Document Type : Original Article
Authors
1 Qaen Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
2 School of Nursing, College of Health Sciences, University of Nizwa, Nizwa, Sultanate of Oman
3 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Mazandaran, Iran
5 Department of Nursing, Qaen Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
Abstract
Background: As the provision of end-of-life care in Iran is in its infancy and is not yet provided in a systematic and standardized manner, there will be challenges in implementing this care method. Therefore, this study aimed to explain the challenges of end-of-life care according to the perceptions of final-year nursing students.
Methods: This qualitative study utilized conventional content analysis integrated with a SWOT (Strengths, Weaknesses, Opportunities, and Threats) framework. The participants included 15 final-year nursing students who were purposefully selected for the study. Data were collected using semi-structured interviews conducted individually in a silent classroom and analyzed using the Elo and Kyngas method. Also, the accuracy of the data was increased using the Lincoln and Guba criteria. The MAXQDA software-2018 version was used to manage the data analysis.
Results: The main category, multifaceted issues in End-of-Life Care provision, included three subcategories: Process Enablers, Socio-Religious Context, and Infrastructures & Support. Prominent challenges identified included poor interprofessional teamwork, adherence to culturally incorrect beliefs regarding futile care, and severe limitations in specialist human resources and opioid access.
Conclusion: There are several challenges to implementing end-of-life care in Iran. Health system officials and planners are recommended to use these findings to plan and develop localized guidelines to provide better quality care while addressing the weaknesses and threats of this study.
Keywords
- Beresford CJ, Gelling L, Baron S, Thompson L. The experiences of people with liver disease of palliative and end‐of‐life care in the United Kingdom—A systematic literature review and metasynthesis. Health Expectations. 2024;27(1):e13893.
- Nacak UA, Erden Y. End-of-life care and nurse’s roles. The Eurasian journal of medicine. 2022;54(Suppl 1):S141.
- Jan Mohamadi S, Seyd Fatemi N, Haghani H. Effectiveness of end-of-life care education on the moral distress of nurses in neonatal intensive care units. Journal of Pediatric Nursing. 2019;5(2):75-82.
- Kim S, Savage TA, Song M-K, Vincent C, Park CG, Ferrans CE, et al. Nurses’ roles and challenges in providing end-of-life care in neonatal intensive care units in South Korea. Applied nursing research. 2019;50:151204.
- Huisman BA, Geijteman EC, Dees MK, Schonewille NN, Wieles M, van Zuylen L, et al. Role of nurses in medication management at the end of life: a qualitative interview study. BMC palliative care. 2020;19(1):68.
- González-Rincón M, de Herrera-Marchal PD, Martínez-Martín M. The role of the nurse at the end of the life of a critically ill patient. Enfermería Intensiva (English ed). 2019;30(2):78-91.
- Mani ZA. Intensive care unit nurses experiences of providing end of life care. Middle East J Nurs. 2016;10(1):3-9.
- Odejide OO, Cronin AM, Condron NB, Fletcher SA, Earle CC, Tulsky JA, et al. Barriers to quality end-of-life care for patients with blood cancers. Journal of Clinical Oncology. 2016;34(26):3126-32.
- Xia L, Kongsuwan W. Factors relating to nurses’ end-of-life care. Journal of Biosciences and Medicines. 2020;8(6):189-200.
- Sandoval SÁ, Vargas MAdO, Zilli F. STRENGTHS AND WEAKNESSES TO FACE THE DYING AND DEATH PROCESS: STUDENTS'REFLECTIONS. Texto & Contexto-Enfermagem. 2020;29:e20190257.
- Akbarian-Rokni M, Mardani-Hamooleh M, Abbasi M, Seyedfatemi N, Pezaro S. Nurses’ perceptions of the challenges involved in providing of end-of-life care to people with heart failure: a context-based study. BMC palliative care. 2023;22(1):180.
- Gysels M, Evans N, Meñaca AEA, Toscani F, Finetti S, Pasman HR, et al. Culture and end of life care: a scoping exercise in seven European countries. The Ethical Challenges of Emerging Medical Technologies. 2020:335-50.
- Johnson JY, Popejoy L. Impact of culture and religion on end-of-life decisions among advanced cancer patients in developing countries. Innovation in Aging. 2020;4(Suppl 1):244.
- Yih C. The Impact of Cultural Diversity on End-of-Life Care. Religions. 2022;13(7):644.
- Ghaemizade Shushtari SS, Molavynejad S, Adineh M, Savaie M, Sharhani A. Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study. BMC nursing. 2022;21(1):102.
- Li J, Smothers A, Fang W, Borland M. Undergraduate nursing students’ perception of end-of-life care education placement in the nursing curriculum. Journal of Hospice & Palliative Nursing. 2019;21(5):E12-E8.
- Camara C, Rosengarten L, Callum J. Experiences of nursing students providing end of life care for children and young people: A focus group study. Nurse education today. 2024;137:106147.
- Ebadinejad Z, Rassouli M, Fakhr-Movahedi A. Assessing the compliance of educational curricula of selected disciplines with the content standards of cancer-related palliative care. Journal of Education and Health Promotion. 2021;10(1):247.
- Barasteh S, Rassouli M, Parandeh A, Vahedian-Azimi A, Zaboli R, Khaghanizadeh M. Palliative care in the health system of Iran: a review of the present status and the future challenges. Asian Pacific journal of cancer prevention: APJCP. 2020;21(3):845.
- Rassouli M, Salmani N. Challenges of palliative care for children with cancer in Iran: a review. Iranian Journal of Pediatric Hematology & Oncology. 2019.
- Hosseinnejad A, Rassouli M, Jahani S, Elahi N, Molavynejad S. Requirements for creating a position for community health nursing within the Iranian primary health care system: a SWOT analysis. Frontiers in Public Health. 2022;9:793973.
- Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care. 2007;19(6):349-57.
- Yang L, QI L, Zhang B. Concepts and evaluation of saturation in qualitative research. Advances in Psychological Science. 2022;30(3):511.
- Elo S, Kyngäs H. The qualitative content analysis process. Journal of advanced nursing. 2008;62(1):107-15.
- Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New directions for program evaluation. 1986;1986(30):73-84.
- Cerni J, Rhee J, Hosseinzadeh H. Challenges and strategies to improve the provision of end‐of‐life cancer care in rural and regional communities: Perspectives from Australian rural health professionals. Australian Journal of Rural Health. 2023;31(4):714-25.
- Hodge G, Kallis G, Oh TM, Wheat H, Pearce S. Exploring perceived barriers to palliative and end of life care provision in South-West England: bringing together the perspectives of professionals, patients, and families. Frontiers in Sociology. 2025;9:1488688.
- Bozorgi N, Khani S, Karamelahi Z, Elyasi F. A review of different roles of family caregivers in caring women with breast Cancer. Iranian Journal of Breast Diseases. 2023 May 10;16(2):101-18.
- 29. Granek L, Krzyzanowska MK, Tozer R, Mazzotta P. Oncologists' strategies and barriers to effective communication about the end of life. Journal of oncology practice. 2013;9(4):e129-e35.
- 30. Korsah EK, Schmollgruber S. Barriers and facilitators to end-of-life care in the adult intensive care unit: a scoping review. International Journal of Africa Nursing Sciences. 2023;19:100636.
- Glover TL, Ehrlich O, Davis A, Lippe M, Cormack CL, Jizba T, Kirkpatrick AJ, Meskis S. An end-of-life nursing education consortium (ELNEC) regional approach to integrating primary palliative care in nursing education. Journal of professional nursing. 2025 May 1;58:77-82.
- Ebadinejad Z, Rassouli M, Fakhr-Movahedi A. Assessing the compliance of educational curricula of selected disciplines with the content standards of cancer-related palliative care. J Educ Health Promot. 2021; 30;10:247.
- Glyn-Blanco MB, Lucchetti G, Badanta B. How do cultural factors influence the provision of end-of-life care? A narrative review. Applied Nursing Research. 2023;73:151720.
- 34. Givler A, Bhatt H, Maani-Fogelman PA. The importance of cultural competence in pain and palliative care. 2018
- Memaryan N, Rassouli M, Nahardani SZ, Amiri P. Integration of spirituality in medical education in Iran: A qualitative exploration of requirements. Evidence-Based Complementary and Alternative Medicine. 2015;2015.
- Memaryan N, Rassouli M, Nahardani SZ, Amiri P. Integration of spirituality in medical education in Iran: A qualitative exploration of requirements. Evidence-Based Complementary and Alternative Medicine. 2015;2015.
- 36. Hatamipour K, Rassouli M, Yaghmaie F, Zendedel K, Majd HA. Spiritual needs of cancer patients: A qualitative study. Indian journal of palliative care. 2015;21(1):61.
- Jafari H, Amjadi S, Kutenai HJ, Jafari MH. Ethical issues of do not resuscitate in cancer patients: A narrative review from a nursing perspective. Journal of Nursing Reports in Clinical Practice. 2023:16-22.
- Dargahi H, Alahdadi S, Salarvand A. Relationship between Mental Health Dimensions with Organizational Commitment and Work Ethics of Nurses Working in General Hospitals Affiliated to Tehran University of Medical Sciences. jhosp 2019; 18 (3) :9-17
- Bouothmani A, Gutierrez R, Lamrous A, Burza S, Maixenchs M, Richardson K. Access to opioids for palliative care in humanitarian settings: two case studies of Médecins Sans Frontières (MSF) experience in India and Bangladesh. BMC palliative care. 2025;24(1):1-12.
- 40. Mota Romero E, Puente Fernández D, Rodríguez Pertíñez C, Árbol Fernández G, Moreno Guerrero S, Montoya Juárez R. Inadequate human resources, equipment and training: A qualitative assessment of the objectives of the NUHELP end-of-life care programme in the context of the COVID-19 pandemic. Palliative Medicine. 2022;36(8):1252-62
- Rangriz H, Mousavi S. The effect of burnout caused by work pressure on the shortage of nurses in Iranian hospitals with regard to general health policies. Strategic and Macro Policies. 2014;2(No. 7):43-64.
- Pagaiya N, Phanthunane P, Bamrung A, Noree T, Kongweerakul K. Forecasting imbalances of human resources for health in the Thailand health service system: application of a health demand method. Human resources for health. 2019 Jan 8;17(1):4.
)