Addressing the concept of total pain in palliative care: A postcolonial South African hospice view.

Objectives: Palliative care, which was formally established in the Global North, is now recognized globally as part of health care. As part of a larger study, we were interested in how decision-makers at a leading hospice in South Africa understood the changing local context and its influence on the delivery of services. We were interested in how the concept of "total pain," as outlined by Saunders, applies in a very unequal and under-resourced society in the shadow of a long, oppressive colonial, and apartheid past.

Methods: We conducted face-to-face semi-structured interviews with 12 staff at St Luke's Combined Hospices in Cape Town, South Africa, and analyzed the data following Braun and Clarke's thematic analysis approach.

Results: Four major themes emerged from the data. First, St Luke's has faced the challenge of serving a larger and far more diverse population than it had under apartheid. Second, the organization has undergone a process of rethinking holism and holistic services offered to palliative care patients in this context. Third, diversity and cultural sensitivity are key to how services are offered, and finally, the concept of "total pain" in this context is linked to questions of power and empowerment.

Significance of results: This study is small and situated within a particular context, and it is clear that more data are needed. Nevertheless, the study shows that considering the Global South and postcolonial context is important for thinking about total pain and a global system of palliative care which is sensitive to the majority world context.