Household concepts of wellbeing and the contribution of palliative care in the context of advanced cancer: A Photovoice study from Blantyre, Malawi

Bates, Jane ORCID: https://orcid.org/0000-0002-4459-837X, Mphwatiwa, Treza, Ardrey, Jane ORCID: https://orcid.org/0000-0003-4558-5113, Desmond, Nicola ORCID: https://orcid.org/0000-0002-2874-8569, Niessen, Louis ORCID: https://orcid.org/0000-0002-8639-5191 and Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2018) 'Household concepts of wellbeing and the contribution of palliative care in the context of advanced cancer: A Photovoice study from Blantyre, Malawi'. PLoS ONE, Vol 13, Issue 8, e0202490.

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Abstract

Introduction
Cancer and other life-limiting non-communicable diseases are on the increase in Africa affecting younger populations frequently diagnosed at an advanced stage of disease. The United Nations Sustainable Development Goal 3 aims for ‘healthy life and wellbeing for all at all ages’, though there is a limited understanding of wellbeing particularly from patients’ and families’ perspectives in these populations. Palliative care is an approach which aims to improve the quality of life for patients and families affected by life-limiting disease, though access to palliative care has been described as an issue which is ‘largely ignored’ on the global health agenda. The aim of this Photovoice study was to explore patient and family perspectives of wellbeing and the contribution of palliative care following a diagnosis of advanced cancer in Blantyre, Malawi.

Methods
Between November 2016 and February 2017, 13 co-researchers (6 patients receiving palliative care for advanced cancer and 7 un-paid family caregivers) gathered photographs to depict aspects of their daily lives. Participatory analysis was conducted and an advocacy event (including photographic exhibits) held.

Results
Wellbeing was described as seeing improvements in the patients’ function facilitating inclusion in activities of daily living (including income generation) that had not previously been possible due to their illness. Family caregivers, neighbours and community members play a key role as ‘courage givers’ supported by health workers and religious groups, though discrimination in the form of social exclusion was also reported to be significant with patients expressing that they may be considered ‘prematurely dead’ in their community. Palliative care improves wellbeing by providing pain and symptom management enabling patients and / or family caregivers to return to household and income generating tasks. Through close interaction with households and ongoing counselling palliative care services assist to reduce fear and discrimination.

Conclusions
To achieve Sustainable Development Goal 3 for patients and families affected by life limiting illnesses in low resource settings, further understanding of the frequency and impact of discrimination is required as well as improved access to palliative care.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 85 Patients. Attitude and compliance W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care WX Hospitals and Other Health Facilities > Hospital Administration > WX 162 Point-of-care. Patient care planning.
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pone.0202490
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	24 Aug 2018 09:04
Last Modified:	17 Aug 2022 08:58
URI:	https://archive.lstmed.ac.uk/id/eprint/9198

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