How do expatriate health workers cope with needs to provide palliative care in humanitarian emergency assistance? A qualitative study with in-depth interviews.

Background: Given the worldwide increase of chronic diseases, expatriate health workers on assignment with humanitarian emergency organisations can face more clinical situations that require advanced pain control or palliative care. Multiple reasons can prevent the provision of this care. Aim: To better know how health workers react to and cope with this dilemma. Design: A qualitative interview study using inductive thematic analysis was performed. Setting/participants: A total of 15 expatriate health workers took part in individual in-depth interviews after their assignment with the organisation 'Medecins sans Frontieres'. Results: Clinical situations requiring advanced pain control or palliative care do occur during assignments. Expatriate health workers have different levels of knowledge of pain control and palliative care. Lacking opioids were a main reason for inadequate pain control. The expatriates felt helpless, distressed and frustrated in such situations. Peer support was sometimes helpful. Guidelines for palliative care in emergency settings would have been useful. Conclusion: Pain control and palliative care needs occur during clinical practice in emergency humanitarian assistance. Training for expatriate health workers should be improved. Humanitarian organisations should strengthen their capacity to provide pain control and palliative care by developing and applying adapted guidelines.