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RA P, Z A, Gikaara N, Qanungo S, ES M, KB C. Research attitudes, practice and literacy among Kenyan palliative care healthcare professionals: an observational, cross-sectional online survey. BMC Palliat Care 2022; 21:206. [PMID: 36419149 PMCID: PMC9684766 DOI: 10.1186/s12904-022-01091-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While research is needed to advocate for implementation of global agendas to strengthen palliative care, healthcare professionals' research literacy must improve to bridge the gap between evidence and practice. A resurgent focus on North-South power disparities, means attention should also focus on understanding low- and middle-income countries' local agency to implement palliative care research agendas. METHODS An observational, cross-sectional online survey among Kenyan palliative healthcare professionals currently working at any of the palliative and hospice care organizations operational during January - December 2019, using descriptive statistics. RESULTS Among the 93 survey respondents, participants were mainly nurses (50.54%; n = 47). Regarding research attitudes: all agreed/strongly agreed research was important for their professional work. Over nine-tenths (91.21%; n = 83) reported having the skills to conduct research, and 91.30% (n = 84) wanted to conduct research in their clinical work. 90% (90.21%; n = 83) reported supervisory support to conduct research. A comparable proportion (90.22%; n = 83) would undertake research if they could find funding. Regarding research practice: over two-thirds (70.65%; n = 65) reported ever having had a mentor who encouraged them to do research, while approximately half (50.59%; n = 43) reported reading evidence-based journal articles about once per month and attending monthly in-house meetings on palliative care (56.79%; n = 46). Regarding research literacy: while over two-fifths of respondents described their current research literacy level as 'none' or 'beginner' (44.56%; n = 41), a comparable proportion described it as 'intermediate' (45.65%; n = 42), with 9 (9.78%) stating it was 'advanced'. CONCLUSION The majority of palliative healthcare professionals report having interest, skills and support at work to conduct palliative care research, with a low-to-medium level of research literacy. The current study explored palliative care staff attitudes to, experience in, and literacy with the research process, which is necessary to creating a dialogue on implementing research findings. This study also adds to the global empowerment agenda, addressing inequities in research opportunities and local capacity to own and undertake palliative care research.
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Affiliation(s)
- Powell RA
- grid.7445.20000 0001 2113 8111Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London, England ,grid.451056.30000 0001 2116 3923Ethnicity and Health Unit, NIHR Applied Research Collaboration Northwest London, London, England ,MWAPO Health Development Group, Nairobi, Kenya
| | - Ali Z
- Kenyan Hospices and Palliative Care Association, Nairobi, Kenya
| | - N Gikaara
- grid.411192.e0000 0004 1756 6158Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - S Qanungo
- grid.259828.c0000 0001 2189 3475College of Nursing, Medical University of South Carolina, Charleston, SC USA
| | - Melikam ES
- grid.26090.3d0000 0001 0665 0280Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC USA
| | - Cartmell KB
- grid.26090.3d0000 0001 0665 0280Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC USA
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LeBaron VT, Horton BJ, Adhikari A, Chapagain S, Dhakal M, Gongal R, Kattel R, Koirala G, Kutcher A, Hass B, Maurer M, Munday D, Neupane B, Sharma K, Shilpakar R, Shrestha A, Shrestha S, Thapa U, Dillingham R, Paudel BD. A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal. FRONTIERS IN PAIN RESEARCH 2022; 3:910995. [PMID: 35965597 PMCID: PMC9366104 DOI: 10.3389/fpain.2022.910995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionQuality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets.MethodsBuilding on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application (“app”) was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted.ResultsNinety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) “agreed” or “strongly agreed” that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030).ConclusionThe NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context.
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Affiliation(s)
- Virginia T. LeBaron
- University of Virginia School of Nursing, Charlottesville, VA, United States
- *Correspondence: Virginia T. LeBaron
| | - Bethany J. Horton
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Sandhya Chapagain
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Manita Dhakal
- B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal
| | | | - Regina Kattel
- Nepal Cancer Hospital & Research Center, Lalitpur, Nepal
| | | | - Anna Kutcher
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Ben Hass
- Hass Software Consulting, Brooklyn, NY, United States
| | - Martha Maurer
- Sonderegger Research Center, University of Wisconsin School of Pharmacy, Madison, WI, United States
| | - Daniel Munday
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Bijay Neupane
- B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal
| | | | - Ramila Shilpakar
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Amuna Shrestha
- Nepal Cancer Hospital & Research Center, Lalitpur, Nepal
| | - Sudip Shrestha
- Nepal Cancer Hospital & Research Center, Lalitpur, Nepal
| | - Usha Thapa
- B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal
| | - Rebecca Dillingham
- University of Virginia School of Medicine, Charlottesville, VA, United States
- University of Virginia Center for Global Health Equity, Charlottesville, VA, United States
| | - Bishnu D. Paudel
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Sallnow L, Smith R, Ahmedzai SH, Bhadelia A, Chamberlain C, Cong Y, Doble B, Dullie L, Durie R, Finkelstein EA, Guglani S, Hodson M, Husebø BS, Kellehear A, Kitzinger C, Knaul FM, Murray SA, Neuberger J, O'Mahony S, Rajagopal MR, Russell S, Sase E, Sleeman KE, Solomon S, Taylor R, Tutu van Furth M, Wyatt K. Report of the Lancet Commission on the Value of Death: bringing death back into life. Lancet 2022; 399:837-884. [PMID: 35114146 PMCID: PMC8803389 DOI: 10.1016/s0140-6736(21)02314-x] [Citation(s) in RCA: 170] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Afsan Bhadelia
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Yali Cong
- Peking University Health Science Center, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | - Julia Neuberger
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Sarah Russell
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Eriko Sase
- Georgetown University, Washington, DC, USA
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Endah Purnamaningsih Maria Margaretha S, Mulatsih S, Effendy C, Kusnanto H. Qualitative Analysis of Family-centered Care for Children with Cancer in Palliative Wards: An Evaluation of Needs and Barriers in Resource-limited Settings. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Many children with cancer are faced with fatal diagnosis and unbearable pain, and palliative care is highly needed. In Indonesia, the provision of palliative care is only accessible in a few major cities where most cancer treatment facilities are located and development has been slow. While, the implementation of family center care identified a number of challenges related to family empowerment to be included in the development and implementation of interventions.
Objectives: This study aimed to assess the perspectives of nurses regarding family-centered treatment in Indonesia’s palliative wards for children with cancer.
Methods: A qualitative approach to content analysis was employed. The study participants were 10 primary nurses in pediatric units who worked with cancer patients regularly. These participants were purposefully chosen. The interview session included 10 study participants. Participants’ work experience ranged from 2 to 11 years, and their age ranged from 27 to 51 years. Data were collected via face-to-face, semi-structured interviews that lasted for an average of 30 to 45 minutes. The interviews were performed to explore the participants’ understanding about the definition of family-centered palliative care, including the needs and obstacles to implementation. These were analyzed using content analysis methodology that includes five main segments: introduction, coding, theme creation, thematic classification, and reporting.
Results: The themes from the study included an appreciation of palliative and family-centered care, palliative care capability and family-centered care, and multidisciplinary cooperation under three principles concerning needs and barriers.
Conclusion: Integrating family-centered care approaches in providing palliative care for children with cancer as well as the resources required for such programs to be implemented by hospital management in working toward improved quality care for patients. Communication and continuity of care remain a challenge; training and equipping clinicians with skills and confidence to carry out family-centered care approaches and palliative care for children with cancer can aid in this process.
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Bazargan M, Bazargan-Hejazi S. Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. Am J Hosp Palliat Care 2021; 38:688-718. [PMID: 33287561 PMCID: PMC8083078 DOI: 10.1177/1049909120966585] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. METHODS The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. DISCUSSION Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Court L, Olivier J. Approaches to integrating palliative care into African health systems: a qualitative systematic review. Health Policy Plan 2020; 35:1053-1069. [PMID: 32514556 PMCID: PMC7553764 DOI: 10.1093/heapol/czaa026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2020] [Indexed: 12/28/2022] Open
Abstract
Africa is characterized by a high burden of disease and health system deficits, with an overwhelming and increasing demand for palliative care (PC). Yet only one African country is currently considered to have advanced integration of palliative care into medical services and generalized PC is said to be available in only a handful of others. The integration of PC into all levels of a health system has been called for to increase access to PC and to strengthen health systems. Contextually appropriate evidence to guide integration is vital yet limited. This qualitative systematic review analyses interventions to integrate PC into African health systems to provide insight into the 'how' of PC integration. Forty articles were identified, describing 51 different interventions. This study found that a variety of integration models are being applied, with limited best practices being evaluated and repeated in other contexts. Interventions typically focused on integrating specialized PC services into individual or multiple health facilities, with only a few examples of PC integrated at a population level. Four identified issues could either promote integration (by being present) or block integration (by their absence). These include the provision of PC at all levels of the health system alongside curative care; the development and presence of sustainable partnerships; health systems and workers that can support integration; and lastly, placing the client, their family and community at the centre of integration. These echo the broader literature on integration of health services generally. There is currently a strong suggestion that the integration of PC contributes to health system strengthening; however, this is not well evidenced in the literature and future interventions would benefit from placing health systems strengthening at the forefront, as well as situating their work within the context of integration of health services more generally.
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Affiliation(s)
- Lara Court
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
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Gafaar TO, Pesambili M, Henke O, Vissoci JRN, Mmbaga BT, Staton C. Good death: An exploratory study on perceptions and attitudes of patients, relatives, and healthcare providers, in northern Tanzania. PLoS One 2020; 15:e0233494. [PMID: 32649715 PMCID: PMC7351142 DOI: 10.1371/journal.pone.0233494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE In the Kilimanjaro region of Tanzania, there are no advance care planning (ACP) protocols being used to document patient preferences for end-of-life (EoL) care. There is a general avoidance of the topic and contemplating ACP in healthcare-limited regions can be an ethically complex subject. Nonetheless, evidence from similar settings indicate that an appropriate quality of life is valued, even as one is dying. What differs amongst cultures is the definition of a 'good death'. OBJECTIVE Evaluate perceptions of quality of death and advance EoL preparation in Moshi, Tanzania. DESIGN 13 focus group discussions (FGDs) were conducted in Swahili using a semi-structured guide. These discussions were audio-recorded, transcribed, translated, and coded using an inductive approach. SETTING Kilimanjaro Christian Medical Centre (KCMC), referral hospital for northern Tanzania. PARTICIPANTS A total of 122 participants, including patients with life-threatening illnesses (34), their relatives/friends (29), healthcare professionals (29; HCPs; doctors and nurses), and allied HCPs (30; community health workers, religious leaders, and social workers) from KCMC, or nearby within Moshi, participated in this study. FINDINGS In characterizing Good Death, 7 first-order themes emerged, and, of these themes, Religious & Spiritual Wellness, Family & Interpersonal Wellness, Grief Coping & Emotional Wellness, and Optimal Timing comprised the second-order theme, EoL Preparation and Life Completion. The other first-order themes for Good Death were Minimal Suffering & Burden, Quality of Care by Formal Caregivers, and Quality of Care by Informal Caregivers. INTERPRETATION The results of this study provide a robust thematic description of Good Death in northern Tanzania and they lay the groundwork for future clinical and research endeavors to improve the quality of EoL care at KCMC.
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Affiliation(s)
- Temitope O. Gafaar
- Duke University School of Medicine, Duke University, Durham, NC, United States of America
| | - Msafiri Pesambili
- Duke University Research Collaboration, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Oliver Henke
- Cancer Care Center, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Blandina Theophil Mmbaga
- Cancer Care Center, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
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A Comparison of Policy Analysis of Palliative Care for Cancer in UK, Malaysia, and South Africa. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.94841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Esmaili BE, Stewart KA, Masalu NA, Schroeder KM. Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting. J Glob Oncol 2019; 4:1-10. [PMID: 30084714 PMCID: PMC6223406 DOI: 10.1200/jgo.17.00047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care. This was combined with 1 month of participant observation through direct clinical care of terminally ill pediatric patients. Results Data from interviews as well as participant observation revealed several barriers to palliative care: financial, infrastructure, knowledge and cultural (including perceptions of pediatric pain), and communication challenges. Although this study focused on barriers, what also emerged were the unique advantages of end-of-life care in this setting, including community cohesiveness and strong faith background. Conclusion This study provides a unique but focused description of barriers to palliative care common in a low-resource setting, extending beyond resource needs. This multidisciplinary qualitative approach combined interviews with participant observation, providing a deeper understanding of the logistical and cultural challenges in this setting. This new understanding will inform the design of more effective-and more appropriate-palliative care policies for young patients with cancer in the developing world.
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Affiliation(s)
- B Emily Esmaili
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Kearsley A Stewart
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Nestory A Masalu
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Kristin M Schroeder
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
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Symptom Burden and Functional Dependencies Among Cancer Patients in Botswana Suggest a Need for Palliative Care Nursing. Cancer Nurs 2017; 39:E29-38. [PMID: 25881812 DOI: 10.1097/ncc.0000000000000249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Palliative care and cancer nursing in sub-Saharan Africa is hampered by inadequate clinical resources and evidence base but is central to symptom management amid the growing cancer burden. OBJECTIVE The aim of this study is to describe symptom burden and functional dependencies of cancer patients in Botswana using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) and Enforced Social Dependency Scale (ESDS). METHODS A cross-sectional multisite study was conducted in Gaborone, Botswana, from June to August 2013 using MSAS-SF, ESDS, and Eastern Cooperative Oncology Group (ECOG) performance status at 1 time point. Descriptive statistics, tests of association, correlation, and scale validity were used. RESULTS Among the 100 cancer patients, 65 were women, 21 were inpatients, 48 were human immunodeficiency virus-positive, 23 had gynecological malignancies, 34 had stage 4 disease, and 54 received chemotherapy only. Sixty-four reported pain; 54, neuropathies; 51, weight loss; and 51, hunger. Most distressing symptoms were weight loss, body image, skin changes, and pain. Recreational/social role was most affected by cancer. Cronbach's α for both the MSAS-SF and ESDS was .91. Variations in means for MSAS-SF and ESDS were associated with ECOG grade 2 (P < .05); the ECOG moderately correlated (0.35) with MSAS-SF (P < .01). No associations with human immunodeficiency virus status were found. CONCLUSIONS Patients reported distressing levels of cancer pain, weight loss, hunger, and dependency in recreational/social activities. The Setswana translations of the MSAS-SF and ESDS were found reliable to assess cancer patients' symptoms and function. IMPLICATIONS FOR PRACTICE Nurses trained in palliative care are needed to meet cancer patients' pain and symptom management care needs.
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Mumm R, Diaz-Monsalve S, Hänselmann E, Freund J, Wirsching M, Gärtner J, Gminski R, Vögtlin K, Körner M, Zirn L, Wittwer-Backofen U, Oni T, Kroeger A. Exploring urban health in Cape Town, South Africa: an interdisciplinary analysis of secondary data. Pathog Glob Health 2017; 111:7-22. [PMID: 28093045 DOI: 10.1080/20477724.2016.1275463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND With modern information technology, an overwhelming amount of data is available on different aspects of societies. Our research investigated the feasibility of using secondary data sources to get an overview of determinants of health and health outcomes in different population strata of Cape Town, a large city of South Africa. METHODS The methodological approach of secondary-data analysis was similar in the different disciplines: Biological Anthropology, Public Health, Environmental Health, Mental Health, Palliative Care, Medical Psychology and Sociology at the University of Freiburg and Public Health at the University of Cape Town. The teams collected information on Cape Town through Internet searches and published articles. The information was extracted, analyzed, condensed, and jointly interpreted. RESULTS Data show the typical picture of a population in epidemiological and demographic transition exposed to often difficult social, mental, and physical environmental conditions. Comparison between low and higher socioeconomic districts demonstrated that the former had higher air pollution, poorer water quality, and deficient sanitary conditions in addition to sub-optimal mental health services and palliative care. CONCLUSION Although important information gaps were identified, the data draw attention to critical public health interventions required in poor health districts, and to motivate for pro-equity policies.
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Affiliation(s)
- Rebekka Mumm
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,b Faculty of Medicine, Biological Anthropology , University of Freiburg , Freiburg , Germany
| | - Sonia Diaz-Monsalve
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany
| | - Eva Hänselmann
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,c Faculty of Medicine, Clinic for Psychosomatic Medicine und Psychotherapy , University of Freiburg , Freiburg , Germany
| | - Johanna Freund
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,c Faculty of Medicine, Clinic for Psychosomatic Medicine und Psychotherapy , University of Freiburg , Freiburg , Germany
| | - Michael Wirsching
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,c Faculty of Medicine, Clinic for Psychosomatic Medicine und Psychotherapy , University of Freiburg , Freiburg , Germany
| | - Jan Gärtner
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,d Faculty of Medicine, Clinic for Palliative Care , University of Freiburg , Freiburg , Germany
| | - Richard Gminski
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,e Faculty of Medicine, Institute of Environmental Medicine and Hospital Hygiene , University of Freiburg , Freiburg , Germany
| | - Katrin Vögtlin
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,e Faculty of Medicine, Institute of Environmental Medicine and Hospital Hygiene , University of Freiburg , Freiburg , Germany
| | - Mirjam Körner
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,f Faculty of Medicine, Medical Sociology and Psychology , University of Freiburg , Freiburg , Germany
| | - Lena Zirn
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,f Faculty of Medicine, Medical Sociology and Psychology , University of Freiburg , Freiburg , Germany
| | - Ursula Wittwer-Backofen
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany.,b Faculty of Medicine, Biological Anthropology , University of Freiburg , Freiburg , Germany
| | - Tolu Oni
- g Division of Public Health Medicine, School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Axel Kroeger
- a Center for Medicine and Society , University of Freiburg , Freiburg , Germany
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Clark J, Gardiner C, Barnes A. International palliative care research in the context of global development: a systematic mapping review. BMJ Support Palliat Care 2016; 8:7-18. [DOI: 10.1136/bmjspcare-2015-001008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 05/17/2016] [Accepted: 07/14/2016] [Indexed: 01/18/2023]
Abstract
ContextAn increasing amount of health policy is formulated at global level. At this global level, palliative care has attracted support primarily from normative institutions (WHO), not funding agencies. To attract greater global attention from policymakers, it has been argued that an international approach to research is required. However, the extent to which an international approach is being undertaken is unknown.ObjectivesTo systematically identify and thematically synthesise all international palliative care research, defined as research involving two or more countries, or focused on the global level.MethodsFive bibliographic databases (CINAHL, Cochrane Library, ASSIA, Web of Knowledge, Psychinfo) were searched for journal articles relevant to international and global palliative care and end-of-life care. Data were extracted using a piloted extraction form and findings were synthesised.Results184 studies were included, published across 75 different academic journals. Research emanates from and focuses on all world regions and there is increasing focus on the global level. Thematically, there is a high focus on Evaluation (n=53) and views of Stakeholders (n=38). The review revealed a predominantly observational research approach and few interventional studies were identified.ConclusionsInternational palliative care research is a relatively new, but growing field. However, many gaps in the evidence base remain and palliative care research continues to take place outside broader discourses of international development. The relative absence of interventional research demonstrating the effectiveness and cost-effectiveness of palliative care risks limiting the tools with which advocates can engage with international policymakers on this topic.
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Ingwu JA, Nwaiku L, Ohaeri B. Knowledge and practice of end-of-life care among nurses in a teaching hospital in Nigeria. Int J Palliat Nurs 2016; 22:194-9. [PMID: 27119407 DOI: 10.12968/ijpn.2016.22.4.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Improving end-of-life care (EoLC) has become a major goal among nurses since they have the most contact with patients and their families at this phase of life. This study examined the knowledge and practice of EoLC among nurses working at the University of Nigeria Teaching Hospital, in Enugu. METHODS A cross-sectional descriptive research study was used. A total of 130 nurses, working in selected wards of the hospital, took part in the study, meeting the inclusion criteria. Data were obtained through a structured questionnaire, analysed using descriptive statistics and results were presented in tables and charts. RESULTS The results showed that 123 respondents (94.6%) had knowledge of EoLC as care given to terminal state of life and or a dying person. Findings also showed the practice of EoLC with a mean score of 3.6±2.8 and inadequate manpower and lack of experience with the mean 2.9±1.6 and 2.9±1.5 respectively, as factors negatively influenced their practice of EoLC. CONCLUSIONS It was recommended that workshop or seminar and advocacy on EoLC should be organised to create awareness and raise the practice of EoLC.
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Affiliation(s)
- Justin Agorye Ingwu
- Lecturer, the Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria; Nsukka, Nigeria
| | - Linda Nwaiku
- Nurse Clinician, the Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria; Nsukka, Nigeria
| | - Beatrice Ohaeri
- Senior Lecturer, Department of Nursing, Faculty of Clinical Sciences, University of Ibadan, Oyo State, Nigeria
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Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, Harding R. Children's palliative care in low- and middle-income countries. Arch Dis Child 2016; 101:85-90. [PMID: 26369576 DOI: 10.1136/archdischild-2015-308307] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/27/2015] [Indexed: 11/03/2022]
Abstract
One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, London, UK Makerere University, Kampala, Uganda
| | | | - Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa
| | - Cornelius Huwa
- Palliative Care Support Trust, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Hannon B, Zimmermann C, Knaul FM, Powell RA, Mwangi-Powell FN, Rodin G. Provision of Palliative Care in Low- and Middle-Income Countries: Overcoming Obstacles for Effective Treatment Delivery. J Clin Oncol 2016; 34:62-8. [DOI: 10.1200/jco.2015.62.1615] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Despite being declared a basic human right, access to adult and pediatric palliative care for millions of individuals in need in low- and middle-income countries (LMICs) continues to be limited or absent. The requirement to make palliative care available to patients with cancer is increasingly urgent because global cancer case prevalence is anticipated to double over the next two decades. Fifty percent of these cancers are expected to occur in LMICs, where mortality figures are disproportionately greater as a result of late detection of disease and insufficient access to appropriate treatment options. Notable initiatives in many LMICs have greatly improved access to palliative care. These can serve as development models for service scale-up in these regions, based on rigorous evaluation in the context of specific health systems. However, a multipronged public health approach is needed to fulfill the humane and ethical obligation to make palliative care universally available. This includes health policy that supports the integration of palliative care and investment in systems of health care delivery; changes in legislation and regulation that inappropriately restrict access to opioid medications for individuals with life-limiting illnesses; education and training of health professionals; development of a methodologically rigorous data and research base specific to LMICs that encompasses health systems and clinical care; and shifts in societal and health professional attitudes to palliative and end-of-life care. International partnerships are valuable to achieve these goals, particularly in education and research, but leadership and health systems stewardship within LMICs are critical factors that will drive and implement change.
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Affiliation(s)
- Breffni Hannon
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Camilla Zimmermann
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Felicia M. Knaul
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Richard A. Powell
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Faith N. Mwangi-Powell
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Gary Rodin
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
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Downing J, Knapp C, Muckaden MA, Fowler-Kerry S, Marston J. Priorities for global research into children's palliative care: results of an International Delphi Study. BMC Palliat Care 2015; 14:36. [PMID: 26238244 PMCID: PMC4522976 DOI: 10.1186/s12904-015-0031-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/16/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is an urgent need to develop an evidence base for children's palliative care (CPC) globally, and in particular in resource-limited settings. Whilst the volume of CPC research has increased in the last decade, it has not been focused on countries where the burden of disease is highest. For example, a review of CPC literature in sub Saharan Africa (SSA) found only five peer-reviewed papers on CPC. This lack of evidence is not confined to SSA, but can be seen globally in specific areas, such as an insufficient research and evidence base on the treatment of pain and other symptoms in children. This need for an evidence base for CPC has been recognised for some time, however without understanding the priorities for research in CPC organisations, many struggle with how to allocate scarce resources to research. METHOD The International Children's Palliative Care Network (ICPCN) undertook a Delphi study between October 2012 and February 2013 in order to identify the global research priorities for CPC. Members of the ICPCN Scientific Committee formed a project working group and were asked to suggest areas of research that they considered to be important. The list of 70 areas for research was put through two rounds of the Delphi process via a web-based questionnaire. ICPCN members and affiliated stakeholders (n = 153 from round 1 and n = 95 from round 2) completed the survey. Participants from SSA were the second largest group of respondents (28.1 % round 1, 24.2 % round 2) followed by Europe. RESULTS A list of 26 research areas reached consensus. The top five priorities were: Children's understanding of death and dying; Managing pain in children where there is no morphine; Funding; Training; and Assessment of the WHO two-step analgesic ladder for pain management in children. CONCLUSIONS Information from this study is important for policy makers, educators, advocates, funding agencies, and governments. Priorities for research pertinent to CPC throughout the world have been identified. This provides a much needed starting place for the allocation of funds and building research infrastructure. Researchers working in CPC are in a unique position to collaborate and produce the evidence that is needed.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, Assagay, South Africa.
- Makerere University, PO Box 7072, Kampala, Uganda.
| | - Caprice Knapp
- Pennsylvania State University, University Park, State College, PA, 16801, USA.
| | | | | | - Joan Marston
- International Children's Palliative Care Network, Assagay, South Africa.
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A Pilot Study of Palliative Care Provider Self-competence and Priorities for Education in Kenya. J Hosp Palliat Nurs 2015; 17:356-363. [PMID: 28539840 DOI: 10.1097/njh.0000000000000176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study explored palliative care provider self-competence and priorities for future education in an inpatient hospice setting in Kenya. Self-competence scores for clinical skills and patient and family communication skills were hypothesized to differ according to provider type. A descriptive, cross-sectional study design was piloted at Kimbilio Hospice, a 26-bed rural, inpatient facility in Kenya. A quantitative survey instrument entitled, "Self assessment of clinical competency and concerns in end-of-life care," was administered to participants. Survey responses were collected from 5 clinical staff, 11 caregivers, and 8 support staff. Data were analyzed using Kruskal-Wallis test to compare between mean scores. Statistically significant differences were found in 5 self-competence variables: performing a basic pain assessment, use of oral opioid analgesics, assessment and management of nausea/vomiting and constipation, and discussing an end-of-life prognosis with a patient's family member (P < .05). Sixteen participants (66%) selected pediatric palliative care as their top priority for future education. The findings support the hypothesis that palliative care providers have varying levels of self-competence. Improving education to build palliative care competencies in adult and pediatric palliative care in sub-Saharan Africa is recommended.
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Schuurman N, Amram O, Crooks VA, Johnston R, Williams A. A comparative analysis of potential spatio-temporal access to palliative care services in two Canadian provinces. BMC Health Serv Res 2015; 15:270. [PMID: 26183702 PMCID: PMC4504407 DOI: 10.1186/s12913-015-0909-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to health services such as palliative care is determined not only by health policy but a number of legacies linked to geography and settlement patterns. We use GIS to calculate potential spatio-temporal access to palliative care services. In addition, we combine qualitative data with spatial analysis to develop a unique mixed-methods approach. METHODS Inpatient health care facilities with dedicated palliative care beds were sampled in two Canadian provinces: Newfoundland and Saskatchewan. We then calculated one-hour travel time catchments to palliative health services and extended the spatial model to integrate available beds as well as documented wait times. RESULTS 26 facilities with dedicated palliative care beds in Newfoundland and 69 in Saskatchewan were identified. Spatial analysis of one-hour travel times and palliative beds per 100,000 population in each province showed distinctly different geographical patterns. In Saskatchewan, 96.7% of the population living within a-1 h of drive to a designated palliative care bed. In Newfoundland, 93.2% of the population aged 65+ were living within a-1 h of drive to a designated palliative care bed. However, when the relationship between wait time and bed availability was examined for each facility within these two provinces, the relationship was found to be weak in Newfoundland (R(2) = 0.26) and virtually nonexistent in Saskatchewan (R(2) = 0.01). CONCLUSIONS Our spatial analysis shows that when wait times are incorporated as a way to understand potential spatio-temporal access to dedicated palliative care beds, as opposed to spatial access alone, the picture of access changes.
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Affiliation(s)
- Nadine Schuurman
- Department of Geography, Simon Fraser University, Burnaby, Canada.
| | - Ofer Amram
- Department of Geography, Simon Fraser University, Burnaby, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Burnaby, Canada
| | - Rory Johnston
- Department of Geography, Simon Fraser University, Burnaby, Canada
| | - Allison Williams
- School of Geography and Earth Sciences, McMaster University, Hamilton, ON, Canada
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Tamannai M, Kaah J, Mbah G, Ndimba J, D'Souza C, Wharin P, Hesseling PB. An evaluation of a palliative care outreach programme for children with Burkitt lymphoma in rural Cameroon. Int J Palliat Nurs 2015. [DOI: 10.12968/ijpn.2015.21.7.331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mona Tamannai
- Paediatrician, Universitätsmedizin Berlin
- Nurses, Banso Baptist Hospital
| | - Joel Kaah
- Nurse Assistant, Banso Baptist Hospital, Cameroon
- Nurses, Banso Baptist Hospital
| | | | | | - Catherine D'Souza
- Registrar, Nottingham University Hospitals, UK
- Nurses, Banso Baptist Hospital
| | - Paul Wharin
- Trustee, Beryl Thyer Memorial Africa Trust, UK
- Nurses, Banso Baptist Hospital
| | - Peter B Hesseling
- Emeritus Professor, Stellenbosch University, South Africa
- Nurses, Banso Baptist Hospital
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van Gurp J, Soyannwo O, Odebunmi K, Dania S, van Selm M, van Leeuwen E, Vissers K, Hasselaar J. Telemedicine's Potential to Support Good Dying in Nigeria: A Qualitative Study. PLoS One 2015; 10:e0126820. [PMID: 26030154 PMCID: PMC4452265 DOI: 10.1371/journal.pone.0126820] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/07/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This qualitative study explores Nigerian health care professionals' concepts of good dying/a good death and how telemedicine technologies and services would fit the current Nigerian palliative care practice. MATERIALS AND METHODS Supported by the Centre for Palliative Care Nigeria (CPCN) and the University College Hospital (UCH) in Ibadan, Nigeria, the authors organized three focus groups with Nigerian health care professionals interested in palliative care, unstructured interviews with key role players for palliative care and representatives of telecom companies, and field visits to primary, secondary and tertiary healthcare clinics that provided palliative care. Data analysis consisted of open coding, constant comparison, diagramming of categorizations and relations, and extensive member checks. RESULTS The focus group participants classified good dying into 2 domains: a feeling of completion of the individual life and dying within the community. Reported barriers to palliative care provision were socio-economic consequences of being seriously ill, taboos on dying and being ill, restricted access to adequate medical-technical care, equation of religion with medicine, and the faulty implementation of palliative care policy by government. The addition of telemedicine to Nigeria's palliative care practice appears problematic, due to irregular bandwidth, poor network coverage, and unstable power supply obstructing interactivity and access to information. However, a tele-education 'lite' scenario seemed viable in Nigeria, wherein low-tech educational networks are central that build on non-synchronous online communication. DISCUSSION Nigerian health care professionals' concepts on good dying/a good death and barriers and opportunities for palliative care provision were, for the greater part, similar to prior findings from other studies in Africa. Information for and education of patient, family, and community are essential to further improve palliative care in Africa. Telemedicine can only help if low-tech solutions are applied that work around network coverage problems by focusing on non-synchronous online communication.
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Affiliation(s)
- Jelle van Gurp
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Olaitan Soyannwo
- Centre for Palliative Care Nigeria and Hospice and Palliative Care Unit, University College Hospital, Ibadan, Nigeria
| | - Kehinde Odebunmi
- Hospice and Palliative Care Unit, University College Hospital, Ibadan, Nigeria
| | - Simpa Dania
- Department of Telemedicine, University College Hospital, Ibadan, Nigeria
| | - Martine van Selm
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Evert van Leeuwen
- Department of IQ Healthcare, Ethics Section, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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Herce ME, Elmore SN, Kalanga N, Keck JW, Wroe EB, Phiri A, Mayfield A, Chingoli F, Beste JA, Tengatenga L, Bazile J, Krakauer EL, Rigodon J. Assessing and responding to palliative care needs in rural sub-Saharan Africa: results from a model intervention and situation analysis in Malawi. PLoS One 2014; 9:e110457. [PMID: 25313997 PMCID: PMC4197005 DOI: 10.1371/journal.pone.0110457] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 09/19/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Palliative care is rarely accessible in rural sub-Saharan Africa. Partners In Health and the Malawi government established the Neno Palliative Care Program (NPCP) to provide palliative care in rural Neno district. We conducted a situation analysis to evaluate early NPCP outcomes and better understand palliative care needs, knowledge, and preferences. METHODS Employing rapid evaluation methodology, we collected data from 3 sources: 1) chart review of all adult patients from the NPCP's first 9 months; 2) structured interviews with patients and caregivers; 3) semi-structured interviews with key stakeholders. RESULTS The NPCP enrolled 63 patients in its first 9 months. Frequent diagnoses were cancer (n = 50, 79%) and HIV/AIDS (n = 37 of 61, 61%). Nearly all (n = 31, 84%) patients with HIV/AIDS were on antiretroviral therapy. Providers registered 112 patient encounters, including 22 (20%) home visits. Most (n = 43, 68%) patients had documented pain at baseline, of whom 23 (53%) were treated with morphine. A majority (n = 35, 56%) had ≥1 follow-up encounter. Mean African Palliative Outcome Scale pain score decreased non-significantly between baseline and follow-up (3.0 vs. 2.7, p = 0.5) for patients with baseline pain and complete pain assessment documentation. Providers referred 48 (76%) patients for psychosocial services, including community health worker support, socioeconomic assistance, or both. We interviewed 36 patients referred to the NPCP after the chart review period. Most had cancer (n = 19, 53%) or HIV/AIDS (n = 10, 28%). Patients frequently reported needing income (n = 24, 67%) or food (n = 22, 61%). Stakeholders cited a need to make integrated palliative care widely available. CONCLUSIONS We identified a high prevalence of pain and psychosocial needs among patients with serious chronic illnesses in rural Malawi. Early NPCP results suggest that comprehensive palliative care can be provided in rural Africa by integrating disease-modifying treatment and palliative care, linking hospital, clinic, and home-based services, and providing psychosocial support that includes socioeconomic assistance.
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Affiliation(s)
- Michael E. Herce
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- Abwenzi Pa Za Umoyo, Neno, Malawi
- Partners in Health, Boston, Massachusetts, United States of America
| | - Shekinah N. Elmore
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Noel Kalanga
- Abwenzi Pa Za Umoyo, Neno, Malawi
- Partners in Health, Boston, Massachusetts, United States of America
| | - James W. Keck
- Abwenzi Pa Za Umoyo, Neno, Malawi
- Partners in Health, Boston, Massachusetts, United States of America
| | - Emily B. Wroe
- Abwenzi Pa Za Umoyo, Neno, Malawi
- Partners in Health, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Atupere Phiri
- Abwenzi Pa Za Umoyo, Neno, Malawi
- Partners in Health, Boston, Massachusetts, United States of America
| | - Alishya Mayfield
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Felix Chingoli
- Neno District Health Office, Neno District Hospital, Ministry of Health, Government of the Republic of Malawi, Neno, Malawi
| | - Jason A. Beste
- Abwenzi Pa Za Umoyo, Neno, Malawi
- Partners in Health, Boston, Massachusetts, United States of America
| | - Listern Tengatenga
- Neno District Health Office, Neno District Hospital, Ministry of Health, Government of the Republic of Malawi, Neno, Malawi
| | - Junior Bazile
- Abwenzi Pa Za Umoyo, Neno, Malawi
- Partners in Health, Boston, Massachusetts, United States of America
| | - Eric L. Krakauer
- Partners in Health, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jonas Rigodon
- Abwenzi Pa Za Umoyo, Neno, Malawi
- Partners in Health, Boston, Massachusetts, United States of America
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Harding R, Albertyn R, Sherr L, Gwyther L. Pediatric palliative care in sub-saharan Africa: a systematic review of the evidence for care models, interventions, and outcomes. J Pain Symptom Manage 2014; 47:642-51. [PMID: 23972573 DOI: 10.1016/j.jpainsymman.2013.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/21/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT The progressive disease burden among children in sub-Saharan Africa means the provision of palliative care is essential and should be provided alongside treatment where it is available. OBJECTIVES To systematically review the evidence for pediatric palliative care models, interventions, and outcomes to appraise the state of the science and inform best practice. METHODS A systematic review search strategy was implemented in eight electronic databases, the search results reported using a PRISMA statement, and findings tabulated. RESULTS In terms of evidence of palliative care provision and outcomes, only five articles were identified. These represent a small range of acute, community, and hospice care and offer some limited guidance on the development and delivery of services. CONCLUSION Pediatric palliative care is a pressing clinical and public health challenge in sub-Saharan Africa. Explicit evidence-based models of service development, patient assessment, and evidence for control of prevalent problems (physical, psychological, social, spiritual, and developmental) are urgently needed. Greater research activity is urgently required to ensure an evidence-based response to the enormous need for pediatric palliative care in sub-Saharan Africa.
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Affiliation(s)
- Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, United Kingdom.
| | - Rene Albertyn
- Department of Paediatric Surgery, Red Cross Children's Hospital, Cape Town, South Africa
| | - Lorraine Sherr
- Infection & Population Health, Institute of Epidemiology & Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Liz Gwyther
- Hospice Palliative Care Association of South Africa, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Powell RA, Harding R, Namisango E, Katabira E, Gwyther L, Radbruch L, Murray SA, El-Ansary M, Leng M, Ajayi IO, Blanchard C, Kariuki H, Kasirye I, Namukwaya E, Gafer N, Casarett D, Atieno M, Mwangi-Powell FN. Palliative care research in Africa: consensus building for a prioritized agenda. J Pain Symptom Manage 2014; 47:315-24. [PMID: 23870840 DOI: 10.1016/j.jpainsymman.2013.03.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/20/2013] [Accepted: 03/29/2013] [Indexed: 11/20/2022]
Abstract
CONTEXT Palliative care research in Africa is in its relative infancy, with dedicated financial support extremely limited. Therefore, setting research priorities to optimize use of limited resources is imperative. OBJECTIVES To develop a prioritized research agenda for palliative care in Africa. METHODS We used a two-stage process involving palliative care professionals and researchers: 1) generation of an initial topic list at a consultative workshop of experts and 2) prioritization of that list using a consensus development process, the nominal group technique. RESULTS Phase 1: 41 topics were generated across five groups, with several topics nominated in more than one group. Phase 2: 16 topics and three broad thematic areas were identified. The two most prioritized topics within each of the three themes were the following: Theme 1: patient, family, and volunteers-1) care outcomes and the impact of palliative care as perceived by patients and caregivers and 2) palliative care needs of children; Theme 2: health providers-1) impact of palliative care training on care and practice and 2) integration of palliative care and antiretroviral therapy services; and Theme 3: health systems-1) palliative care needs assessments at the micro-, meso-, and macro-levels and 2) integration of palliative care into health systems and educational curricula. CONCLUSION Consensus-based palliative care topics determined by the study can assist researchers in optimizing limited research capacities by focusing on these prioritized areas. Subsequent to the identification and publication of the research agenda, concrete steps will be undertaken by the African Palliative Care Research Network and other partners to help implement it.
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Affiliation(s)
| | - Richard Harding
- King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom; Palliative Medicine Programme, Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Elly Katabira
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Liz Gwyther
- Division of Family Medicine, School of Public Health University of Cape Town, Cape Town, South Africa
| | - Lukas Radbruch
- Department of Palliative Medicine, University of Bonn, Bonn, Germany; Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Scott A Murray
- Primary Palliative Care Research Group, General Practice Section, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Maged El-Ansary
- Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mhoira Leng
- Makerere Palliative Care Unit, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ike O Ajayi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Centre for Palliative Care, Ibadan, Nigeria
| | - Charmaine Blanchard
- Gauteng Centre of Excellence for Palliative Care, Chris Hani Baragwanath Academic Hospital and University of Witwatersrand, Johannesburg, South Africa
| | - Helen Kariuki
- Department of Medical Physiology, University of Nairobi, Kenya
| | | | - Elizabeth Namukwaya
- Makerere Palliative Care Unit, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nahla Gafer
- Palliative Care Unit, Radiation and Isotope Centre, Khartoum, Sudan
| | - David Casarett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Defilippi K, Downing J. Feedback from African palliative care practitioners on the use of the APCA POS. Int J Palliat Nurs 2013; 19:577-8, 580-1. [DOI: 10.12968/ijpn.2013.19.12.577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kath Defilippi
- Hospice Palliative Care Association of South Africa, and African Palliative Care Association
| | - Julia Downing
- Makerere University, Kampala, Uganda, and International Palliative Care Consultant
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Downing J, Namisango E, Kiyange F, Luyirika E, Gwyther L, Enarson S, Kampi J, Sithole Z, Kemigisha-Ssali E, Masclee M, Mukasa I. The net effect: spanning diseases, crossing borders-highlights from the fourth triennial APCA conference and annual HPCA conference for palliative care. Ecancermedicalscience 2013; 7:371. [PMID: 24222787 PMCID: PMC3816847 DOI: 10.3332/ecancer.2013.371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
The African Palliative Care Association (APCA) jointly hosted its triennial palliative care conference for Africa with the Hospice and Palliative Care Association of South Africa (HPCA) on 17-20 September 2013 in Johannesburg, South Africa. At the heart of the conference stood a common commitment to see patient care improved across the continent. The theme for the conference, 'The Net Effect: Spanning Diseases, Crossing Borders', reflected this joint vision and the drive to remember the 'net effect' of our work in palliative care-that is, the ultimate impact of the care that we provide for our patients and their families across the disease and age spectrum and across the borders of African countries. The conference, held in Johannesburg, brought together 471 delegates from 34 countries. The key themes and messages from the conference are encapsulated in ten 'C's of commitment to political will and support at the highest levels of governance; engaging national, regional, and international bodies; collaboration; diversity; palliative care for children; planning for human resources and capacity building; palliative care integration at all levels; developing an evidence base for palliative care in Africa; using new technologies; and improved quality of care. Participants found the conference to be a forum that challenged their understanding of the topics presented, as well as enlightening in terms of applying best practice in their own context. Delegates found a renewed commitment and passion for palliative care and related health interventions for children and adults with life-limiting and life-threatening illnesses within the region. This conference highlighted many of the developments in palliative care in the region and served as a unique opportunity to bring people together and serve as a lynchpin for palliative care provision and development in Africa. The delegates were united in the fact that together we can 'span diseases,' 'cross borders,' and realise the 'African Dream' for palliative care.
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Affiliation(s)
- J Downing
- Makerere University, Kampala, Uganda ; International Children's Palliative Care Network, Hillcrest 3624, South Africa ; African Palliative Care Association UK, London DA15 8AD, UK
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Philips PL, Lazenby M. The emotional and spiritual well-being of hospice patients in Botswana and sources of distress for their caregivers. J Palliat Med 2013; 16:1438-45. [PMID: 24083653 DOI: 10.1089/jpm.2013.0114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little regional data exists on the distress of people nearing the end of their lives and their caregivers. OBJECTIVE The purpose of this study was to describe the quality of life and the emotional and spiritual well-being of people at the end of life and the sources of distress for their primary caregivers in Gaborone, Botswana, in order to inform further development of hospice services. DESIGN This study employed a mixed-methods design. SETTING/SUBJECTS Twenty-eight primary caregivers who cared for an adult who passed away fewer than 14 months prior to the interview date and in the care of a nongovernmental hospice in Botswana were interviewed between June and August 2012. MEASUREMENTS Semistructured interviews and the Quality of Death and Dying questionnaire (QODD) were used. Quantitative descriptive analysis and qualitative content analysis were performed. RESULTS Quality of life of decedents was poor. Emotional and spiritual distress persist at high rates even for those receiving support from a nongovernmental hospice (NGH). Caregiver distress arises from practical needs, including lack of food, clothing, and shelter, the need for assistance physically caring for their loved one, and from emotional and spiritual concerns. CONCLUSIONS The practical, physical, emotional, and spiritual needs of people at the end of life in Botswana and their caregivers are not being fully met, with poor overall quality of life among the dying. More research is needed to explore how hospice and home health services and the services of spiritual leaders can be expanded to meet their needs.
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Huang KTL, Owino C, Gramelspacher GP, Monahan PO, Tabbey R, Hagembe M, Strother RM, Njuguna F, Vreeman RC. Prevalence and correlates of pain and pain treatment in a western Kenya referral hospital. J Palliat Med 2013; 16:1260-7. [PMID: 24032753 DOI: 10.1089/jpm.2013.0080] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pain is often inadequately evaluated and treated in sub-Saharan Africa (SSA). OBJECTIVE We sought to assess pain levels and pain treatment in 400 hospitalized patients at a national referral hospital in western Kenya, and to identify factors associated with pain and pain treatment. DESIGN Using face-validated Kiswahili versions of two single-item pain assessment tools, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), we determined patients' pain levels. Additional data collected included patient demographics, prescribed analgesics, and administered analgesics. We calculated mean pain ratings and pain management index (PMI) scores. RESULTS Averaged between the NRS and FPS-R, 80.5% of patients endorsed a nonzero level of pain and 30% of patients reported moderate to severe pain. Older patients, patients with HIV, and cancer patients had higher pain ratings. Sixty-six percent of patients had been prescribed analgesics at some point during their hospitalization, the majority of which were nonopioids. A majority of patients (66%) had undertreated pain (negative scores on the PMI). CONCLUSION This study shows that hospitalized patients in Kenya are experiencing pain and that this pain is often undertreated.
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Affiliation(s)
- Kristin T L Huang
- 1 USAID - Academic Model Providing Access to Healthcare (AMPATH) , Eldoret, Kenya
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Onyeka TC, Velijanashvili M, Abdissa SG, Manase FA, Kordzaia D. Twenty-first century palliative care: a tale of four nations. Eur J Cancer Care (Engl) 2013; 22:597-604. [PMID: 23647421 DOI: 10.1111/ecc.12064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 02/05/2023]
Abstract
Hospice and palliative care development, in terms of availability and services, occur to varying degrees in the developing world. In this paper, the evolution of palliative care practices in four developing nations (Nigeria, Georgia, Ethiopia and Tanzania) is described. By highlighting common problems as well as the unique individual perspectives of each country's practice, this paper aims at increasing global awareness of palliative care in the developing world. While the call for palliative care to become a fundamental human right is sustained, it is also hoped that this article will stimulate a global discussion on the best possible way to encourage the establishment and growth of palliative care services in other developing countries where hitherto it has not been in existence, with policymakers and healthcare professionals taking the lead through the institution of sound national policies to promote and provide palliative care to all citizenry.
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Affiliation(s)
- T C Onyeka
- Pain & Palliative Care Unit, Multidisciplinary Oncology Centre, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
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Shah KG, Slough TL, Yeh PT, Gombwa S, Kiromera A, Oden ZM, Richards-Kortum RR. Novel open-source electronic medical records system for palliative care in low-resource settings. BMC Palliat Care 2013; 12:31. [PMID: 23941694 PMCID: PMC3751569 DOI: 10.1186/1472-684x-12-31] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/08/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The need for palliative care in sub-Saharan Africa is staggering: this region shoulders over 67% of the global burden of HIV/AIDS and cancer. However, provisions for these essential services remain limited and poorly integrated with national health systems in most nations. Moreover, the evidence base for palliative care in the region remains scarce. This study chronicles the development and evaluation of DataPall, an open-source electronic medical records system that can be used to track patients, manage data, and generate reports for palliative care providers in these settings.DataPall was developed using design criteria encompassing both functional and technical objectives articulated by hospital leaders and palliative care staff at a leading palliative care center in Malawi. The database can be used with computers that run Windows XP SP 2 or newer, and does not require an internet connection for use. Subsequent to its development and implementation in two hospitals, DataPall was tested among both trained and untrained hospital staff populations on the basis of its usability with comparison to existing paper records systems as well as on the speed at which users could perform basic database functions. Additionally, all participants evaluated this program on a standard system usability scale. RESULTS In a study of health professionals in a Malawian hospital, DataPall enabled palliative care providers to find patients' appointments, on average, in less than half the time required to locate the same record in current paper records. Moreover, participants generated customizable reports documenting patient records and comprehensive reports on providers' activities with little training necessary. Participants affirmed this ease of use on the system usability scale. CONCLUSIONS DataPall is a simple, effective electronic medical records system that can assist in developing an evidence base of clinical data for palliative care in low resource settings. The system is available at no cost, is specifically designed to chronicle care in the region, and is catered to meet the technical needs and user specifications of such facilities.
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Affiliation(s)
- Kamal G Shah
- Rice 360: Institute for Global Health Technologies, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Tara Lyn Slough
- Rice 360: Institute for Global Health Technologies, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Ping Teresa Yeh
- Rice 360: Institute for Global Health Technologies, Rice University, 6100 Main St., Houston, TX 77005, USA
| | | | | | - Z Maria Oden
- Rice 360: Institute for Global Health Technologies, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Rebecca R Richards-Kortum
- Rice 360: Institute for Global Health Technologies, Rice University, 6100 Main St., Houston, TX 77005, USA
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Dekker AM, Amon JJ, le Roux KW, Gaunt CB. "What is killing me most": chronic pain and the need for palliative care in the Eastern Cape, South Africa. J Pain Palliat Care Pharmacother 2013; 26:334-40. [PMID: 23216172 DOI: 10.3109/15360288.2012.734897] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Palliative care and the provision of pain relief medicine are essential components of health care, yet little research has been conducted on access to pain medicine in rural areas of sub-Saharan Africa. The objective of this study was to examine patient experiences and health care provider attitudes towards chronic pain and palliative care in Eastern Cape Province, South Africa. The study used a mixed-methods approach to evaluate experience of chronic pain in a district hospital and associated clinics. Questionnaires and in-depth interviews were conducted with 45 current and former patients receiving care and 26 health care providers. Forty-six percent (n = 19) of patients rated their pain in the last month as severe. Thirty-nine percent (n = 17) of individuals stated that they had never been provided with an explanation for the cause of their pain. Multiple regression analysis found that being female, not having received a social welfare grant, and not having received an explanation for the cause of pain were associated with higher ratings of pain (P < .10 for each variable). Factors inhibiting the provision of palliative care included insufficient access and availability of pain medication and providers' association of palliative care with end-of-life care. Adequate pain relief is often deprioritized in a busy health care setting. Ensuring patients receive sufficient relief for their pain requires interventions at clinical and policy levels, including the provision of needed pain medication and training in palliative care for all providers.
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Affiliation(s)
- Annette M Dekker
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA.
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Current state of palliative and end-of-life care in home versus inpatient facilities and urban versus rural settings in Africa. Palliat Support Care 2013; 11:425-42. [DOI: 10.1017/s1478951512000612] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Because palliative care in sub-Saharan Africa may not fit the style of delivery of palliative care in the global north, exploring the evidence can serve to reduce existing barriers and help streamline national policies that determine the optimal setting to implement formal palliative and end-of-life services.Method:A search was conducted in Ovid MEDLINE®, PubMed, and Google Scholar databases using the search terms nursing care, terminal care, end of life care, palliative care, dying, death, hospice, opioids, morphine, Africa, sub-Saharan Africa, caregivers, and place of death. Eighty-seven relevant articles were found using the search terms. Of these, 22 matched inclusion criteria and were reviewed.Results:Opioid availability and distribution is best accessed at the inpatient level, and hence, pain and end-of-life symptoms are best managed at the inpatient level. Despite the great need, nurses’ lack of prescription power in the home-based setting is a shortcoming. Home deaths have not been adequately studied, but research suggests that palliative care generally causes economic strain, psychosocial distress on family members, and increased risk of transmission of communicable disease. Hospice is understudied but shows favorable outcomes.Significance of results:Funding and research need to focus on development of inpatient palliative and hospice care units in urban areas. In rural areas, the priority should be a home-based care model that involves nurses who are privileged to prescribe opioids and adjunctive medication therapies.
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Pastrana T, De Lima L, Eisenchlas J, Wenk R. Palliative care research in Latin America and the Caribbean: from the beginning to the Declaration of Venice and beyond. J Palliat Med 2012; 15:352-8. [PMID: 22401357 DOI: 10.1089/jpm.2011.0429] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Research in palliative care has increased significantly in the last decade, while the vast majority of the global disease burden occurs in developing countries. AIMS To explore the palliative care research activity in Latin America and the Caribbean (LAC) and its visibility in the international palliative care literature, with a special focus on research studies. METHODS A bibliometric analysis was conducted in MEDLINE(®), Embase(®), PsycINFO(®), and CINAHL(®). Inclusion criteria were: (1) articles published in peer-reviewed scientific journals; (2) main subject was palliative care; (3) research study; (4) the first author or coauthors was based in LAC; and/or (5) the data collected derived from LAC. RESULTS One hundred six articles from 10 countries were identified in the literature research. The first publication dates from 1989 and was a qualitative study in Brazil. This study shows a modest contribution of publications from LAC. However, the volume of publications within the region is distributed unequally, reflecting the heterogeneity of the region: Brazil published more than half of the articles, while 35 countries have no publications. Most of the studies were quantitative research, predominantly cross-sectional studies. Qualitative studies often used interviews. Health care service was the most researched issue. Seventy percent of studies were carried out in institutions. CONCLUSIONS Palliative care research should have a place in LAC. The development of a regional research agenda tailored to the needs and features of the region considering the health care structure and local resources available is indispensable.
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Affiliation(s)
- Tania Pastrana
- Department of Palliative Medicine, RWTH Aachen University, Aachen, Germany.
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Selman L, Siegert RJ, Higginson IJ, Agupio G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll T, Sebuyira LM, Ikin B, Harding R. The “Spirit 8” successfully captured spiritual well-being in African palliative care: factor and Rasch analysis. J Clin Epidemiol 2012; 65:434-43. [DOI: 10.1016/j.jclinepi.2011.09.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 08/15/2011] [Accepted: 09/14/2011] [Indexed: 11/28/2022]
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Downing J, Simon ST, Mwangi-Powell FN, Benalia H, Daveson BA, Higginson IJ, Harding R, Bausewein C. Outcomes 'out of africa': the selection and implementation of outcome measures for palliative care in Africa. BMC Palliat Care 2012; 11:1. [PMID: 22221932 PMCID: PMC3280153 DOI: 10.1186/1472-684x-11-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 01/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND End-of-life care research across Africa is under-resourced and under-developed. A central issue in research in end-of-life care is the measurement of effects and outcomes of care on patients and families. Little is known about the experiences of health professionals' selection and implementation of outcome measures (OM) in clinical care, research, audit, or teaching in Africa. METHODS An online survey was undertaken of those using outcome measures across the region, as part of the PRISMA project. A questionnaire addressing the use of OMs was developed for a similar survey in Europe and adapted for Africa. Participants were sampled through the contacts database of APCA. Invitation emails were sent out in January 2010 and reminders in February 2010. RESULTS 168/301 invited contacts (56%) from 24 countries responded, with 78 respondents having previously used OM (65% in clinical practice, 12% in research and 23% for both). Main reasons for not using OM were a lack of guidance/training on using and analysing OM, with 49% saying that they would use the tools if this was provided. 40% of those using OM in clinical practice used POS, and 80% used them to assess, evaluate and monitor change. The POS was also the main tool used in research, with the principle criteria for use being validation in Africa, access to the tool and time needed to complete it. Challenges to the use of tools were shortage of time and resources, lack of guidance and training for the professionals, poor health status of patients and complexity of OM. Researchers also have problems analysing OM data. The APCA African POS was the most common version of the POS used, and was reported as a valuable tool for measuring outcomes. Respondents indicated the ideal outcome tool should be short, multi-dimensional and easy to use. CONCLUSION This was the first survey on professionals' views on OM in Africa. It showed that the APCA African POS was the most frequently OM used. Training and support are needed to help professionals utilise OM in palliative care, and OMs have an ongoing and important role in palliative care in Africa.
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Affiliation(s)
- Julia Downing
- Honorary Professor Palliative Care, Makerere University, Kampala, c/o PO Box 72518, Kampala, Formerly Deputy Executive Director, African Palliative Care Association, Kampala, Uganda.
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Abstract
Everyone, young and old, male and female, rich and poor, should have access to excellent care during the course of a serious illness and at the end of life. Therefore, a denial of such care becomes an infringement of the individual's human rights. Because of the efforts of pioneers in this field of Medicine in Africa and beyond, both living and immortalized, we can now say that palliative care in the African context is affordable and achievable. In this article, some of the challenges faced in setting up and running a new palliative care practice in an emerging and developing economy are examined.
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Affiliation(s)
- Tonia C Onyeka
- Department of Anaesthesia/Pain and Palliative Care Unit, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Enugu State, Nigeria
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Alexander CS, Memiah P, Henley YB, Kaiza-Kangalawe A, Shumbusho AJ, Obiefune M, Enejoh V, Stanis-Ezeobi W, Eze C, Odion E, Akpenna D, Effiong A, Miriti K, Aduda S, Oko J, Melaku GD, Baribwira C, Umutesi H, Shimabale M, Mugisa E, Amoroso A. Palliative care and support for persons with HIV/AIDS in 7 African countries: implementation experience and future priorities. Am J Hosp Palliat Care 2011; 29:279-85. [PMID: 21998442 DOI: 10.1177/1049909111419292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programming and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. Given infrastructure requisites, individual care delivery beyond ART management alone has received minimal funding yet care remains necessary for durable viral suppression and overall quality of life for individuals. Technical assistance staff of one implementing partner representing seven African countries met to clarify domains of palliative care compared with the substituted term "care and support" to understand potential gaps in on-going HIV care. They prioritized care needs as: 1) mental health (depression and other mood disorders); 2) communication skills (age-appropriate disclosure of HIV status); 3) support of care-providers (stress management for sustainability of a skilled HIV workforce); 4) Tied Priorities: symptom management in opportunistic infections; end-of-life care; spiritual history-taking; and 5) Tied Priorities: attention to grief-related needs of patients, their families and staff; and management of HIV co-morbidities. This process can inform health policy as funding transitions to new priorities.
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Affiliation(s)
- Carla S Alexander
- University of Maryland School of Medicine, Institute of Human Virology, 29 S Greene Street, Baltimore, MD 21201, USA.
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The MVQOLI successfully captured quality of life in African palliative care: a factor analysis. J Clin Epidemiol 2011; 64:913-24. [DOI: 10.1016/j.jclinepi.2010.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 12/06/2010] [Accepted: 12/10/2010] [Indexed: 11/20/2022]
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Selman LE, Higginson IJ, Agupio G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll T, Sebuyira LM, Ikin B, Harding R. Quality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study. Health Qual Life Outcomes 2011; 9:21. [PMID: 21477274 PMCID: PMC3094195 DOI: 10.1186/1477-7525-9-21] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 04/08/2011] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Quality of life (QOL) is a core outcome of palliative care, yet in African settings there is a lack of evidence on patients' levels of QOL. We aimed to describe QOL among patients with incurable, progressive disease receiving palliative care in South Africa and Uganda, to compare QOL in cancer and HIV, to determine how domains of QOL correlate with overall QOL, and compare levels of QOL in this population with those in other studies using the same tool. METHODS A cross-sectional survey was conducted using the Missoula Vitas Quality of Life Index (MVQOLI), a 26-item QOL questionnaire with five subscales (Function, Symptom, Interpersonal, Well being, Transcendent) covering physical, social, psychological and spiritual domains and one global QOL item. One item in each subscale assesses the subjective importance of the domain on a score from 1 (least important) to 5 (most important), used to weight the contribution of the subscale towards the Total QOL score. The tool was translated into 6 languages and administered to consecutively recruited patients at four facilities in South Africa and one in Uganda. RESULTS 285 patients were recruited, with a mean age of 40.1; 197 (69.1%) were female. Patients' primary diagnoses were HIV (80.7%), cancer (17.9%) and other conditions (1.4%). The mean global QOL score was 2.81 (possible range 0 (worst) to 5 (best)); mean Total score 17.32 (possible range 0 to 30). Patients scored most poorly on Function (mean 0.21), followed by Well being (2.59), Symptoms (5.38), Transcendent (5.50), Interpersonal (9.53) (possible range for subscale scores -30 to 30). Most important to patients were: close relationships (mean 4.13), feeling at peace (4.12), sense of meaning in life (4.10), being active (3.84), physical comfort (2.58). Cancer patients were predominantly recruited at three of the sites; hence comparison with HIV-infected patients was restricted to these sites. HIV+ patients (n = 115) scored significantly worse than cancer patients (n = 50) on Well being (Z = -2.778, p = 0.005), Transcendence (Z = -2.693, p = 0.007) and Total QOL (Z = -2.564, p = 0.01). Global QOL score was most weakly correlated with Total QOL (r = 0.37) and the Transcendent subscale was most highly correlated (r = 0.77) (both p < 0.001). Patients receiving palliative care in South Africa and Uganda exhibited significantly poorer QOL compared to similar populations in the USA. CONCLUSIONS Feeling at peace and having a sense of meaning in life were more important to patients than being active or physical comfort, and spiritual wellbeing correlated most highly with overall QOL. It is therefore vital to identify and meet the psychological and spiritual care needs of patients, as well as to assess and treat pain and other symptoms. Our finding that patients scored most poorly on the Function domain warrants further research.
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Affiliation(s)
- Lucy E Selman
- King's College London, Dept. Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK
| | - Irene J Higginson
- King's College London, Dept. Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK
| | - Godfrey Agupio
- Hospice Africa Uganda, PO Box 7757, Makindye, Kampala, Uganda
| | - Natalya Dinat
- The Division of Palliative Care, Department of Internal Medicine, University of the Witwatersrand, Theatre Road, The Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Julia Downing
- Formerly of the African Palliative Care Association, PO Box 72518, Plot 850, Dr Gibbons Road, Kampala, Uganda
| | - Liz Gwyther
- Hospice Palliative Care Association of South Africa, PO Box 38785, Howard Place, 7450 Suite 11a, Lonsdale Building, Lonsdale Way, Pinelands, 7430, Cape Town, South Africa
| | - Thandi Mashao
- Palliative Medicine Unit, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Keletso Mmoledi
- The Division of Palliative Care, Department of Internal Medicine, University of the Witwatersrand, Theatre Road, The Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Tony Moll
- Church of Scotland Hospital, P/Bag X502, Tugela Ferry 3010, KwaZulu Natal, South Africa
| | - Lydia Mpanga Sebuyira
- Infectious Diseases Institute, Faculty of Medicine, Makerere University, PO Box 22418, Kampala, Uganda
| | - Barbara Ikin
- Msunduzi Hospice, Head Office, PO Box 22023, Mayors Walk 3208, Pietermaritzburg, KwaZulu Natal, South Africa
| | - Richard Harding
- King's College London, Dept. Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK
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Gysels M, Pell C, Straus L, Pool R. End of life care in sub-Saharan Africa: a systematic review of the qualitative literature. BMC Palliat Care 2011; 10:6. [PMID: 21388538 PMCID: PMC3070681 DOI: 10.1186/1472-684x-10-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 03/09/2011] [Indexed: 11/17/2022] Open
Abstract
Background End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence. Methods Relevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format. Results Of the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process. Conclusions The data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.
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Affiliation(s)
- Marjolein Gysels
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), C/Rosselló 132 SA 1ª, Barcelona 08036, Spain.
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Harding R, Simms V, Penfold S, McCrone P, Moreland S, Downing J, Powell RA, Mwangi-Powell F, Namisango E, Fayers P, Curtis S, Higginson IJ. Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol. BMC Public Health 2010; 10:584. [PMID: 20920241 PMCID: PMC2955697 DOI: 10.1186/1471-2458-10-584] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 09/29/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A public health response is essential to meet the multidimensional needs of patients and families affected by HIV disease in sub-Saharan Africa. In order to appraise current provision of HIV care and support in East Africa, and to provide evidence-based direction to future care programming, and Public Health Evaluation was commissioned by the PEPFAR programme of the US Government. METHODS/DESIGN This paper described the 2-Phase international mixed methods study protocol utilising longitudinal outcome measurement, surveys, patient and family qualitative interviews and focus groups, staff qualitative interviews, health economics and document analysis. Aim 1) To describe the nature and scope of HIV care and support in two African countries, including the types of facilities available, clients seen, and availability of specific components of care [Study Phase 1]. Aim 2) To determine patient health outcomes over time and principle cost drivers [Study Phase 2]. The study objectives are as follows. 1) To undertake a cross-sectional survey of service configuration and activity by sampling 10% of the facilities being funded by PEPFAR to provide HIV care and support in Kenya and Uganda (Phase 1) in order to describe care currently provided, including pharmacy drug reviews to determine availability and supply of essential drugs in HIV management. 2) To conduct patient focus group discussions at each of these (Phase 1) to determine care received. 3) To undertake a longitudinal prospective study of 1200 patients who are newly diagnosed with HIV or patients with HIV who present with a new problem attending PEPFAR care and support services. Data collection includes self-reported quality of life, core palliative outcomes and components of care received (Phase 2). 4) To conduct qualitative interviews with staff, patients and carers in order to explore and understand service issues and care provision in more depth (Phase 2). 5) To undertake document analysis to appraise the clinical care procedures at each facility (Phase 2). 6) To determine principle cost drivers including staff, overhead and laboratory costs (Phase 2). DISCUSSION This novel mixed methods protocol will permit transparent presentation of subsequent dataset results publication, and offers a substantive model of protocol design to measure and integrate key activities and outcomes that underpin a public health approach to disease management in a low-income setting.
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Affiliation(s)
- Richard Harding
- King's College London, Cicely Saunders Institute Department of Palliative Care, Policy and Rehabilitation School of Medicine at Guy's, King's and St Thomas' Hospitals Bessemer Road, London SE5 9PJ, UK
| | - Victoria Simms
- King's College London, Cicely Saunders Institute Department of Palliative Care, Policy and Rehabilitation School of Medicine at Guy's, King's and St Thomas' Hospitals Bessemer Road, London SE5 9PJ, UK
| | - Suzanne Penfold
- King's College London, Cicely Saunders Institute Department of Palliative Care, Policy and Rehabilitation School of Medicine at Guy's, King's and St Thomas' Hospitals Bessemer Road, London SE5 9PJ, UK
| | - Paul McCrone
- King's College London Department of Health Service and Population Research Institute of Psychiatry Box P024, De Crespigny Park London, SE5 8AF, UK
| | - Scott Moreland
- Futures Group One Thomas Circle, NW, Suite 200 Washington DC 20005, USA
| | - Julia Downing
- African Palliative Care Association PO Box 72518 Kampala, Uganda
| | - Richard A Powell
- African Palliative Care Association PO Box 72518 Kampala, Uganda
| | | | - Eve Namisango
- African Palliative Care Association PO Box 72518 Kampala, Uganda
| | - Peter Fayers
- University of Aberdeen Department of Public Health, School of Medicine Polwarth Building Foresterhill, Aberdeen AB25 2ZD, UK
| | - Siân Curtis
- MEASURE Evaluation Project Carolina Population Center University of North Carolina at Chapel Hill, CB 8120 Chapel Hill, NC 27599, USA
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute Department of Palliative Care, Policy and Rehabilitation School of Medicine at Guy's, King's and St Thomas' Hospitals Bessemer Road, London SE5 9PJ, UK
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Harding R, Powell RA, Kiyange F, Downing J, Mwangi-Powell F. Provision of pain- and symptom-relieving drugs for HIV/AIDS in sub-Saharan Africa. J Pain Symptom Manage 2010; 40:405-15. [PMID: 20685071 DOI: 10.1016/j.jpainsymman.2009.12.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 12/10/2009] [Accepted: 01/19/2010] [Indexed: 11/20/2022]
Abstract
CONTEXT Although pain and burdensome symptoms among HIV-infected persons can be effectively managed, the availability of opioids and other symptom-controlling drugs is a particular challenge in sub-Saharan Africa. OBJECTIVES This study aimed to identify current drug availability and prescribing practices in 12 sub-Saharan African countries and to examine the barriers and potential facilitators for use of opioids and other key HIV/AIDS symptom-controlling drugs. METHODS This was a cross-sectional survey, integrating data from palliative care facilities and competent authorities within ministries of health in 12 African countries. RESULTS Of 62 responding facilities, problems were reported in accessing named nonopioids, with a small number of facilities unable to dispense them. Less than half the facilities were currently prescribing opioids of any strength. Further problems were identified in terms of the availability and supply continuity of named antiemetics and anxiolytics. The data identified a number of systemic problems, suggesting that opioid supply issues are similar to less controlled drugs, such as antiemetics. Among competent authorities, there was no agreement on whether further opioid expansion was possible. Integration of data from care facilities and competent authorities highlighted a disparity in the understanding of the availability of specific drugs, with competent authorities naming drugs that were not listed by any responding facility in their respective country. CONCLUSION This study shows that opioid expansion needs to balance supply and skills: Currently there are insufficient trained clinical personnel to prescribe, and supply is unreliable. Efforts to expand supply should ensure that they do not weaken current systems.
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Affiliation(s)
- Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.
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Harding R, Gwyther L, Mwangi-Powell F, Powell RA, Dinat N. How can we improve palliative care patient outcomes in low- and middle-income countries? Successful outcomes research in sub-Saharan Africa. J Pain Symptom Manage 2010; 40:23-6. [PMID: 20619209 DOI: 10.1016/j.jpainsymman.2010.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 04/25/2010] [Indexed: 11/16/2022]
Abstract
Palliative care has striven to be evidence-based and to measure and prove its outcomes, although the population we serve offers significant challenges in determining and measuring outcomes. Within low- and middle-income countries, there has been comparatively little outcome evidence in relation to the numbers of patients seen and the magnitude of need for palliative care. Here we report a novel collaborative effort to measure and improve outcomes for patients and families receiving palliative care in two sub-Saharan African countries.
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Affiliation(s)
- Richard Harding
- Cicely Saunders Institute, King's College London School of Medicine, London, United Kingdom.
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Harding R, Selman L, Agupio G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll T, Sebuyira LM, Panjatovic B, Higginson IJ. Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale. Health Qual Life Outcomes 2010; 8:10. [PMID: 20100332 PMCID: PMC2825183 DOI: 10.1186/1477-7525-8-10] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 01/25/2010] [Indexed: 12/02/2022] Open
Abstract
Background Despite the burden of progressive incurable disease in Africa, there is almost no evidence on patient care or outcomes. A primary reason has been the lack of appropriate locally-validated outcome tools. This study aimed to validate a multidimensional scale (the APCA African Palliative Outcome Scale) in a multi-centred international study. Methods Validation was conducted across 5 African services and in 3 phases: Phase 1. Face validity: content analysis of qualitative interviews and cognitive interviewing of POS; Phase 2. Construct validity: correlation of POS with Missoula-Vitas Quality of Life Index (Spearman's rank tests); Phase 3. Internal consistency (Cronbach's alpha calculated twice using 2 datasets), test-retest reliability (intraclass correlation coefficients calculated for 2 time points) and time to complete (calculated twice using 2 datasets). Results The validation involved 682 patients and 437 family carers, interviewed in 8 different languages. Phase 1. Qualitative interviews (N = 90 patients; N = 38 carers) showed POS items mapped well onto identified needs; cognitive interviews (N = 73 patients; N = 29 carers) demonstrated good interpretation; Phase 2. POS-MVQoLI Spearman's rank correlations were low-moderate as expected (N = 285); Phase 3. (N = 307, 2nd assessment mean 21.2 hours after first, SD 7.2) Cronbach's Alpha was 0.6 on both datasets, indicating expected moderate internal consistency; test-retest found high intra-class correlation coefficients for all items (0.78-0.89); median time to complete 7 mins, reducing to 5 mins at second visit. Conclusions The APCA African POS has sound psychometric properties, is well comprehended and brief to use. Application of this tool offers the opportunity to at last address the omissions of palliative care research in Africa.
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Affiliation(s)
- Richard Harding
- Dept Palliative Care, King's College London, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK.
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Pastrana T, Vallath N, Mastrojohn J, Namukwaya E, Kumar S, Radbruch L, Clark D. Disparities in the contribution of low- and middle-income countries to palliative care research. J Pain Symptom Manage 2010; 39:54-68. [PMID: 19892510 DOI: 10.1016/j.jpainsymman.2009.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/19/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
CONTEXT Important aspects of the palliative care needs of patients from low- and middle-income countries (LMIC) are largely unexplored. About 44 million of the 56 million annual deaths worldwide occur in developing countries, and it is estimated that more than 33 million of those concerned would benefit from palliative care. In this context, the understanding of specific social and cultural needs is fundamental to the development of appropriate health policy and clinical practice concerning palliative and end-of-life care. OBJECTIVES This study aims to answer the question: what are the contributions, in terms of generation of knowledge, of LMIC to the published palliative care literature? METHODS A bibliometric analysis was conducted in Medline and EMBASE (to June 2008). Articles were included when either the first author (institutional affiliation or contact address) or the data collection was derived from LMIC, as defined by criteria of the World Bank. Excluded were articles done in migrant and non-palliative care populations. RESULTS The literature search resulted in 845 references. In total, 245 articles coming from LMIC were identified, being published by 34 LMIC (27.3% of LMIC). The first publications appeared in 1982. The study shows a rather modest contribution of publications from LMIC. However, the volume of publications within LMIC is distributed unequally: upper-middle-income countries published almost half of the articles (46.9%), whereas only 11% of the publications came from low-income countries. In contrast, 104 LMIC (72.7% of LMIC) do not have any registered publications. Surprisingly, 25% of the articles with data from LMIC have been done and published by high-income countries. Reasons for the underrepresentation, as well a possible correction of this imbalance, are discussed. CONCLUSION Palliative care research should be a priority in LMIC, where many patients could benefit tremendously from it, and publication of findings in these countries should be encouraged.
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Affiliation(s)
- Tania Pastrana
- Department of Palliative Medicine, RWTH Aachen University, 52074 Aachen, Germany.
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Selman L, Higginson IJ, Agupio G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll AP, Sebuyira LM, Panajatovic B, Harding R. Meeting information needs of patients with incurable progressive disease and their families in South Africa and Uganda: multicentre qualitative study. BMJ 2009; 338:b1326. [PMID: 19386672 PMCID: PMC3273778 DOI: 10.1136/bmj.b1326] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To explore the information needs of patients with progressive, life limiting disease and their family caregivers in South Africa and Uganda and to inform clinical practice and policy in this emerging field. DESIGN Semistructured qualitative interview study. SETTING Four palliative care services in South Africa and one in Uganda, covering rural, urban, and peri-urban locations. PARTICIPANTS 90 patients and 38 family caregivers enrolled in palliative care services; 28 patients had cancer, 61 had HIV infection (including 6 dual HIV/cancer diagnoses), and 1 had motor neurone disease. RESULTS Five themes emerged from the data. (1) INFORMATION SOURCES: a lack of information from general healthcare providers meant that patients and caregivers had to draw on alternative sources of information. (2) Information needs: patients and caregivers reported needing more information in the key areas of the causes and progression of the disease, its symptoms and treatment, and financial/social support. (3) Impact of unmet needs: poor provision of information had a detrimental effect on patients' and caregivers' ability to cope. (4) Communication: negative experiences of communication with general healthcare staff were reported (misinformation, secrecy, insensitivity). (5) Barriers to effective provision of information: barriers related to symptoms, culture, time constraints in hospital, and paternalism in general health care. CONCLUSIONS Lack of information was a major theme for both patients and carers, who had important unanswered questions relating to living with a progressive incurable disease. Evidence based recommendations for clinicians are presented, including the proactive provision of information tailored to individual patients and families.
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Affiliation(s)
- Lucy Selman
- King's College London, Department of Palliative Care, Policy and Rehabilitation, King's College London, London SE5 9RJ.
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Bibliography. PROGRESS IN PALLIATIVE CARE 2009. [DOI: 10.1179/096992609x392222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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