Challenges of paediatric palliative care in Romania: a focus groups study

Abstract

Background The availability of palliative care facilities for children vary considerably among the European member states. In Romania, a country where health expenditure is among the lowest in Europe, palliative care has been mainly provided by charitable organizations. Despite the high number of children needing palliative care, there is scant literature and research available on paediatric palliative care in Romania. The study explores the viewpoints of various paediatric oncology providers with regard to paediatric palliative care provision in Romania. Methods Four mixed focus groups were conducted at four university-affiliated paediatric oncology centres located in three distinct Romanian regions (Bucuresti-llfov, Nord-Est and Nord-Vest). The focus groups were analyzed using thematic coding. Results For many healthcare professionals, emotional burden inherent to the profession; unhealthy work-life balance and understaffing were among the biggest barriers to the successful integration of pediatric palliative care. The lack of staff was attributed to a shortage of financial resources, and to the persisting cultural stigma surrounding palliative care and oncology. Also political turmoil was identified as an important obstacle to palliative care implementation. Conclusion Significant barriers persist limiting the broader implementation of pediatric palliative care in Romania. In order to render palliative care in pediatric oncology more sustainable, more attention should be paid to the mental health care of healthcare professionals working in this field, to the development of mobile palliative care services and to the emigration of skilled medical staff.

Stress Factors for the Paediatric and Adult Palliative Care Multidisciplinary Team and Workplace Wellbeing Solutions

“…In Romania, physicians specializing in paediatric palliative care are very few in number and are generally involved in consultative and care coordination roles, providing expertise and support in pain management, symptom management, and the development of personalised care plans. They are not involved in on-call activities, which can be a challenge to effectively manage emergencies or complex care needs outside of normal working hours [52,53].…”

“…We developed our questionnaire based on our knowledge of the Romanian context [52,53] and the results of the studies in the literature on the causes and effects of stress perceived by palliative healthcare professionals at work [4,9,14,[17][18][19][20][22][23][24]27,28,30,39,46] (Table 1), the impact of the COVID-19 pandemic on stress and burnout in palliative care [36,37,39,[46][47][48], and expectations and solutions for improving the workplace [4,14,18,[34][35][36]49,50,55,[57][58][59]. All this formed the theoretical basis of this study and contributed to the identification of the issues, the development of the hypothesis and the items of the questionnaire, and the overall aim of the research.…”

“…Staff shortages were attributed to a lack of financial resources and the continuing cultural stigma associated with palliative care and oncology. Political unrest was also identified as a major barrier to the implementation of palliative care [53].…”

Status of Healthy Choices, Attitudes and Health Education of Children and Young People in Romania—A Literature Review

“…The barriers to broader paediatric palliative care in Romania include mental health support for providers, mobile service development, and the retention of qualified staff. Addressing these areas is crucial for sustainable paediatric palliative care in oncology [129].…”

Benefits of Respite Services on the Psycho-Emotional State of Families of Children Admitted to Hospice Palliative Care Unit: Preliminary Study on Parents’ Perceptions

“…However, according to the study by Pacurari N et al in 2021, there are still significant barriers preventing the expansion of palliative care implementation for children. These include a lack of qualified staff in this field, insufficient financial resources, political instability in the country and migration of qualified medical staff, which remain significant barriers to the uniform development of these services nationwide [15].…”