right to die with dignity, without forfeiting his autonomy and the right to make decisions about his life and death, is now accepted in Western countries [1, 2]. Nonetheless, many patients struggle with the fear of slow death and a situation where they will not be able to express their opinion on the question of which medical treatments *Correspondence: [email protected] † Avi Zigdon and Rachel Nissanholtz-Gannot contributed equally to this work 1 Department of Health Systems Management, School of Health Sciences, Ariel University, Science Park, P.O.B. 3, 4070000 Ariel, Israel Full list of author information is available at the end of the article
they wish to receive, or not receive, at the end of their lives [3, 4]. Different countries reach a different balance between patient autonomy and other values [5]. Even at the individual level, differences of opinion may arise among family members and between family members and medical staff, and frequently these involve no information about the patient’s wishes regarding end-of-life treatment [6]. Conversations with patients for end-of-life planning are associated with fewer aggressive interventions and with improved quality of life at the end of life [7]. In addition, it is linked to low
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