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Tsao L, Kwete XJ, Slater SE, Doyle KP, Cuong DD, Khanh QT, Mauer R, Thy DNM, Thinh DHQ, Tuan TD, Van Dung D, Khue LN, Krakauer EL. Effect of Training on Physicians' Palliative Care-Related Knowledge and Attitudes in Vietnam. J Pain Symptom Manage 2023; 66:146-159. [PMID: 37088114 DOI: 10.1016/j.jpainsymman.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/21/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
CONTEXT Palliative care remains largely inaccessible in low- and middle-income countries (LMICs), and efforts to increase access are impeded by lack of training of proven effectiveness for physicians. OBJECTIVES To measure the effectiveness of palliative care training for Vietnamese physicians. METHODS The palliative care-related knowledge, attitudes, and self-assessment of Vietnamese physicians were studied prior to a basic course in palliative care (baseline), just after the physicians completed the course (post), and 6-18 months later (follow-up). RESULTS The self-assessment scores and knowledge scores increased significantly from baseline to post and decreased significantly from post to follow-up, but the follow-up scores remained significantly higher than baseline. There were significant interactions between changes over time of the knowledge scores and baseline age, degree, years of graduation, training, type of work, and whether participants had ever prescribed morphine for pain. Medically appropriate attitudes increased significantly from baseline to post and did not decrease significantly from post to follow-up. CONCLUSION Our basic palliative care course in Vietnam resulted in significant and enduring improvements among physicians in palliative care-related knowledge, attitudes, and self-assessed competence. To respond to the enormous unmet need for palliative care in LMICs, primary care providers and physician-specialists in many fields, among others, should receive palliative care training of proven effectiveness, receive ongoing mentoring or refresher training, and be given the responsibility and opportunity to practice what they learn.
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Affiliation(s)
- Lulu Tsao
- Harvard Medical School (L.T.), Boston, Massachusetts, USA; Department of Medicine, School of Medicine, University of California (L.T.), San Fransisco, california, USA
| | - Xiaoxiao J Kwete
- Health Systems Group, Harvard School of Public Health (X.J.K.), Boston, Massachusetts, USA
| | - Sarah E Slater
- Department of Medical Oncology, Dana Farber Cancer Institute (S.E.S.), Boston, Massachusetts, USA; Department of Medicine, Harvard Medical School (S.E.S., K.P.D., E.L.K.), Boston, Massachusetts, USA
| | - Kathleen P Doyle
- Department of Medicine, Harvard Medical School (S.E.S., K.P.D., E.L.K.), Boston, Massachusetts, USA; Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital (E.L.K.), Boston, Massachusetts, USA
| | - Do Duy Cuong
- Department of Infectious Disease, Bach Mai National Hospital (D.D.C.), Hanoi, Vietnam
| | - Quach T Khanh
- Department of Infectious Disease, Bach Mai National Hospital (D.D.C.), Hanoi, Vietnam; Department of Palliative Care, Ho Chi Minh City Oncology Hospital (Q.T.K., D.H.Q.T.), Ho Chi Minh City, Vietnam
| | - Rie Mauer
- Department of Medicine, Brigham & Women's Hospital (R.M.), Boston, Massachusetts, USA
| | - Dang Ngoc Minh Thy
- Department of Medicine, St. Elizabeth Hospital (D.N.M.T.), Boston, Massachusetts, USA
| | - Dang Huy Quoc Thinh
- Department of Radiation Oncology, Ho Chi Minh City Oncology Hospital (Q.T.K., D.H.Q.T.), Ho Chi Minh City, Vietnam; Department of Palliative Care, Ho Chi Minh City Oncology Hospital (Q.T.K., D.H.Q.T.), Ho Chi Minh City, Vietnam
| | - Tran Diep Tuan
- Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City (T.D.T.), Ho Chi Minh City, Vietnam
| | - Do Van Dung
- Department of Public Health, University of Medicine and Pharmacy (D.V.D.), Ho Chi Minh City, Vietnam
| | - Luong Ngoc Khue
- Administration of Medical Services, Ministry of Health of Vietnam (L.N.K.), Hanoi, Vietnam
| | - Eric L Krakauer
- Harvard Medical School (L.T.), Boston, Massachusetts, USA; Department of Medicine, Harvard Medical School (S.E.S., K.P.D., E.L.K.), Boston, Massachusetts, USA; Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital (E.L.K.), Boston, Massachusetts, USA; Department of Palliative Care, University of Medicine and Pharmacy (E.L.K.), Ho Chi Minh City, Vietnam.
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Lohman D, Callaway M, Pardy S, Mwangi-Powell F, Foley KM. Six Key Approaches in Open Society Foundations' Support for Global Palliative Care Development. J Pain Symptom Manage 2023; 65:47-57. [PMID: 36064160 DOI: 10.1016/j.jpainsymman.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Between 1998 and 2021, the Open Society Foundations (OSF) network invested around US$50 million in supporting the emerging field of palliative care worldwide, funding different approaches and interventions to advance its objective of putting palliative care on the global public health agenda. OBJECTIVE To describe six approaches that were instrumental to the successes of Open Society Foundations' support in building the global field of palliative care. A robust discussion of lessons learnt is unfortunately not possible because Open Society Foundations did not commission a rigorous evaluation of the impacts of its investments. METHODS This article describes these six approaches: Investing in versatile palliative care leaders at national and regional level; investing in palliative care champions within the OSF network; proactively engaging the World Health Organization (WHO) in efforts to promote palliative care; developing tools and skills to improve palliative care financing; using a human rights-based approach; and supporting self-advocacy by people with palliative care needs. RESULTS Deep, long-term investments in national and regional champions from the palliative care community and OSF's own network built palliative care leaders with well-rounded skills, knowledge and opportunities to develop their own networks. The active engagement and involvement of the WHO in efforts to advance palliative care enhanced the credibility of palliative care as a discipline as well its champions, whereas the human rights approach resulted in more diverse strategies to overcome barriers to palliative care. The focus on palliative care financing and self-advocacy showed significant promise for impact. DISCUSSION The approaches and strategies described helped a nascent palliative care field develop into a health service that is increasingly integrated into public health systems. Other funders and national governments can build on OSF's long term support for the palliative care field and support further integration of palliative care within public health to increase access.
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Affiliation(s)
- Diederik Lohman
- Former Senior Advisor to Open Society Foundations' Public Health Program (D.L.), New York, USA.
| | - Mary Callaway
- Former director of the International Palliative Care Initiative (M.C.), New York, USA
| | - Sara Pardy
- Former Senior Administrative Specialist to Open Society Foundations' Public Health Program (S.P.), New York, USA
| | - Faith Mwangi-Powell
- Former Senior Program Officer Advocacy and Financing in the International Palliative Care Initiative; current CEO Girls Not Brides (F.M.P.), London, UK
| | - Kathleen M Foley
- Former medical director of the International Palliative Care Initiative (K.M.F.), New York, USA
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Ferrell B, Rosa WE. Understanding End of Life Nursing Practices and End of Life Across Cultures. Cancer Treat Res 2023; 187:137-149. [PMID: 37851224 DOI: 10.1007/978-3-031-29923-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Nurses are the largest group of health and social care professionals globally and they are central to the provision of palliative care.
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Affiliation(s)
- Betty Ferrell
- Division of Nursing Research and Education, City of Hope National Medical Center, 1500 E. Duarte Road, Pop Sci Bldg 173, Duarte, CA, 91010, USA.
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, UK
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Rosa WE, Ahmed E, Chaila MJ, Chansa A, Cordoba MA, Dowla R, Gafer N, Khan F, Namisango E, Rodriguez L, Knaul FM, Pettus KI. Can You Hear Us Now? Equity in Global Advocacy for Palliative Care. J Pain Symptom Manage 2022; 64:e217-e226. [PMID: 35850443 PMCID: PMC9482940 DOI: 10.1016/j.jpainsymman.2022.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York, USA; Institute for Advanced Study of the Americas, University of Miami (W.E.R. and F.M.K.), Coral Gables, Florida, USA.
| | - Ebtesam Ahmed
- Department of Clinical Health Professions (E.A.), St. John's University College of Pharmacy and Health Sciences, Queens, New York, USA; MJHS Institute for Innovation in Palliative Care (E.A.), New York, New York, USA
| | | | - Abidan Chansa
- National Palliative Care Program (A.C.), Ministry of Health, Lusaka, Zambia
| | - Maria Adelaida Cordoba
- Pediatric Palliative Section (M.A.C.), Fundación Hospital Pediátrico de La Misericordia, Bogotá, Colombia; Department of Pediatrics (M.A.C.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rumana Dowla
- Palliative Medicine Cancer Care Centre (R.D.), United Hospital, Dhaka, Bangladesh
| | - Nahla Gafer
- Integrated Palliative and Oncology Unit (N.G.), Khartoum Oncology Hospital, Khartoum, Sudan
| | - Farzana Khan
- Fasiuddin Khan Research Foundation (F.K.), Uttara, Dhaka, Bangladesh; Global Health Academy (F.K.), University of Edinburgh, Scotland, United Kingdom
| | - Eve Namisango
- African Palliative Care Association (E.N.), Kampala, Uganda; Department of Palliative Care and Rehabilitation (E.N.), Cicely Saunders Institute, King's College, London, United Kingdom
| | - Luisa Rodriguez
- Department of Anesthesia (L.R.), Pain and Palliative Medicine, Universidad de La Sabana, Chia, Colombia; Asociación Colombiana de Cuidados Paliativos (L.R.), Bogotá, Colombia
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami (W.E.R. and F.M.K.), Coral Gables, Florida, USA; Department of Public Health Sciences (F.M.K.), University of Miami Miller School of Medicine, Miami, Florida, USA; Tómatelo a Pecho, Mexico City (F.M.K.), Mexico; Fundación Mexicana para la Salud (F.M.K.), Mexico City, Mexico
| | - Katherine I Pettus
- International Association for Hospice and Palliative Care (K.I.P.), Houston, Texas, USA
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Pham VA, Nguyen H, Krakauer EL, Harding R. "I Wish I Could Die So I Would Not Be in Pain": A Qualitative Study of Palliative Care Needs Among People With Cancer or HIV/AIDS in Vietnam and Their Caregivers. J Pain Symptom Manage 2021; 62:364-372. [PMID: 33285274 DOI: 10.1016/j.jpainsymman.2020.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT Although cancer and HIV/AIDS are common causes of death in Vietnam, limited data exist on their palliative care needs. As palliative care becomes part of Universal Health Coverage, evidence is needed to scale up appropriate care. OBJECTIVES To elicit from people with cancer or HIV/AIDS in Vietnam, and their caregivers, the specific multidimensional symptoms and concerns that cause serious health-related suffering. METHODS Semistructured, qualitative, in-depth interviews were conducted with stage III or IV cancer patients, people with HIV/AIDS, and their caregivers at three cancer treatment centers and two HIV/AIDS treatment centers in northern, central, and southern Vietnam. Interviews were analyzed using thematic analysis. RESULTS Sixty people were interviewed (21 cancer patients, 20 people with HIV/AIDS, 19 caregivers). Pain and other physical symptoms severely impacted their daily lives. Psychological distress-including sadness, depression, worry, and a feeling of having no future-was mentioned frequently, and it was exacerbated by disease progression and by social problems such as financial difficulties and, among people with HIV/AIDS, stigma. Caregivers also suffered physically and psychosocially. Spirituality emerged as a source of strength for patients. Findings highlighted patients' and family caregivers' desire for more information about diagnosis, prognosis, and treatment, a shift toward individual decision-making. CONCLUSION The findings demonstrate common, multidimensional, and severe suffering among people living with cancer or HIV/AIDS and their caregivers in Vietnam. These qualitative data should guide development of optimum clinical assessment tools and palliative care services for these populations.
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Affiliation(s)
- Van Anh Pham
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Hannah Nguyen
- California State University, Dominguez Hills, Carson, CA, USA.
| | - Eric L Krakauer
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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Le QV, Trinh HL, Mai KNT, Pham MD, Glare PA. Screening Patients With Cancer Admitted to Hanoi Medical University Hospital for Palliative Care Needs. JCO Glob Oncol 2021; 6:1321-1327. [PMID: 32841066 PMCID: PMC7456321 DOI: 10.1200/go.20.00102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate a screening tool for identifying which patients admitted to the oncology ward of a Vietnamese hospital should be referred to specialist palliative care (PC). METHODS We performed a cross-sectional survey of consecutive patients hospitalized in the Department of Oncology and Palliative Care at Hanoi Medical University Hospital between June 2019 and September 2019. We translated a validated 11-item screening tool into Vietnamese and used a total score of ≥ 5 as a positive screen. RESULTS One hundred participants were recruited. Forty-four patients (44%) screened positive. Of these, 37 (84%) had locally advanced or metastatic disease, 31 (70%) had uncontrolled symptoms, and 43 (98%) requested a PC consultation. A score ≥ 5 was significantly more common in patients with stage IV disease versus earlier stage, performance status of Eastern Cooperative Oncology Group (ECOG) 2 versus ECOG 0, and when life-limiting complications of cancer were present. Screening identified four patients overlooked by oncologists as needing referral, and 34% of patients requesting a referral had scores < 5. CONCLUSION This screening tool provided oncologists with easy-to-use criteria for referring patients for PC. At the same time, it relieved the work load for under-resourced PC physicians by screening out requests with low-level need. This tool should be part of routine assessment on admission in all oncology units in Vietnam.
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Affiliation(s)
- Quang V Le
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Socialist Republic of Vietnam
| | - Huy L Trinh
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Socialist Republic of Vietnam
| | - Kim Ngan T Mai
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Socialist Republic of Vietnam
| | - Manh D Pham
- Hanoi Medical University, Hanoi, Socialist Republic of Vietnam
| | - Paul A Glare
- Sydney Medical School, University of Sydney, New South Wales, Australia
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Rosa WE, Krakauer EL, Farmer PE, Karanja V, Davis S, Crisp N, Rajagopal MR. The global nursing workforce: realising universal palliative care. LANCET GLOBAL HEALTH 2020; 8:e327-e328. [DOI: 10.1016/s2214-109x(19)30554-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
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Elmore SNC, Grover S, Bourque JM, Chopra S, Nyakabau AM, Ntizimira C, Krakauer EL, Balboni TA, Gospodarowicz MK, Rodin D. Global palliative radiotherapy: a framework to improve access in resource-constrained settings. ANNALS OF PALLIATIVE MEDICINE 2019; 8:274-284. [PMID: 30823841 DOI: 10.21037/apm.2019.02.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in less-developed countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. Several recent initiatives have highlighted the need for expanded access to both palliative medicine and radiotherapy globally. Yet, these efforts have remained largely independent, without attention to overlap and integration. This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.
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Affiliation(s)
- Shekinah N C Elmore
- Harvard Radiation Oncology Program, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Botswana-UPENN Partnership, University of Botswana, Gaborone, Botswana
| | - Jean-Marc Bourque
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ontario, Canada; Institute of Cancer Policy, Kings College London, Guy's Hospital, London, UK
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Anna Mary Nyakabau
- Ministry of Health and Child Welfare, Parirenyatwa Group of Hospitals, Harare, Zimbabwe; CancerServe Trust, Harare, Zimbabwe
| | - Christian Ntizimira
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric L Krakauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Global Palliative Care Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tracy A Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA; 13Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mary K Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario,Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario,Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada
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