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Sue-A-Quan R, Sorensen A, Lo S, Pope A, Swami N, Rodin G, Hannon B, Wentlandt K, Zimmermann C. Palliative Care Physicians' Perceptions of Conditions Required to Provide Early Palliative Care. J Pain Symptom Manage 2023; 66:93-101. [PMID: 37084825 DOI: 10.1016/j.jpainsymman.2023.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/15/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
CONTEXT Early palliative care (EPC) is widely recommended but its implementation may be challenging. OBJECTIVES We conducted a qualitative analysis of Canadian palliative care physicians' opinions about conditions necessary to provide EPC. METHODS A survey assessing attitudes and opinions regarding EPC was distributed to physicians providing primary or specialized palliative care, as identified by the Canadian Society of Palliative Care Physicians. The survey included an optional final section for respondents' general comments; we screened these for relevance to our study aims and conducted a thematic analysis of relevant comments. RESULTS Of 531 completed surveys, 129 (24%) respondents provided written comments, of whom 104 mentioned conditions they felt to be necessary to provide EPC. Four key themes were identified: 1) Clear delineation of roles of primary and specialized palliative care physicians-all physicians should be empowered to provide primary palliative care, with specialists providing additional support; 2) Shared care with needs-dependent referral-primary and specialized palliative care physicians should work collaboratively, with referral to specialized palliative care based on need rather than on prognosis; 3) Adequate resources to support primary palliative care-education, financial incentives, and collaboration with interdisciplinary team members such as nurses and specialized providers were specifically mentioned; 4) Addressing the misconception that palliative care equals end-of-life care-there was particular emphasis on education of both healthcare providers and the public. CONCLUSION Changes are necessary at the level of palliative care referral systems, providers, resources, and policy to enable implementation of EPC.
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Affiliation(s)
- Rachel Sue-A-Quan
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada
| | - Anna Sorensen
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada
| | - Samantha Lo
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine (G.R., B.H., C.Z.), University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health (G.R.), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry (G.R.), University of Toronto, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine (G.R., B.H., C.Z.), University of Toronto, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada; Division of Palliative Care (K.W.), Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care (R.S.A.Q., A.S., S.L., A.P., N.S., G.R., B.H., K.W., C.Z.), University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine (G.R., B.H., C.Z.), University of Toronto, Toronto, Ontario, Canada.
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Jiwnani S, Penumadu P, Ashok A, Pramesh CS. Lung Cancer Management in Low and Middle-Income Countries. Thorac Surg Clin 2022; 32:383-395. [PMID: 35961746 DOI: 10.1016/j.thorsurg.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lung cancer is an increasing problem in the developing world due to rising trends in smoking, high incidence of air pollution, lack of awareness and screening, delayed presentation, and diagnosis at the advanced stage. Even after diagnosis, there are disparities in access to health care facilities and inequitable distribution of resources and treatment options. In addition, the shortage of trained personnel and infrastructure adds to the challenges faced by patients with lung cancer in these regions. A multi-pronged effort targeting tobacco cessation, health promotion and awareness, capacity building, and value-based care are the need of the hour.
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Affiliation(s)
- Sabita Jiwnani
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, India.
| | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Medical Education and Research, JIPMER, 5343, 3rd Floor, SSB, Gorimedu, Pondicherry 605006, India
| | - Apurva Ashok
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Tata Memorial Hospital, 3rd Floor, Dr. E. Borges Road, Parel, Mumbai 400012, India
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Tata Memorial Hospital, Main Building, Ground Floor, Dr. E. Borges Road, Parel, Mumbai 400012, India
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Pramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, de Andrade VP, Hunter DJ, Gopal S, Gospodarowicz M, Gunasekera S, Ilbawi A, Kapambwe S, Kingham P, Kutluk T, Lamichhane N, Mutebi M, Orem J, Parham G, Ranganathan P, Sengar M, Sullivan R, Swaminathan S, Tannock IF, Tomar V, Vanderpuye V, Varghese C, Weiderpass E. Priorities for cancer research in low- and middle-income countries: a global perspective. Nat Med 2022; 28:649-657. [PMID: 35440716 PMCID: PMC9108683 DOI: 10.1038/s41591-022-01738-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 01/22/2023]
Abstract
Cancer research currently is heavily skewed toward high-income countries (HICs), with little research conducted in, and relevant to, the problems of low- and middle-income countries (LMICs). This regional discordance in cancer knowledge generation and application needs to be rebalanced. Several gaps in the research enterprise of LMICs need to be addressed to promote regionally relevant research, and radical rethinking is needed to address the burning issues in cancer care in these regions. We identified five top priorities in cancer research in LMICs based on current and projected needs: reducing the burden of patients with advanced disease; improving access and affordability, and outcomes of cancer treatment; value-based care and health economics; quality improvement and implementation research; and leveraging technology to improve cancer control. LMICs have an excellent opportunity to address important questions in cancer research that could impact cancer control globally. Success will require collaboration and commitment from governments, policy makers, funding agencies, health care organizations and leaders, researchers and the public.
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Affiliation(s)
- C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Rajendra A Badwe
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Satish Gopal
- Centre for Global Health, National Cancer Institute, Rockville, MD, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Peter Kingham
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tezer Kutluk
- Faculty of Medicine and Cancer Institute, Hacettepe University, Ankara, Turkey
| | | | | | | | | | | | - Manju Sengar
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Ian F Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine and Korle Bu Teaching Hospital, Accra, Ghana
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