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Kenneson SA, Hughes-Visentin A, Wrigley J, Gujral P, Lodhi S, Phadke S, Rayala S, Gentica X, Malipeddi D, Sarvode S, Kaye EC, Doherty M. Pediatric Palliative Care Program Implementation in LMICs: A Systematic Review using SWOT Analysis. J Pain Symptom Manage 2023; 66:338-350.e11. [PMID: 37414349 DOI: 10.1016/j.jpainsymman.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
CONTEXT Of the estimated 21 million children world-wide who need access to pediatric palliative care (PPC), about 97% currently reside in low-and middle-income countries (LMIC). Access to PPC programs in LMIC are limited, and successful strategies and barriers to program implementation remain understudied. OBJECTIVES We conducted a systematic review to characterize the strengths, weaknesses, opportunities, and threats (SWOT) of PPC program implementation in LMIC. METHODS Using PRISMA guidelines, we searched key databases from inception to April 2022 and reviewed references manually. Eligible abstracts and articles included content related to composition, role, function, purpose, development, or implementation of PPC programs in LMIC. RESULTS From 7,846 titles and abstracts and 229 full-text articles, we identified 62 eligible abstracts and articles; 16 articles were added following manual searching of references, resulting in 78 items (28 abstracts, 50 articles). A total of 82 unique programs were described, including nine from low-income, 27 from lower-middle income, and 44 from upper-middle income countries. Common strengths included presence of multidisciplinary teams and psychosocial care. Common weaknesses included lack of PPC training and research infrastructure. Common opportunities involved collaboration between institutions, government support, and growth of PPC education. Common threats comprised limited access to PPC services, medications, and other resources. CONCLUSION PPC programs are being successfully implemented in resource limited settings. Hospice and palliative medicine organizations should sponsor PPC clinicians to describe and disseminate more detailed descriptions of successes and challenges with program implementation to help build and grow further PPC initiatives in LMICs.
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Affiliation(s)
- Sarah Ann Kenneson
- College of Medicine (S.A.K., D.M.), University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Jordan Wrigley
- Biomedical Library (J.W.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; University of Colorado (J.W.), Boulder, Colorado, USA
| | - Preet Gujral
- Faculty of Medicine (A.H-V., P.G., S.L., S.P., M.D.), University of Ottawa, Ottawa, Ontario, Canada
| | - Sumiya Lodhi
- Faculty of Medicine (A.H-V., P.G., S.L., S.P., M.D.), University of Ottawa, Ottawa, Ontario, Canada
| | - Saloni Phadke
- Faculty of Medicine (A.H-V., P.G., S.L., S.P., M.D.), University of Ottawa, Ottawa, Ontario, Canada
| | - Spandana Rayala
- Two Worlds Cancer Collaboration Foundation (S.R., M.D.), Kelowna, Canada; Department of Pain and Palliative Care (S.R.), MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | - Xiohara Gentica
- National Children's Hospital (X.G.), Quezon City, Philippines
| | - Dhatri Malipeddi
- College of Medicine (S.A.K., D.M.), University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Supriya Sarvode
- Department of Oncology (S.S., E.C.K.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Erica C Kaye
- Department of Oncology (S.S., E.C.K.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Megan Doherty
- Faculty of Medicine (A.H-V., P.G., S.L., S.P., M.D.), University of Ottawa, Ottawa, Ontario, Canada; Two Worlds Cancer Collaboration Foundation (S.R., M.D.), Kelowna, Canada; Children's Hospital of Eastern Ontario (M.D.), Ottawa, Canada.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Knapp C, Woodworth L, Wright M, Downing J, Drake R, Fowler-Kerry S, Hain R, Marston J. Pediatric palliative care provision around the world: a systematic review. Pediatr Blood Cancer 2011; 57:361-8. [PMID: 21416582 DOI: 10.1002/pbc.23100] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 01/27/2011] [Indexed: 11/05/2022]
Abstract
Pediatric palliative care is recommended by many organizations. Yet, there is no information available on the progress that has been made in providing this care or the gaps that still exist in provision around the world. We conducted a systematic review to address this gap in knowledge. The systematic review identified 117 peer-reviewed and non-peer reviewed resources. Based on this information, each country was assigned a level of provision; 65.6% of countries had no known activities, 18.8% had capacity building activities, 9.9% had localized provision, and 5.7% had provision that was reaching mainstream providers. Understanding the geographic distribution in the level of provision is crucial for policy makers and funders.
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Affiliation(s)
- Caprice Knapp
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
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Abstract
Children with life-threatening illnesses and their families may face physical, emotional, psychosocial, and spiritual challenges throughout the children's course of illness. Pediatric palliative care is designed to meet such challenges. Given the psychosocial and emotional needs of children and their families it is clear that psychiatrists can, and do, play a role in delivering pediatric palliative care. In this article the partnership between pediatric palliative care and psychiatry is explored. The authors present an overview of pediatric palliative care followed by a summary of some of the roles for psychiatry. Two innovative pediatric palliative care programs that psychiatrists may or may not be aware of are described. Finally, some challenges that are faced in further developing this partnership and suggestions for future research are discussed.
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Affiliation(s)
- Caprice Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL 32610, USA.
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Knapp CA, Madden VL, Wang H, Kassing K, Curtis CM, Sloyer PJ, Shenkman EA. Effect of a pediatric palliative care program on nurses' referral preferences. J Palliat Med 2009; 12:1131-6. [PMID: 19698028 DOI: 10.1089/jpm.2009.0146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Florida was the first state to develop and implement a publicly funded pediatric palliative care program, which provides supportive care services to children and families from the point of diagnosis onward. Nurses employed by the Florida Department of Health, Children's Medical Services Network (CMSN) play an important role in this program as they are charged with identifying children with life-limiting illnesses in their caseloads for referral to the program. This study aims to estimate the differtences in referral preferences of nurses who work in Partners in Care: Together for Kids (PIC:TFK) program areas versus nurses who work in non-PIC:TFK areas. METHODS Mail and Web-based surveys were conducted with 279 nurses, 141 of whom work in a PIC:TFK site and 138 did not. RESULTS Results of the multivariate analyses suggest that few significant differences exist in the nurse's preferences to refer children to pediatric palliative care; however, there were significant differences in the preferred timing of referral. Nurses who work in an PIC:TFK area were 3.7 to 10.4 times as likely as nurses who do not work in a PIC:TFK area to refer children prior to the end of life. CONCLUSION Our study provides evidence that nurses who have experience with a pediatric palliative care program are more likely to refer children to programs before the end of life. While our study results are encouraging, they also suggest that as the PIC:TFK program expands nurse training will be essential for equitable and appropriate referrals across a diverse set of illnesses.
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Affiliation(s)
- Caprice A Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32604, USA.
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