Crises in Caring for Dying Patients Regarding Cancer Within Iranian Cultural Backgrounds: A Systematic Review of Qualitative Studies

Context: Peaceful death is a primary goal in the philosophy of palliative care. However, there are some distressing situations that can cause this unachievable that are termed “dying process crises”. The leading causes are interrelated to cultural and religious backgrounds of different societies. Objectives: The main causes of end of life crises are sought from integration of viewpoints of health care providers and extracted results are discussed as priorities for a future implication on a cancer end of life framework. Data Sources: A literature search for was performed published English qualitative studies that measured challenges or crises of end of life care in dying patients in perspective of health care providers by interview-based content analysis approaches from January 2008 to March 2018 via PubMed, MedLine, Google Scholar, ScienceDirect, and PsycINFO databases. Study Selection: Studies related to death in acute or non-hospital settings, hastened death, and structural or modeled studies were excluded. At the end, 8 articles were entered in the Meta-synthesis of qualitative studies. Data Extraction: The selected articles were repeatedly read and related themes to research question were extracted. Then, overarching themes were synthesized among descriptive themes of each article. Results: The identified overarching themes were poorly controlled symptoms, unexpected death, time and facility constrains, lack of education or knowledge, weak coping skills, communication barriers, family conflicts, and systematic issues. By discussion on the cultural aspects and isolated palliative care framework of Iran, important priorities to prevent death crises were symptom management and appropriate communication skills. Conclusions: Regarding the themes in priority, planning educational programs for family meetings directed to the Iranian cultural and religious context, besides developing high quality cancer palliative services, are in a real necessity