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Peeler A, Afolabi O, Adcock M, Evans C, Nkhoma K, van Breevoort D, Farrant L, Harding R. Primary palliative care in low- and middle-income countries: A systematic review and thematic synthesis of the evidence for models and outcomes. Palliat Med 2024:2692163241248324. [PMID: 38693716 DOI: 10.1177/02692163241248324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Serious health-related suffering is predicted to double in low- and middle-income countries by 2060. Primary care offers the best opportunity to meet Universal Health Coverage in an equitable way. Primary palliative care growth should be evidence-based to ensure provision is feasible, acceptable and culturally congruent. AIM To identify the current evidence related to primary palliative care and to describe how primary palliative is defined in this setting, dominant typologies of care and meaningful outcome measures in LMICs. DESIGN A systematic review and thematic synthesis was conducted. We described the nature, extent and distribution of published literature on primary palliative care in low- and middle-income countries, use thematic synthesis to characterize typologies of primary palliative care and design a process model for care delivery in low- and middle-income countries. DATA SOURCES Medline, Psychinfo, Global Health, Embase and CINAHL. RESULTS Thirty-five publications were included. Nearly half took place in Asia (n = 16, 45.7%). We identified five dominant typologies of primary palliative care, including delivery in primary care clinics by multidisciplinary healthcare teams and palliative care specialists, in people's homes by healthcare professionals and volunteers and in tertiary healthcare facilities by generalists. We designed a process model for how these models operate within larger health systems and identified barriers and facilitators to implementing primary palliative care in this context. CONCLUSION Evidence supporting primary palliative care in low- and middle-income countries is limited, and much of the published literature comes from Asia and southern Africa. Health systems in low- and middle-income countries have unique strengths and needs that affect primary palliative care services that should guide how services evolve to meet future need.
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Affiliation(s)
- Anna Peeler
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative care, Cicely Saunders Institute, London, UK
| | - Oladayo Afolabi
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative care, Cicely Saunders Institute, London, UK
| | - Michael Adcock
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative care, Cicely Saunders Institute, London, UK
| | - Catherine Evans
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative care, Cicely Saunders Institute, London, UK
| | - Kennedy Nkhoma
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative care, Cicely Saunders Institute, London, UK
| | | | | | - Richard Harding
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative care, Cicely Saunders Institute, London, UK
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2
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Donkor A, Adotey PN, Ofori EO, Ayitey JA, Ferguson C, Luckett T, Vanderpuye V, Osei-Bonsu EB, Phelan C, Hunt K. Prevalence of Preferences for End-of-Life Place of Care and Death Among Patients With Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2024; 10:e2400014. [PMID: 38815191 DOI: 10.1200/go.24.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/18/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE There is limited information on preferences for place of care and death among patients with cancer in low- and middle-income countries (LMICs). The aim was to report the prevalence and determinants of preferences for end-of-life place of care and death among patients with cancer in LMICs and identify concordance between the preferred and actual place of death. METHODS Systematic review and meta-analysis guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. Four electronic databases were searched to identify studies of any design that reported on the preferred and actual place of care and death of patients with cancer in LMICs. A random-effects meta-analysis estimated pooled prevalences, with 95% CI, with subgroup analyses for region and risk of bias. RESULTS Thirteen studies were included. Of 3,837 patients with cancer, 62% (95% CI, 49 to 75) preferred to die at home; however, the prevalence of actual home death was 37% (95% CI, 13 to 60). Subgroup analyses found that preferences for home as place of death varied from 55% (95% CI, 41 to 69) for Asia to 64% (95% CI, 57 to 71) for South America and 72% (95% CI, 48 to 97) for Africa. The concordance between the preferred and actual place of death was 48% (95% CI, 41 to 55) for South Africa and 92% (95% CI, 88 to 95) for Malaysia. Factors associated with an increased likelihood of preferred home death included performance status and patients with breast cancer. CONCLUSION There is very little literature from LMICs on the preferences for end-of-life place of care and death among patients with cancer. Rigorous research is needed to help understand how preferences of patients with cancer change during their journey through cancer.
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Affiliation(s)
- Andrew Donkor
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Prince Nyansah Adotey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Oparebea Ofori
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jennifer Akyen Ayitey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Verna Vanderpuye
- National Centre for Radiotherapy Oncology Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Caroline Phelan
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Katherine Hunt
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
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3
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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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4
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Ghoshal A, Joad AK, Spruijt O, Nair S, Rajagopal MR, Patel F, Damani A, Deodhar J, Goswami D, Joshi G, Butola S, Singh C, Rao SR, Bhatwadekar M, Muckaden MA, Bhatnagar S. Situational analysis of the quality of palliative care services across India: a cross-sectional survey. Ecancermedicalscience 2022; 16:1486. [PMID: 36819806 PMCID: PMC9934966 DOI: 10.3332/ecancer.2022.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Palliative care services in India were established in the 1980s but there is no detailed up-to-date knowledge about the quality-of-service provision nationally. We aim to describe the current quality of palliative care provision in India, as measured against nationally adopted standards. Method A digital survey adapted from the Indian Association of Palliative Care Standards Audit Tool was administered to 250 palliative care centres. Results Two hundred and twenty-three (89%) palliative care centres participated - 26.4% were government-run, while the rest include non-governmental organisations, private hospitals, community-led initiatives and hospices. About 200 centres 'often' or 'always' fulfilled 16/21 desirable criteria; however, only 2/15 essential criteria were 'often' or 'always' fulfilled. Only 5.8% provide uninterrupted access to oral morphine. Significance of the results Palliative care centres in India are falling short of meeting the essential quality standards, indicating the urgent need for new initiatives to drive national change.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anjum Khan Joad
- Department of Anaesthesia and Palliative Care Medicine, Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur 302017, India
| | - Odette Spruijt
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Shobha Nair
- Department of Palliative Medicine, Amrita Hospital, Kochi 682041, India
| | - MR Rajagopal
- Trivandrum Institute of Palliative Sciences and Pallium India, Aisha Memorial Hospital Building, Paruthikuzhy, Thiruvananthapuram 695009, India
| | - Firuza Patel
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Dinesh Goswami
- Guwahati Pain and Palliative Care Society, Uzan Bazar, Guwahati, Assam 781001, India
| | - Geeta Joshi
- Community Oncology Center, Gujarat Cancer Society, Ahmedabad 380007, India
| | - Savita Butola
- Border Security Force Sector Hospital, Panisagar, Tripura 799260, India
| | - Charu Singh
- Department of Palliative Medicine, Amrita Hospital, Kochi 682041, India
| | | | | | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
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5
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Lohman D, Cleary J, Connor S, De Lima L, Downing J, Marston J, Morris C, Pardy S, Pettus K. Advancing Global Palliative Care Over Two Decades: Health System Integration, Access to Essential Medicines, and Pediatrics. J Pain Symptom Manage 2022; 64:58-69. [PMID: 35263621 DOI: 10.1016/j.jpainsymman.2022.03.001] [Citation(s) in RCA: 6] [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: 11/12/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
CONTEXT Between 2000 and 2020 Open Society Foundations was one of very few funders that supported global palliative care development and advocacy. OBJECTIVES To describe progress made in three priority areas-the integration of palliative care into public health systems, access to controlled medicines, and pediatric palliative care-during those 20 years. METHODS Activities and developments between 2000 and 2020 on global integration of palliative care into health systems, access to and availability of controlled medicines, and pediatric palliative care are described and analyzed. RESULTS Major progress has been made in each area. Whereas in 2000, integration of palliative care into public healthcare systems was on the agenda in just a few pioneering countries, by 2020 a global consensus had emerged that palliative care should be integral to all health systems including in universal health coverage and countries were increasingly taking steps to integrate it into national health systems. While limited availability of these medicines was barely recognized as a public health or drug control issue in 2000, it had become an important priority in global drug policy debates by 2020 and numerous countries had taken steps to improve access to these medicines. Pediatric palliative care, available mostly in a small number of wealthy countries in the 1990s, has seen rapid growth, especially in low- and middle-income countries, and now has a solid foothold in all world regions. CONCLUSION Despite this progress, significant challenges remain as funding for palliative care advocacy is limited, the overdose crisis in the US has recently had a chilling effect on efforts to improve availability of opioid analgesics, and economic crises related to the COVID-19 pandemic create uncertainty over the future of universal health coverage.
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Affiliation(s)
- Diederik Lohman
- Open Society Foundations (D.L., S.P.), New York, New York, USA.
| | - James Cleary
- Walther Global Palliative Care and Supportive Oncology, IUSCC, Indianapolis (J.C.), Indiana, USA
| | - Stephen Connor
- Worldwide Hospice Palliative Care Alliance (S.C., C.M.), London, UK
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston (L.D., K.P.), Texas, USA
| | - Julia Downing
- International Children's Palliative Care Network, Makerere University (J.D.), London/ Kampala, UK/ Uganda
| | - Joan Marston
- PatchSA Palliative Treatment for Children South Africa (J.M.), Bloemfontein, South Africa
| | - Claire Morris
- Worldwide Hospice Palliative Care Alliance (S.C., C.M.), London, UK
| | - Sara Pardy
- Open Society Foundations (D.L., S.P.), New York, New York, USA
| | - Katherine Pettus
- International Association for Hospice and Palliative Care, Houston (L.D., K.P.), Texas, USA
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6
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Luyirika E, Lohman D, Ali Z, Atieno M, Mahenge A, Mmbando P, Muinga E, Musyoki D, Mwesiga MD, Namisango E, Nosim P, Opio G, Pardy S, Ruzima A, Skowronska E, Uhagaze B, Zalwango J, Aluso A. Progress Update: Palliative Care Development Between 2017 and 2020 in Five African Countries. J Pain Symptom Manage 2022; 63:729-736. [PMID: 34973351 DOI: 10.1016/j.jpainsymman.2021.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT This article provides a progress update on the development of palliative care in five countries in Africa-Kenya, Rwanda, South Africa, Tanzania, and Uganda-between 2017 and 2021, and explores the role of palliative care advocates and the Open Society Foundations in this process. OBJECTIVES To provide a progress update on the development of palliative care in Kenya, Rwanda, South Africa, Tanzania, and Uganda between 2017 and 2021 and to examine the impact of twenty years of Open Society Foundations support for palliative care in the region on the integration of palliative care into publicly funded health systems. METHODS In the mid-2000s, palliative care pioneers in these five countries, supported by Open Society Foundations, began to train health care providers and engage policy makers to ensure that people with life-limiting illnesses and their families had access to appropriate services and essential medicines. In the late 2010s, it embraced an approach that mixed strategic communications and advocacy for inclusion of palliative care into universal health coverage with technical assistance. RESULTS By the mid-2010s, a vibrant palliative care community existed that worked closely with governments to develop palliative care policies, train providers, and ensure access to morphine. By 2021, Kenya and Rwanda had made significant progress scaling up palliative care services as part of the public health care system, and Uganda's government had instructed public hospitals to start providing these services. In South Africa and Tanzania, governments had yet to commit to publicly funded palliative care services. CONCLUSION The experiences in these countries suggest that mixing advocacy, communications, and technical assistance can lead to substantial progress for patient access although full inclusion in universal health coverage remained uncertain in all but Rwanda.
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Affiliation(s)
| | - Diederik Lohman
- Open Society Foundations (D.L., S.P.), New York, New York, USA.
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association (Z.A., M.A., E.M., D.M.), Nairobi, Kenya
| | - Mackuline Atieno
- Kenya Hospices and Palliative Care Association (Z.A., M.A., E.M., D.M.), Nairobi, Kenya
| | - Anna Mahenge
- Evangelical Lutheran Church in Tanzania (ELCT) (A.M., P.M., P.N.), Arusha, Tanzania
| | - Paul Mmbando
- Evangelical Lutheran Church in Tanzania (ELCT) (A.M., P.M., P.N.), Arusha, Tanzania
| | - Esther Muinga
- Kenya Hospices and Palliative Care Association (Z.A., M.A., E.M., D.M.), Nairobi, Kenya
| | - David Musyoki
- Kenya Hospices and Palliative Care Association (Z.A., M.A., E.M., D.M.), Nairobi, Kenya
| | - Mark Donald Mwesiga
- Palliative Care Association of Uganda (PCAU) (M.D.M., J.Z.), Kampala, Uganda
| | - Eve Namisango
- African Palliative Care Association (E.L., E.N.), Kampala, Uganda
| | - Peter Nosim
- Evangelical Lutheran Church in Tanzania (ELCT) (A.M., P.M., P.N.), Arusha, Tanzania
| | - Geoffrey Opio
- Open Society Initiative for East Africa (G.P., A.A.), Kampala, Uganda
| | - Sara Pardy
- Open Society Foundations (D.L., S.P.), New York, New York, USA
| | - Aimable Ruzima
- Rwanda Palliative Care and Hospice Organization (A.R., B.U.), Kigali, Rwanda
| | - Eva Skowronska
- Hospice Palliative Care Association (HPCA) (E.S.), Cape Town, South Africa
| | - Blaise Uhagaze
- Rwanda Palliative Care and Hospice Organization (A.R., B.U.), Kigali, Rwanda
| | - Joyce Zalwango
- Palliative Care Association of Uganda (PCAU) (M.D.M., J.Z.), Kampala, Uganda
| | - Aggrey Aluso
- Open Society Initiative for East Africa (G.P., A.A.), Kampala, Uganda
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7
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Namisango E, Bhakta N, Wolfe J, McNeil MJ, Powell RA, Kibudde S, Luyirika EBK, Mulema V, Feudtner C, Baker JN. Status of Palliative Oncology Care for Children and Young People in Sub-Saharan Africa: A Perspective Paper on Priorities for New Frontiers. JCO Glob Oncol 2021; 7:1395-1405. [PMID: 34546790 PMCID: PMC8457851 DOI: 10.1200/go.21.00102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The burden of cancer disproportionately affects low- and middle-income countries. Low 5-year survival figures for children with cancer in low-income countries are due to late presentation at diagnosis, treatment abandonment, absence of sophisticated multidisciplinary care, and lack of adequate resources. The reasons for late presentation are partly due to limited awareness of cancer symptoms, high treatment costs, and facility-level barriers to timely access to treatment. Given the systemic challenges, the regional need for palliative oncology care for children care is high. Despite the enormity of the need for palliative oncology for children with cancer in Africa, its level of development remains poor. This paper presents the evidence on the status of palliative oncology care for children in sub-Saharan Africa. Countries must prioritize integration of pediatric palliative care in SSA pediatric oncology.![]()
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda.,Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Nickhill Bhakta
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Joanne Wolfe
- Department of Pediatrics, Boston Children's Hospital, Boston, MA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Michael J McNeil
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Richard A Powell
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.,MWAPO Health Development Group, Nairobi, Kenya
| | - Solomon Kibudde
- Department of Medical Oncology, Uganda Cancer Institute, Kampala, Uganda
| | | | | | - Chris Feudtner
- Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA.,Departments of Pediatrics and of Medical Ethics and Health Policy, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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8
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Poudel A, Kc B, Shrestha S, Nissen L. Access to palliative care: discrepancy among low-income and high-income countries. J Glob Health 2020; 9:020309. [PMID: 31656599 PMCID: PMC6812938 DOI: 10.7189/jogh.09.020309] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Queensland, Australia.,Sankalpa Foundation Pvt. Ltd., Pokhara, Nepal
| | - Bhuvan Kc
- Sankalpa Foundation Pvt. Ltd., Pokhara, Nepal.,School of Pharmacy, Monash University, Malaysia
| | - Shakti Shrestha
- Sankalpa Foundation Pvt. Ltd., Pokhara, Nepal.,School of Pharmacy, University of Queensland, Queensland, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Queensland, Australia.,School of Pharmacy, University of Queensland, Queensland, Australia
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9
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Glasgow JM, Zhang Z, O'Donnell LD, Guerry RT, Maheshwari V. Hospital palliative care consult improves value-based purchasing outcomes in a propensity score-matched cohort. Palliat Med 2019; 33:452-456. [PMID: 30729864 PMCID: PMC8008250 DOI: 10.1177/0269216318824270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hospital-based palliative care consultation is consistently associated with reduced hospitalization costs and more importantly with improved patient quality of life. As healthcare systems move toward value-based purchasing rather than fee-for-service models, understanding how palliative care consultation is associated with value-based purchasing metrics can provide evidence for expanded health system support for a greater palliative care presence. AIM To understand how a palliative care consultation impacts rates of patient readmission and hospital-acquired infections associated with value-based purchasing metrics. DESIGN Retrospective propensity-matched case-control study evaluating the impact of palliative care consultation on hospital charges, hospital and intensive care unit length of stay, readmission rates, and rates of hospital-acquired conditions. SETTING/PARTICIPANTS All adult patients admitted to a two hospital healthcare system over a 2-year period from 1 April 2015 to 31 March 2017. The palliative care team involved three physicians, five advanced practice providers, a social worker, and a chaplain during the study period. RESULTS A total of 3415 patients receiving a palliative consult were propensity matched to 25,028 controls. Compared to controls, cases had decreased charges per day and decreased rates of 7-, 30-, and 90-day readmissions. CONCLUSION Through value-based purchasing, hospitals have 3% of their Medicare reimbursements at risk based on readmission rates. By clarifying prognosis and patient goals, palliative care consultation reduces readmission rates. Hospital systems may want to invest in larger palliative care programs as part of their efforts to reduce hospital readmissions.
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Affiliation(s)
- Justin M Glasgow
- 1 Department of Internal Medicine, Christiana Care Health System, Newark, DE, USA.,2 Value Institute, Christiana Care Health System, Newark, DE, USA
| | - Zugui Zhang
- 2 Value Institute, Christiana Care Health System, Newark, DE, USA
| | - Linsey D O'Donnell
- 1 Department of Internal Medicine, Christiana Care Health System, Newark, DE, USA
| | - Roshni T Guerry
- 1 Department of Internal Medicine, Christiana Care Health System, Newark, DE, USA
| | - Vinay Maheshwari
- 1 Department of Internal Medicine, Christiana Care Health System, Newark, DE, USA
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10
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Soares LGL, Gomes RV, Japiassu AM. Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil. Am J Hosp Palliat Care 2019; 36:775-779. [DOI: 10.1177/1049909119828086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66). Patients received an average of 13 days of inpatient care and the majority of them died in the hospital (53%, n = 58). We also found that almost 40% of patients (38%, n = 42) used chemotherapy in the last 14 days of life. These patients were more likely to be male (64% vs 22%; P < .001), to receive blood transfusions (57% vs 38%; P = .05), and to die in the hospital (76% vs 39%; P = .009) than patients who did not use chemotherapy in the last 14 days of life. This study suggests that patients with HM have high rates of health-care utilization at the end of life in Brazil. Patients who used chemotherapy in the last 14 days of life were more likely to receive blood transfusions and to die in the hospital.
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Affiliation(s)
- Luiz Guilherme L. Soares
- Department of Health Services and Costs, End of Life Care Study Group, Unimed Federação Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renato Vieira Gomes
- Department of Health Services and Costs, End of Life Care Study Group, Unimed Federação Rio de Janeiro, Rio de Janeiro, Brazil
| | - André M. Japiassu
- Research Laboratory of Intensive Care Medicine, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Hartwig KN, Hartwig KA, DiSorbo P, Hofgren B, Motz-Storey L, Mmbando P, Msurri M, Mwangi-Powell F, Powell RA, Smith S, Jacobson M. Scaling up A Community-Based Palliative Care Program among Faith-Based Hospitals in Tanzania. J Palliat Care 2018. [DOI: 10.1177/082585971002600308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kristopher N. Hartwig
- Whole Village Project, Minnesota Population Center, University of Minnesota, 225 19th Ave. S., Minneapolis, Minnesota, USA
| | | | - Phil DiSorbo
- Foundation for Hospices in Sub-Saharan Africa, Alexandria, Virginia, USA
| | - Berit Hofgren
- Evangelical Lutheran Church in Tanzania, Arusha, Tanzania
| | | | - Paul Mmbando
- Evangelical Lutheran Church in Tanzania, Arusha, Tanzania
| | - Mellow Msurri
- Evangelical Lutheran Church in Tanzania, Arusha, Tanzania
| | | | | | - Shelley Smith
- Foundation for Hospices in Sub-Saharan Africa, Alexandria, Virginia, USA
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Centeno C, Sitte T, de Lima L, Alsirafy S, Bruera E, Callaway M, Foley K, Luyirika E, Mosoiu D, Pettus K, Puchalski C, Rajagopal MR, Yong J, Garralda E, Rhee JY, Comoretto N. White Paper for Global Palliative Care Advocacy: Recommendations from a PAL-LIFE Expert Advisory Group of the Pontifical Academy for Life, Vatican City. J Palliat Med 2018; 21:1389-1397. [PMID: 30256135 PMCID: PMC6201784 DOI: 10.1089/jpm.2018.0248] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which aims to develop and promote Catholic teachings on questions of biomedical ethics. Palliative care (PC) experts from around the world professing different faiths were invited by the PAV to develop strategic recommendations for the global development of PC (“PAL-LIFE group”). Design: Thirteen experts in PC advocacy participated in an online Delphi process. In four iterative rounds, participants were asked to identify the most significant stakeholder groups and then propose for each, strategic recommendations to advance PC. Each round incorporated the feedback from previous rounds until consensus was achieved on the most important recommendations. In a last step, the ad hoc group was asked to rank the stakeholders' groups by order of importance on a 13-point scale and to propose suggestions for implementation. A cluster analysis provided a classification of the stakeholders in different levels of importance for PC development. Results: Thirteen stakeholder groups and 43 recommendations resulted from the first round, and, of those, 13 recommendations were chosen as the most important (1 for each stakeholder group). Five groups had higher scores. The recommendation chosen for these top 5 groups were as follows: (1) Policy makers: Ensure universal access to PC; (2) Academia: Offer mandatory PC courses to undergraduates; (3) Healthcare workers: PC professionals should receive adequate certification; (4) Hospitals and healthcare centers: Every healthcare center should ensure access to PC medicines; and (5) PC associations: National Associations should be effective advocates and work with their governments in the process of implementing international policy framework. A recommendation for each of the remaining eight groups is also presented. Discussion: This white paper represents a position statement of the PAV developed through a consensus process in regard to advocacy strategies for the advancement of PC in the world.
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Affiliation(s)
- Carlos Centeno
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,2 ATLANTES Research Programme, Institute for Culture and Society, University of Navarra , Pamplona, Spain
| | - Thomas Sitte
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,3 Deutsche PalliativStiftung , Fulda, Germany
| | - Liliana de Lima
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,4 International Association for Hospice and Palliative Care (IAHPC) , Houston, Texas
| | - Sami Alsirafy
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,5 Palliative Medicine Unit, Kasr Al-Ainy School of Medicine, Cairo University , Cairo, Egypt
| | - Eduardo Bruera
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,6 Department of Palliative Medicine and Supportive Care, UT MD Anderson Cancer Center , Houston, Texas
| | - Mary Callaway
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,4 International Association for Hospice and Palliative Care (IAHPC) , Houston, Texas
| | - Kathleen Foley
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,7 Memorial Sloan Kettering Cancer Center , New York, New York
| | - Emmanuel Luyirika
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,8 African Palliative Care Association , Kampala, Uganda
| | - Daniela Mosoiu
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,9 Casa Sperantei, Transylvania University , Brasov, Romania
| | - Katherine Pettus
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,4 International Association for Hospice and Palliative Care (IAHPC) , Houston, Texas
| | - Christina Puchalski
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,10 The George Washington University's Institute for Spirituality and Health (GWish) , Washington, DC
| | - M R Rajagopal
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,11 WHO Collaborating Centre for Training and Policy on Access to Pain Relief , Pallium India, Trivandrum, Kerala, India
| | - Julianna Yong
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,12 The Catholic University of Korea (CUK) , Seoul, Korea
| | - Eduardo Garralda
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,2 ATLANTES Research Programme, Institute for Culture and Society, University of Navarra , Pamplona, Spain
| | - John Y Rhee
- 13 Icahn School of Medicine at Mount Sinai , New York, New York
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13
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Centeno C, Sitte T, de Lima L, Alsirafy S, Bruera E, Callaway M, Foley K, Luyirika E, Mosoiu D, Pettus K, Puchalski C, Rajagopal MR, Yong J, Garralda E, Rhee JY, Comoretto N. Documento de Posición Oficial sobre la Promoción Global de Cuidados Paliativos: Recomendaciones del Grupo Internacional Asesor PAL-LIFE de la Academia Pontificia de la Vida, Ciudad del Vaticano. J Palliat Med 2018; 21:1398-1407. [PMID: 30256150 PMCID: PMC6201785 DOI: 10.1089/jpm.2018.0387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Contexto: La Academia Pontificia de la Vida (PAV) es una institución académica de la Santa Sede (Vaticano) cuyo objetivo es promover una visión católica de la ética biomédica. La PAV invitó a una serie de expertos en Cuidados Paliativos (CP) de todo el mundo, de todas las creencias, a desarrollar recomendaciones estratégicas para el desarrollo global de CP (“Grupo PAL-LIFE”). Diseño: Trece expertos internacionales reconocidos por su actividad promotora global de CP participaron en un estudio Delphi on-line. En un proceso de cuatro rondas, se pidió a los participantes que identificasen los grupos de interés o instituciones claves para la promoción de CP y que propusieran, para cada uno de ellos, recomendaciones estratégicas para el desarrollo de CP. Cada ronda incorporaba los comentarios de las rondas previas hasta lograr el consenso en las recomendaciones más importantes. En una última fase, al grupo de expertos se le solicitó la jerarquización por importancia de los grupos clave en una escala de 1 a 13. También se solicitaron sugerencias concretas para la implementación de las recomendaciones. Mediante análisis clúster se ordenaron los grupos de interés en dos niveles de importancia para el desarrollo de CP. Resultados: Trece recomendaciones fueron seleccionadas como las más importantes (una por cada grupo clave). Las recomendaciones para los grupos mejor puntuados fueron: (1) Responsables Políticos: garantizar el acceso universal a los CP; (2) Academia: ofrecer cursos obligatorios de CP en el pregrado; (3) Profesionales sanitarios: promover una certificación adecuada; (4) Hospitales e Instituciones sanitarias: asegurar el acceso a medicamentos de CP; y (5) Asociaciones de CP: ser promotoras eficaces y trabajar con los gobiernos en la implementación de las recomendaciones internacionales sobre CP. También se presentan recomendaciones para los ocho grupos clave restantes. Discusión: Este documento representa la posición oficial de la PAV en lo que respecta a estrategias de promoción para el desarrollo de los CP en el mundo.
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Affiliation(s)
- Carlos Centeno
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,2 ATLANTES Research Programme, Institute for Culture and Society, University of Navarra , Pamplona, Spain
| | - Thomas Sitte
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,3 Deutsche PalliativStiftung , Fulda, Germany
| | - Liliana de Lima
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,4 International Association for Hospice and Palliative Care (IAHPC) , Houston, Texas
| | - Sami Alsirafy
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,5 Palliative Medicine Unit, Kasr Al-Ainy School of Medicine, Cairo University , Cairo, Egypt
| | - Eduardo Bruera
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,6 Department of Palliative Medicine and Supportive Care, UT MD Anderson Cancer Center , Houston, Texas
| | - Mary Callaway
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,4 International Association for Hospice and Palliative Care (IAHPC) , Houston, Texas
| | - Kathleen Foley
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,7 Memorial Sloan Kettering Cancer Center , New York, New York
| | - Emmanuel Luyirika
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,8 African Palliative Care Association , Kampala, Uganda
| | - Daniela Mosoiu
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,9 Casa Sperantei, Transylvania University , Brasov, Romania
| | - Katherine Pettus
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,4 International Association for Hospice and Palliative Care (IAHPC) , Houston, Texas
| | - Christina Puchalski
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,10 The George Washington University's Institute for Spirituality and Health (GWish) , Washington, District of Columbia
| | - M R Rajagopal
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,11 WHO Collaborating Centre for Training and Policy on Access to Pain Relief , Pallium India, Trivandrum, Kerala, India
| | - Julianna Yong
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,12 The Catholic University of Korea (CUK) , Seoul, Korea
| | - Eduardo Garralda
- 1 PAL-LIFE Project-Pontifical Academy for Life, International Advisory Group for Global Palliative Care Advocacy , Vatican City.,2 ATLANTES Research Programme, Institute for Culture and Society, University of Navarra , Pamplona, Spain
| | - John Y Rhee
- 13 Icahn School of Medicine at Mount Sinai , New York, New York
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14
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Rhee JY, Garralda E, Namisango E, Luyirika E, de Lima L, Powell RA, Robinson CA, Centeno C. Factors Affecting Palliative Care Development in Africa: In-Country Experts' Perceptions in Seven Countries. J Pain Symptom Manage 2018; 55:1313-1320.e2. [PMID: 29409870 DOI: 10.1016/j.jpainsymman.2018.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/27/2022]
Abstract
CONTEXT Factors contributing to and impeding palliative care (PC) development in Africa can provide insights into current strategies for advancing PC. OBJECTIVES To identify key factors affecting PC development in African countries from in-country PC experts' perspectives. METHODS About 16 PC experts from seven African countries undertook semistructured interviews on PC development in their respective countries. An interpretive description approach was adopted, with data analyzed using constant comparison. RESULTS Emerged themes included drivers, strengths, challenges, and aspirations for PC development in Africa. Drivers included advocates and pioneering organizations, HIV/AIDS, culture of caregiving, and the World Health Assembly PC resolution. Strengths included community health workers, the special role of nurses, diversity of services, and short training courses. Challenges included lack of PC education; lack of standardization in implementation; limited availability of and/or accessibility to morphine; poverty and disease burden; and lack of funding for PC. Aspirations included integration of PC, specialization in PC, nurse prescribing, and strong partnerships with Ministries of Health. Factors already highlighted in the literature were only briefly discussed. CONCLUSION The key factors underpinning PC development in the seven countries contributed to the beginnings of PC in Africa, fueled by advocates who built on existing strengths to maximize opportunities. However, the current approach is at high risk in terms of its sustainability, and strategies for maximizing existing resources and growing infrastructure support are needed moving forward.
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Affiliation(s)
- John Y Rhee
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Eduardo Garralda
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Navarra, Spain; IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Navarra, Spain
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | | | - Liliana de Lima
- International Association for Hospice and Palliative Care, Houston, Texas, USA
| | | | | | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Navarra, Spain; IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Navarra, Spain; Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
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15
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Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, Arreola-Ornelas H, Gómez-Dantés O, Rodriguez NM, Alleyne GAO, Connor SR, Hunter DJ, Lohman D, Radbruch L, Del Rocío Sáenz Madrigal M, Atun R, Foley KM, Frenk J, Jamison DT, Rajagopal MR. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet 2018; 391:1391-1454. [PMID: 29032993 DOI: 10.1016/s0140-6736(17)32513-8] [Citation(s) in RCA: 640] [Impact Index Per Article: 106.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Felicia Marie Knaul
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, FL, USA; Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL, USA; Tómatelo a Pecho, A.C., Mexico City, Mexico; Fundación Mexicana para la Salud, A.C., Mexico City, Mexico.
| | | | - Eric L Krakauer
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; World Health Organization, Geneva, Switzerland
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, TX, USA
| | - Afsan Bhadelia
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaoxiao Jiang Kwete
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Héctor Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Tómatelo a Pecho, A.C., Mexico City, Mexico; Fundación Mexicana para la Salud, A.C., Mexico City, Mexico
| | | | - Natalia M Rodriguez
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA
| | - George A O Alleyne
- Pan American Health Organization, Regional Office of WHO, Washington, DC, USA
| | | | - David J Hunter
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Diederik Lohman
- Health and Human Rights Division, Human Rights Watch, Maplewood, NJ, USA
| | - Lukas Radbruch
- International Association for Hospice and Palliative Care, Houston, TX, USA; Department of Palliative Medicine, University Hospital Bonn, Germany; The Malteser Hospital, Bonn, Germany
| | | | - Rifat Atun
- Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Julio Frenk
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, FL, USA; School of Business Administration, University of Miami, Coral Gables, FL, USA
| | | | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
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16
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Callaway MV, Connor SR, Foley KM. World Health Organization Public Health Model: A Roadmap for Palliative Care Development. J Pain Symptom Manage 2018; 55:S6-S13. [PMID: 28801003 DOI: 10.1016/j.jpainsymman.2017.03.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 12/01/2022]
Abstract
The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made.
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Affiliation(s)
| | - Stephen R Connor
- Worldwide Hospice Palliative Care Alliance, Fairfax, Virginia, USA
| | - Kathleen M Foley
- Memorial Sloan Kettering Cancer Center Emeritus, New York, New York, USA
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Viswanath V, Palat G, Chary S, Broderick A. Challenges of Using Methadone in the Indian Pain and Palliative Care Practice. Indian J Palliat Care 2018; 24:S30-S35. [PMID: 29497252 PMCID: PMC5806303 DOI: 10.4103/ijpc.ijpc_168_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Palliative care providers across India lobbied to gain access to methadone for pain relief and this has finally been achieved. Palliative care activists will count on the numerous strengths for introducing methadone in India, including the various national and state government initiatives that have been introduced recognizing the importance of palliative care as a specialty in addition to improving opioid accessibility and training. Adding to the support are the Non-Governmental Organizations (NGOs), the medical fraternity and the international interactive and innovative programs such as the Project Extension for Community Health Outcome. As compelling as the need for methadone is, many challenges await. This article outlines the challenges of procuring methadone and also discusses the challenges specific to methadone. Balancing the availability and diversion in a setting of opioid phobia, implementing the amended laws to improve availability and accessibility in a country with diverse health-care practices are the major challenges in implementing methadone for relief of pain. The unique pharmacology of the drug requires meticulous patient selection, vigilant monitoring, and excellent communication and collaboration with a multidisciplinary team and caregivers. The psychological acceptance of the patient, the professional training of the team and the place where care is provided are also challenges which need to be overcome. These challenges could well be the catalyst for a more diligent and vigilant approach to opioid prescribing practices. Start low, go slow could well be the way forward with caregiver education to prescribe methadone safely in the Indian palliative care setting.
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Affiliation(s)
- Vidya Viswanath
- Department of Palliative Care, Homi Bhabha Cancer Hospital and Research Centre, A Unit of Tata Memorial Centre, Visakhapatnam, Andhra Pradesh, India
| | - Gayatri Palat
- Consultant, Pain and Palliative Medicine, MNJ Institute of Oncology and RCC, Hyderabad, India
| | - Srini Chary
- Department of Oncology and Family Medicine, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
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Zaman S, Inbadas H, Whitelaw A, Clark D. Common or multiple futures for end of life care around the world? Ideas from the 'waiting room of history'. Soc Sci Med 2017; 172:72-79. [PMID: 27894008 PMCID: PMC5224187 DOI: 10.1016/j.socscimed.2016.11.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
Around the world there is growing interest in the manner in which care is delivered to people at the end of life. However, there is little unanimity on what constitutes a 'good death' and the appropriate societal responses to the issue of delivering culturally relevant and sustainable forms of end of life care in different settings are not subjects of broad agreement. In this critical conceptual paper we focus on the emerging narratives of global palliative care and offer an assessment of their implications. We relate this to calls to improve end of life care across jurisdictions and settings, attempts to map and grade the development of palliative care provision, and to the emergence of a widely recognised global 'quality of death index'. We consider an alternative approach to framing this debate, drawn from a subaltern and post-colonial studies perspective and suggest that adopting a truly global perspective will require acceptance of the plurality of past and present local problems and issues relating to end of life care, as well as the plural possibilities of how they might be overcome. In that context, we would not aim to universalise or privilege one particular global future for end of life care. Instead of homogenising end of life interventions, we seek to be open to multiple futures for the care of the dying.
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Affiliation(s)
- Shahaduz Zaman
- School of Interdisciplinary Studies, The University of Glasgow, Crichton University Campus, Dumfries, DG1 4ZL, Scotland, UK.
| | - Hamilton Inbadas
- School of Interdisciplinary Studies, The University of Glasgow, Crichton University Campus, Dumfries, DG1 4ZL, Scotland, UK.
| | - Alexander Whitelaw
- School of Interdisciplinary Studies, The University of Glasgow, Crichton University Campus, Dumfries, DG1 4ZL, Scotland, UK.
| | - David Clark
- School of Interdisciplinary Studies, The University of Glasgow, Crichton University Campus, Dumfries, DG1 4ZL, Scotland, UK.
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Providing palliative care for cardiovascular disease from a perspective of sociocultural diversity: a global view. Curr Opin Support Palliat Care 2016; 10:11-7. [PMID: 26808051 DOI: 10.1097/spc.0000000000000188] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article discusses the available information on providing palliative care for cardiovascular disease (CVD) for individuals from culturally and linguistically diverse populations, and argues the need for cultural competence and awareness of healthcare providers. RECENT FINDINGS The burden of CVD is increasing globally and access to palliative care for individuals and populations is inconsistent and largely driven by policy, funding models, center-based expertise and local resources. Culture is an important social determinant of health and moderates health outcomes across the life trajectory. Along with approachability, availability, accommodation, affordability and appropriateness, culture moderates access to services. Health disparities and inequity of access underscore the importance of ensuring services meet the needs of diverse populations and that care is provided by individuals who are culturally competent. In death and dying, the vulnerability of individuals, families and communities is most pronounced. Using a social-ecological model as an organising framework, we consider the evidence from the literature in regard to the interaction between the individual, interpersonal relationships, community and society in promoting access to individuals with cardiovascular disease. SUMMARY This review highlights the need for considering individual, provider and system factors to tailor and target healthcare services to the needs of culturally diverse populations. Beyond translation of materials, there is a need to understand the cultural dimensions influencing health-seeking behaviors and acceptance of palliative care and ensuring the cultural competence of health professionals in both primary and specialist palliative care.
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Musyoki D, Gichohi S, Ritho J, Ali Z, Kinyanjui A, Muinga E. Integration of legal aspects and human rights approach in palliative care delivery-the Nyeri Hospice model. Ecancermedicalscience 2016; 10:656. [PMID: 27563351 PMCID: PMC4970627 DOI: 10.3332/ecancer.2016.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 11/10/2022] Open
Abstract
Palliative care is patient and family-centred care that optimises quality of life by anticipating, preventing, and treating suffering. Open Society Foundation public health program (2011) notes that people facing life-threatening illnesses are deeply vulnerable: often in severe physical pain, worried about death, incapacitation, or the fate of their loved ones. Legal issues can increase stress for patients and families and make coping harder, impacting on the quality of care. In the absence of a clear legal provision expressly recognising palliative care in Kenya, providers may face numerous legal and ethical dilemmas that affect the availability, accessibility, and delivery of palliative care services and commodities. In order to ensure positive outcomes from patients, their families, and providers, palliative care services should be prioritised by all and includes advocating for the integration of legal support into those services. Palliative care service providers should be able to identify the various needs of patients and their families including specific issues requiring legal advice and interventions. Access to legal services remains a big challenge in Kenya, with limited availability of specialised legal services for health-related legal issues. An increased awareness of the benefits of legal services in palliative care will drive demand for easily accessible and more affordable direct legal services to address legal issues for a more holistic approach to quality palliative care.
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Affiliation(s)
- David Musyoki
- Kenya Hospices and Palliative Care Association, PO Box 20854, 00202 Nairobi, Kenya
| | | | | | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, PO Box 20854, 00202 Nairobi, Kenya
| | - Asaph Kinyanjui
- Kenya Hospices and Palliative Care Association, PO Box 20854, 00202 Nairobi, Kenya
| | - Esther Muinga
- Kenya Hospices and Palliative Care Association, PO Box 20854, 00202 Nairobi, Kenya
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Bergman J, Laviana AA. Opportunities to maximize value with integrated palliative care. J Multidiscip Healthc 2016; 9:219-26. [PMID: 27226721 PMCID: PMC4863682 DOI: 10.2147/jmdh.s90822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Palliative care involves aggressively addressing and treating psychosocial, spiritual, religious, and family concerns, as well as considering the overall psychosocial structures supporting a patient. The concept of integrated palliative care removes the either/or decision a patient needs to make: they need not decide if they want either aggressive chemotherapy from their oncologist or symptom-guided palliative care but rather they can be comanaged by several clinicians, including a palliative care clinician, to maximize the benefit to them. One common misconception about palliative care, and supportive care in general, is that it amounts to “doing nothing” or “giving up” on aggressive treatments for patients. Rather, palliative care involves very aggressive care, targeted at patient symptoms, quality-of-life, psychosocial needs, family needs, and others. Integrating palliative care into the care plan for individuals with advanced diseases does not necessarily imply that a patient must forego other treatment options, including those aimed at a cure, prolonging of life, or palliation. Implementing interventions to understand patient preferences and to ensure those preferences are addressed, including preferences related to palliative and supportive care, is vital in improving the patient-centeredness and value of surgical care. Given our aging population and the disproportionate cost of end-of-life care, this holds great hope in bending the cost curve of health care spending, ensuring patient-centeredness, and improving quality and value of care. Level 1 evidence supports this model, and it has been achieved in several settings; the next necessary step is to disseminate such models more broadly.
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Affiliation(s)
- Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA
| | - Aaron A Laviana
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Abstract
The World Health Organization estimated that more than 60% of the 14 million new cancer cases worldwide in 2012 were reported in the developing part of the world, including Asia, Africa, Central and South America. Cancer survival rate is poorer in developing countries due to diagnosis at late stage and limited access to timely treatment. Since the disease per se cannot be treated even with the best available treatment modalities, what remains important is symptom management and providing comfort care to these patients. The incidence of pain in advanced stages of cancer approaches 70-80%. Lack of preventive strategies, poverty, illiteracy, and social stigma are the biggest cause of pain suffering and patient presenting in advance stage of their disease. The need for palliative care is expanding due to aging of world's population and increase in the rate of cancer in developed and developing countries. A huge gap remains between demand and current palliative care services. Overcoming barriers to palliative care is a major global health agenda that need immediate attention. Main causes of inadequate pain relief remain lack of knowledge among physician and patients, lack of adequate supply of opioids and other drugs for pain relief, strong bureaucracy involved in terms of procurement, and dispensing of opioids. Beside this, poverty and illiteracy remain the most important factors of increased suffering.
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Affiliation(s)
- Shalini Saini
- Department of Anesthesiology, BLK Super Speciality Hospital, New Delhi, India
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
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Langer A, Meleis A, Knaul FM, Atun R, Aran M, Arreola-Ornelas H, Bhutta ZA, Binagwaho A, Bonita R, Caglia JM, Claeson M, Davies J, Donnay FA, Gausman JM, Glickman C, Kearns AD, Kendall T, Lozano R, Seboni N, Sen G, Sindhu S, Temin M, Frenk J. Women and Health: the key for sustainable development. Lancet 2015; 386:1165-210. [PMID: 26051370 DOI: 10.1016/s0140-6736(15)60497-4] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ana Langer
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Afaf Meleis
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Ruth Bonita
- University of Auckland, Auckland, New Zealand
| | - Jacquelyn M Caglia
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Jewel M Gausman
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Annie D Kearns
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Tamil Kendall
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rafael Lozano
- National Institute of Public Health, Cuernavaca, Mexico
| | - Naomi Seboni
- International Planned Parenthood Federation Governing Council, London, UK
| | - Gita Sen
- Indian Institute of Management, Bangalore, India
| | | | - Miriam Temin
- Center for Global Development, Washington, DC, USA
| | - Julio Frenk
- Harvard T H Chan School of Public Health, Boston, MA, USA
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Lysaght Hurley S, Barg FK, Strumpf N, Ersek M. Same agency, different teams: perspectives from home and inpatient hospice care. QUALITATIVE HEALTH RESEARCH 2015; 25:923-931. [PMID: 25294344 PMCID: PMC4454620 DOI: 10.1177/1049732314554091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Tremendous growth in hospice over the past 30 years in the United States has increased the number of terminally ill patients dying at home. Recently, however, more hospice patients are dying at inpatient facilities. To understand the varying perceptions about care in the home and inpatient hospice, we conducted semistructured interviews with 24 interdisciplinary team (IDT) members and analyzed the data using the constant comparative method. Core interdisciplinary tasks, including identifying the focus of energy, tailoring family caregiver involvement, acknowledging who is in charge, and knowing both sides differed in the home and inpatient settings. Despite the overarching umbrella of hospice care, home and inpatient hospice settings create different foci for IDT members, burdens and privileges for family caregivers, and control of the care plan. Key differences between home and inpatient hospice processes of care highlight the complexity of patient-centered end-of-life care in the United States.
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Affiliation(s)
| | - Frances K Barg
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Mary Ersek
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, Villarreal-Garza C, Unger-Saldaña K, Ferreyra M, Debiasi M, Liedke PER, Touya D, Werutsky G, Higgins M, Fan L, Vasconcelos C, Cazap E, Vallejos C, Mohar A, Knaul F, Arreola H, Batura R, Luciani S, Sullivan R, Finkelstein D, Simon S, Barrios C, Kightlinger R, Gelrud A, Bychkovsky V, Lopes G, Stefani S, Blaya M, Souza FH, Santos FS, Kaemmerer A, de Azambuja E, Zorilla AFC, Murillo R, Jeronimo J, Tsu V, Carvalho A, Gil CF, Sternberg C, Dueñas-Gonzalez A, Sgroi D, Cuello M, Fresco R, Reis RM, Masera G, Gabús R, Ribeiro R, Knust R, Ismael G, Rosenblatt E, Roth B, Villa L, Solares AL, Leon MX, Torres-Vigil I, Covarrubias-Gomez A, Hernández A, Bertolino M, Schwartsmann G, Santillana S, Esteva F, Fein L, Mano M, Gomez H, Hurlbert M, Durstine A, Azenha G. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14:391-436. [PMID: 23628188 DOI: 10.1016/s1470-2045(13)70048-2] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
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Affiliation(s)
- Paul E Goss
- Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
Accompanying the ascendance of cancer as a leading cause of death worldwide is a new set of global health priorities focused on palliative care--the relief of symptoms and suffering, optimization of functional status, and quality of life for those with advanced, potentially life-limiting illnesses. In high-income countries, palliative care improves outcomes for patients, caregivers, provider organizations, and health systems. Data are not yet available to demonstrate similar benefits in low- and middle-income countries, where access to even the most basic palliative interventions (eg, opioids for pain management) is inadequate and unevenly distributed. This article describes current global disparities in the availability of palliative care. We make the case for international prioritization of palliative care as a critical strategy for improving outcomes for people with cancer and their caregivers worldwide.
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Affiliation(s)
- David C Currow
- Flinders University Discipline, Palliative and Supportive Services, Bedford Park, South Australia, Australia.
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Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, Baugh V, Bekedam H, Billo N, Casswell S, Cecchini M, Colagiuri R, Colagiuri S, Collins T, Ebrahim S, Engelgau M, Galea G, Gaziano T, Geneau R, Haines A, Hospedales J, Jha P, Keeling A, Leeder S, Lincoln P, McKee M, Mackay J, Magnusson R, Moodie R, Mwatsama M, Nishtar S, Norrving B, Patterson D, Piot P, Ralston J, Rani M, Reddy KS, Sassi F, Sheron N, Stuckler D, Suh I, Torode J, Varghese C, Watt J. Priority actions for the non-communicable disease crisis. Lancet 2011; 377:1438-47. [PMID: 21474174 DOI: 10.1016/s0140-6736(11)60393-0] [Citation(s) in RCA: 1026] [Impact Index Per Article: 78.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis--leadership, prevention, treatment, international cooperation, and monitoring and accountability--and the delivery of five priority interventions--tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.
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Availability of palliative care services for children with cancer in economically diverse regions of the world. Eur J Cancer 2010; 46:2260-6. [PMID: 20541395 DOI: 10.1016/j.ejca.2010.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 03/23/2010] [Accepted: 05/04/2010] [Indexed: 02/01/2023]
Abstract
PURPOSE We assessed the availability and quality of palliative care for children with cancer according to national income per capita. METHODS We surveyed physicians who care for children with cancer using the Cure4Kids website (http://www.cure4kids.org). Queries addressed oncology practice site; reimbursement; specialised palliative care, pain management and bereavement care; location of death; decision-making support and perceived quality of care. Responses were categorised by low-, middle- and high-income country (LIC, MIC and HIC). RESULTS Of 262 completed questionnaires from 58 countries (response rate, 59.8%), 242 were evaluable (55%). Out-of-pocket payment for oncology (14.8%), palliative care (21.9%) and comfort care medications (24.3%) was most likely to be required in LIC (p<0.001). Availability of specialised palliative care services, pain management, bereavement care and institutional or national decision-making support was inversely related to income level. Availability of high-potency opioids (p=0.018) and adjuvant drugs (p=0.006) was significantly less likely in LIC. Physicians in LIC were significantly less likely than others to report high-quality pain control (p<0.001), non-pain symptom control (p=0.003) and emotional support (p=0.001); bereavement support (p=0.035); interdisciplinary care (p<0.001) and parental participation in decisions (p=0.013). CONCLUSION Specialised palliative care services are unavailable to children with cancer in economically diverse regions, but particularly in LIC. Access to adequate palliation is associated with national income. Programme development strategies and collaborations less dependent on a single country's economy are suggested.
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Coughlin SS, Ekwueme DU. Breast cancer as a global health concern. Cancer Epidemiol 2009; 33:315-8. [PMID: 19896917 DOI: 10.1016/j.canep.2009.10.003] [Citation(s) in RCA: 320] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 01/22/2023]
Abstract
Public health data indicate that the global burden of breast cancer in women, measured by incidence, mortality, and economic costs, is substantial and on the increase. Worldwide, it is estimated that more than one million women are diagnosed with breast cancer every year, and more than 410,000 will die from the disease. In low- and middle-income countries (LMCs), the infrastructure and resources for routine screening mammography are often unavailable. In such lower resource settings, breast cancers are commonly diagnosed at late stages, and women may receive inadequate treatment, pain relief, or palliative care. There have been an increasing number of global health initiatives to address breast cancer including efforts by Susan G. Komen for the Cure((c)), the Breast Health Global Initiative (BHGI), the U.S. Centers for Disease Control and Prevention (CDC), the American Cancer Society, the National Cancer Institute (NCI), and ongoing work by leading oncology societies in different parts of the world. To support such initiatives, and to provide a scientific evidence base for health policy and public health decision making, there is a need for further health services research and program evaluations. Cancer registries can be invaluable in ascertaining the magnitude of cancer disease burden and its distribution in these countries. Additional data are needed for various geographic areas to assess resources required, cost-effectiveness, and humane approaches for preventing or controlling breast cancer in low resource settings in developing countries.
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Affiliation(s)
- Steven S Coughlin
- Environmental Epidemiology Service, Office of Public Health and Environmental Hazards, Department of Veterans Affairs, Washington, DC, USA.
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