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Cascella M, Monaco F, Vittori A, Elshazly M, Carlucci A, Piazza O. Bridging knowledge gaps: a bibliometric analysis of non-invasive ventilation in palliative care studies. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:5. [PMID: 38268041 PMCID: PMC10809455 DOI: 10.1186/s44158-024-00140-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Despite being a useful strategy for providing respiratory support to patients with advanced or terminal illnesses, non-invasive ventilation (NIV) requires in-depth investigation in several key aspects. OBJECTIVES This bibliometric analysis seeks to comprehensively examine the existing research on the subject. Its goal is to uncover valuable insights that can inform the prediction trajectory of studies, guide the implementation of corrective measures, and contribute to the improvement of research networks. METHODS A comprehensive review of literature on NIV in the context of palliative care was conducted using the Web of Science core collection online database. The search utilized the key terms "non-invasive ventilation" and "palliative care" to identify the most relevant articles. All data were gathered on November 7, 2023. Relevant information from documents meeting the specified criteria was extracted, and Journal Citation Reports™ 2022 (Clarivate Analytics) served as the data source. The analysis employed literature analysis and knowledge visualization tools, specifically CiteScope (version 6.2.R4) and VOSviewer (version 1.6.20). RESULTS A dataset with bibliometric findings from 192 items was analyzed. We found a consistent upward of the scientific output trend over time. Guidelines on amyotrophic lateral sclerosis management received the highest number of citations. Most documents were published in top-ranked journals. Less than one-third of the documents pertain to clinical studies, especially retrospective analyses (25%). Key topics such as "decision making", and "communication" were less addressed. CONCLUSIONS Given the substantial clinical implications, further high-quality studies on this subject are recommended. Encouraging international collaborations is needed. Despite the growing volume of documents in the field, this bibliometric analysis indicates a decline in collaborative networks.
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Affiliation(s)
- Marco Cascella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy
| | | | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | | | - Annalisa Carlucci
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Ornella Piazza
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy.
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Rohilla KK, Kalyani CV, Gupta A, Gupta S, Gupta M, Matella N. Development and Validation of Palliative Care Bundle for Advanced Gallbladder Cancer "PALLICR". South Asian J Cancer 2023; 12:384-389. [PMID: 38130282 PMCID: PMC10733058 DOI: 10.1055/s-0043-1764377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Kusum K. RohillaBackground The aim of this study was to develop and validate a comprehensive palliative care bundle "PALLICR" for advanced gallbladder cancer (GBC) patients. Materials and Methods The present study was an exploratory study with instrument validation design which was conducted at All India Institute of Medical Sciences, Rishikesh, India. A total of 25 advance cancer patients were selected using the purposive sampling technique. Results The newly developed PALLICR bundle consists of six items under three subfactors, that is, functional recovery, resilience, and quality of life. The final version of bundle with six items of PALLICR bundle was validated and showed a good fit to provide palliative care to advanced GBC patients. Standardized scales, that is, palliative care outcome scale, European Organization for Research and Treatment of Cancer quality-of-life scale for patients and caregiver strain index for caregivers were used for evaluation of PALLICR bundle effectiveness. Conclusion PALLICR bundle is valid and reliable methods to provide palliative care to advanced GBC patients.
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Affiliation(s)
- Kusum K. Rohilla
- College of Nursing, All India Institute of Medical Sciences, Deoghar, India
| | - C Vasantha Kalyani
- College of Nursing, All India Institute of Medical Sciences, Deoghar, India
| | - Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Manoj Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
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Clark J, Salins N, Daniel S, Currow DC, Jones L, Pearson M, Bunton R, Mankel J, Braithwaite C, Gilchrist MM, Johnson MJ. Views and experiences of opioid access amongst palliative care providers and public representatives in a low-resource setting: A qualitative interview study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002401. [PMID: 37733698 PMCID: PMC10513320 DOI: 10.1371/journal.pgph.0002401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023]
Abstract
Opioids (e.g. morphine) are affordable, effective interventions for cancer-related pain. However, equity of access to this key medication remains a global challenge, particularly in low- and middle-income countries. We aimed to explore views of palliative care providers and public-representatives about opioid analgesia access in two States in India. We conducted a qualitative study using semi-structured interviews. Transcribed audio-recordings were subjected to thematic analysis using a Framework Approach. Palliative care providers and public-representatives were purposively sampled from services reporting consistent opioid availability and prescribing (≥4kg per annum) from Karnataka and Kerala. Twenty participants (doctors (10), nurses (4), pharmacists (2), service managers (2) and public-representatives (2) were interviewed. Three themes were identified: 1) Attitudes and awareness: opioid treatments are perceived as end-of-life (last days/weeks) interventions; fears of addiction and misunderstanding of pain management goals limit access. 2) Expected and unexpected inequities: patients/carers from lower socioeconomic strata accept doctor recommendations if opioids are affordable, more educated patients/families have reservations about opioids, delay access and perceive expensive medicines as better. Non-palliative care specialist doctors have negative entrenched views and require specialist training. 3) Experiential learning-positive experiences can positively alter attitudes (e.g., participants in Kerala report improved attitudes, awareness and understanding influenced by exposure and community awareness, but experience can also reinforce perceptions as end-of-life care. Entrenched negative views are reinforced by poor experiences while positive experiences improve attitudes. To promote access, opioid prescribing must be needs-based rather than prognosis-based. Addressing the lack of training for non-palliative care workforce would help overcome a major barrier.
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Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sunitha Daniel
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - David C. Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Lesley Jones
- Hull York Medical School, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Robin Bunton
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Joseph Mankel
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Christopher Braithwaite
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Marianne M. Gilchrist
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Miriam J. Johnson
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
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Samuels A, Lemos Dekker N. Palliative care practices and policies in diverse socio-cultural contexts: aims and framework of the ERC globalizing palliative care comparative ethnographic study. Palliat Care Soc Pract 2023; 17:26323524231198546. [PMID: 37706167 PMCID: PMC10496469 DOI: 10.1177/26323524231198546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Background Palliative care as a specialist professional practice of care for people with advanced illness is becoming increasingly influential worldwide. This process is affected by global health inequalities as well as cultural dimensions of approaching death and practicing care in life-limiting illness. Objectives The European Research Council-funded Globalizing Palliative Care (ENDofLIFE) project aims to understand how palliative care policies, discourses and practices are translated, adapted and reconstituted in diverse socio-cultural settings and how cultural dimensions of approaching death and local practices of care shape palliative care implementation. Methods and Analysis Using a multi-scalar and multi-sited ethnographic approach, the project uses person-centered ethnography, participant observation, semi-structured interviewing, focus group discussions and policy and discourse analysis at transnational, national and local levels. Ethnographic case-studies are conducted in Brazil, India and Indonesia. Discussion The globalizing palliative care project develops a novel ethnographic methodology of studying end-of-life care trajectories through long-term participant observation with individual patients and families as they manage and practice formal and informal health care in advanced illness. By analyzing how patients and families experience and navigate care over time, complemented by stakeholder interviews, the study advances critical theoretical insight into the relation between (large-scale and dynamically traveling) palliative care models, policies and discourses on the one hand and the experience and practice of palliative care in the lives of patients and informal care givers in local health care practices on the other hand. Insights are expected to benefit culturally situated palliative care policies and practices.
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Affiliation(s)
- Annemarie Samuels
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, The Netherlands
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Burden of respiratory problems in low-income and middle-income countries. Curr Opin Support Palliat Care 2022; 16:210-215. [PMID: 36102933 DOI: 10.1097/spc.0000000000000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Chronic respiratory diseases are a leading cause of morbidity and mortality in low-income and middle-income countries (LMICs). We aim to review prevalence of respiratory diseases and related symptoms, which contribute significantly to burden of disease in LMICs. We report global estimates of respiratory problems amongst adults in LMICs and recent findings relating to community prevalence and impact of respiratory problems. We conclude by identifying research priorities for improved recognition and palliation of respiratory problems. RECENT FINDINGS We report findings from 16 studies, highlighting key issues relevant to burden of respiratory problems in LMICs. COPD and associated symptoms are identified as important drivers of increasing respiratory problems in LMICs, with an estimated prevalence of 7.2%. Negative impacts of respiratory diseases include: reduced physical function (capacity to work), quality of life (depression; anxiety) and socioeconomic wellbeing (healthcare costs; earning potential). Locally appropriate palliative care interventions may improve quality of life without increasing costs. SUMMARY Prevention and treatment of respiratory diseases is essential for improved wellbeing. We identify missed opportunities for measurement and understanding of burden caused by respiratory problems within efforts to measure illness prevalence. We highlight need for symptom management interventions, developed in context of local cultural beliefs and behaviours.
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Whitelaw S, Bell A, Clark D. The expression of 'policy' in palliative care: A critical review. Health Policy 2022; 126:889-898. [PMID: 35840439 DOI: 10.1016/j.healthpol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
The importance of 'policy' within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a 'policy turn' in palliative care. Applying Bacchi's "What's the Problem Represented to Be?" (WPR) framework to data from a systematic search, we address the research question, "in what ways has 'policy' been articulated in palliative care literature?". The paper describes the construction of 'the problem' context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of 'Global North' approaches; (3) the use of a policy narrative based on 'catastrophe' in justifying the need for palliative care; (4) the use of idealistic and aspirational 'calls to action'; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on 'Global South' perspectives, 'assets-based' approaches and attention to pragmatic implementation.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom.
| | - Anthony Bell
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
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Clark J, Crowther L, Johnson MJ, Ramsenthaler C, Currow DC. Calculating worldwide needs for morphine for pain in advanced cancer and proportions feasibly met by country estimates of requirements and consumption. Retrospective, time-series analysis (1997-2017). PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000533. [PMID: 36962467 PMCID: PMC10021698 DOI: 10.1371/journal.pgph.0000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
Abstract
Lack of access to therapeutic opioids continuing causes global health inequalities. Access to morphine for symptom control is regulated under the terms of the Single Convention on Narcotics, countries must submit annual morphine requirement estimates and report consumption to the International Narcotics Control Board (INCB). INCB indicates access to morphine is increasing, however, estimated needs are unreported so changing proportions of needs feasibly met by requirements and consumption are unknown. Retrospective time series-analysis taking cross-sections every five years of gaps between calculated needs for morphine for people who die from cancer and total treatable using estimates of requirements and consumption (1997, 2002, 2007, 2012, 2017). We calculated need using INCB-recommended methods (80% of people who die from cancer require 67.5mg of morphine daily for 90 days (6.075g)) for countries reporting estimates and consumption using Global Burden of Disease cancer deaths by country. Gaps between calculated need and total treatable population using estimates and consumption were calculated. We report proportions of need feasibly met by estimates and consumption for included countries, by World Bank Income group. Global availability of morphine increased, from estimates sufficient to treat 86% of calculated needs in 1997, to 701% in 2017. However, proportion of countries estimating requirements feasibly meeting >100% of calculated needs rose only from 16% to 30%. Almost all Low-and-Middle-Income Countries submitted inadequate estimates with little change in 20 years. Consumption was lower than calculated needs at all time-points. Very few countries reported consumption greater than their estimate of requirement. Most countries submitted morphine estimates insufficient to meet analgesic needs of people who died from cancer. Estimates of requirements contextualise future Consumption, and increases in adequacy of estimates and consumption were minimal over 20 years. Annual publication of calculated morphine needs alongside estimates and consumption may be a key step to drive countries' accountabilities.
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Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
| | - Lucia Crowther
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
| | - Christina Ramsenthaler
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
- Faculty of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
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Jane Bates M, Gordon MRP, Gordon SB, Tomeny EM, Muula AS, Davies H, Morris C, Manthalu G, Namisango E, Masamba L, Henrion MYR, MacPherson P, Squire SB, Niessen LW. Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study. Lancet Glob Health 2021; 9:e1750-e1757. [PMID: 34756183 PMCID: PMC8600125 DOI: 10.1016/s2214-109x(21)00408-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. METHODS In this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed. FINDINGS We recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was -36% (95% CI -94 to 594; p=0·707). INTERPRETATION Vulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified. FUNDING Wellcome Trust; National Institute for Health Research; and EMMS International.
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Affiliation(s)
- Maya Jane Bates
- Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Miriam R P Gordon
- Department of Economics, Global Development Institute, University of Manchester, Manchester, UK
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Ewan M Tomeny
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adamson S Muula
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Helena Davies
- Worldwide Hospice Palliative Care Alliance, London, UK
| | - Claire Morris
- Worldwide Hospice Palliative Care Alliance, London, UK
| | - Gerald Manthalu
- Department of Planning, Ministry of Health, Lilongwe, Malawi
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Leo Masamba
- Department of Medicine, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi
| | - Marc Y R Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi; London School of Hygiene & Tropical Medicine, London, UK
| | - S Bertel Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louis W Niessen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Johns Hopkins School of Public Health, Baltimore, MD, USA
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Sánchez-Cárdenas MA, Garralda E, Benítez E, Arias-Casais N, van Steijn D, Centeno C. Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010753. [PMID: 34682495 PMCID: PMC8535241 DOI: 10.3390/ijerph182010753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
Background: The coverage of palliative care (PC) may be understood as a country’s capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countries´ coverage capacities. Method: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. Results: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. Conclusion: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs.
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Affiliation(s)
- Miguel Antonio Sánchez-Cárdenas
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
- Correspondence:
| | - Eduardo Garralda
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
| | - Edgar Benítez
- DATAI, Instituto de Ciencia de los Datos e Inteligencia Artificial, University of Navarra, 31001 Pamplona, Spain;
| | - Natalia Arias-Casais
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
| | - Danny van Steijn
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
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Sánchez-Cárdenas MA, Garralda E, Arias-Casais NS, Benitez Sastoque ER, Van Steijn D, Moine S, Murray SA, Centeno C. Palliative care integration indicators: an European regional analysis. BMJ Support Palliat Care 2021:bmjspcare-2021-003181. [PMID: 34518283 DOI: 10.1136/bmjspcare-2021-003181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/28/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To estimate the capacity of European countries to integrate palliative care (PC) into their health systems through PC service provision for patients of all ages, with different care needs and diseases, in various settings and by a range of providers. METHODS Secondary analysis of survey data from 51 countries with 22 indicators explored the integration of available PC resources for children, for patients of all ages, at the primary care level, for oncology and cardiac patients, and in long-term care facilities. We also measured volunteer participation. Results were quantified, converted into weighted subscores by area and combined into a single 'Integration Capacity Score (ICS)' for each country. RESULTS Thirty-eight countries reported 543 specialised paediatric PC services. One-third of all surveyed countries reported 20% or more of patients with PC needs at the primary care level. Twenty-four countries have a total of 155 designated centres that integrate oncology and PC. Eight countries were pioneering cardiology services that integrate PC. Eight reported a volunteer workforce of over 1000 and 12 had policies regulating PC provision and interventions in long-term care facilities. Across all indicators, 39 countries (76%) score from low to very low integration capacity, 8 (16%) score at an intermediate level, and 4 (8%; the Netherlands, UK, Germany and Switzerland) report a high-level integration of PC into their health systems. CONCLUSION Variable progress according to these indicators shows that most European countries are still in the process of integrating PC into their health systems.
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Affiliation(s)
| | - Eduardo Garralda
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Natalia Sofia Arias-Casais
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | | | - Danny Van Steijn
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Sébastien Moine
- Health Education and Practices Laboratory, University of Paris 13, Paris, France
- Primary Palliative Care Research Group, The University of Edinburgh, Edinburgh, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, The University of Edinburgh, Edinburgh, UK
| | - Carlos Centeno
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain
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McNeil MJ, Kaye EC, Vedaraju Y, Baker JN, Devidas M, Downing J, Graetz D, Ranadive R, Rosenberg AR, Wiener L, Weaver MS. Global Experiences of Pediatric Palliative Care Teams During the First 6 Months of the SARS-CoV-2 Pandemic. J Pain Symptom Manage 2021; 62:e91-e99. [PMID: 33794302 PMCID: PMC8007190 DOI: 10.1016/j.jpainsymman.2021.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/02/2021] [Accepted: 03/24/2021] [Indexed: 01/12/2023]
Abstract
CONTEXT The coronavirus pandemic (COVID-19) has profoundly impacted the provision of pediatric palliative care (PPC) interventions including goals of care discussions, symptom management, and end-of-life care. OBJECTIVE Gaining understanding of the professional and personal experiences of PPC providers on a global scale during COVID-19 is essential to improve clinical practices in an ongoing pandemic. METHODS The Palliative Assessment of Needed DEvelopments & Modifications In the Era of Coronavirus Survey-Global survey was designed and distributed to assess changes in PPC practices resulting from COVID-19. Quantitative and qualitative data were captured through the survey. RESULTS One hundred and fifty-six providers were included in the final analysis with 59 countries and six continents represented (31% from lower- or lower middle-income countries). Nearly half of PPC providers (40%) reported programmatic economic insecurity or employment loss. Use of technology influenced communication processes for nearly all participants (91%), yet most PPC providers (72%) reported receiving no formal training in use of technological interfaces. Respondents described distress around challenges in provision of comfort at the end of life and witnessing patients' pain, fear, and isolation. CONCLUSIONS PPC clinicians from around the world experienced challenges related to COVID-19. Technology was perceived as both helpful and a hinderance to high quality communication. The pandemic's financial impact translated into concerns about programmatic sustainability and job insecurity. Opportunities exist to apply these important experiential lessons learned to improve and sustain care for future patients, families, and interdisciplinary teams. ARTICLE SUMMARY This original article describes the impact of the COVID-19 pandemic on pediatric palliative care clinicians from 59 countries including financial losses, use of virtual communication modalities, and the respondents' distress in provision of comfort at the end of life.
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Affiliation(s)
- Michael J McNeil
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, Tennesse, USA; St. Jude Children's Research Hospital, Division of Quality and Life and Palliative Care, Department of Oncology, Memphis, Tennesse, USA.
| | - Erica C Kaye
- St. Jude Children's Research Hospital, Division of Quality and Life and Palliative Care, Department of Oncology, Memphis, Tennesse, USA
| | - Yuvanesh Vedaraju
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, Tennesse, USA
| | - Justin N Baker
- St. Jude Children's Research Hospital, Division of Quality and Life and Palliative Care, Department of Oncology, Memphis, Tennesse, USA
| | - Meenakshi Devidas
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, Tennesse, USA
| | - Julia Downing
- International Children's Palliative Care Network, Assagay, South Africa
| | - Dylan Graetz
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, Tennesse, USA
| | - Radhikesh Ranadive
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, Tennesse, USA
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA; Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Lori Wiener
- National Institutes of Health, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Meaghann S Weaver
- National Center for Ethics in Healthcare, Washington, District of Columbia, USA; Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
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12
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Sánchez-Cárdenas MA, León MX, Rodríguez-Campos LF, Correa Morales JE, Buitrago Reyes LA, Vargas Villanueva MA, Garralda E, Van Steijn D, Centeno C. The Development of Palliative Care in Colombia: An Analysis of Geographical Inequalities Through the Application of International Indicators. J Pain Symptom Manage 2021; 62:293-302. [PMID: 33348032 DOI: 10.1016/j.jpainsymman.2020.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT The national evaluation of an individual country is a tool used to improve the universal provision of palliative care. The evaluation of a country's internal situation, by means of an analysis of the development of palliative care by region, may also be an instrument for improvement. OBJECTIVES The aim of this study was to understand the regional development of palliative care in Colombia, through the application of international indicators. METHODS Regional development was analyzed for Colombia, with a country-specific adaptation of the evaluation method used in the latest edition of the Palliative Care World Map (Clark D, 2020), the need for palliative care per death with serious health-related suffering (Knaul FN, 2019), and the coverage of specialized services, following European standards (Centeno, 2016). A total of 33 of the country's regions were classified. RESULTS Some 41% of the people who die in Colombia need palliative care. The average figure for specialized services is 0.5/100,000 inhabitants, with a maximum coverage of 51%. In Colombia, there are 12 regions with a generalized level of provision; six regions with isolated provision, nine regions developing their capacity, four with no known activity, and two at an advanced level of palliative care integration. The regions with the highest level of palliative care development coincide with higher demand and coverage of specialized services. CONCLUSION Regional palliative care development is unequal and unbalanced. Applying international indicators to levels of regional development allows for the identification of geographical inequalities and highlights low palliative care development, especially in the rural areas of the country.
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Affiliation(s)
| | | | | | | | | | | | - Eduardo Garralda
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Danny Van Steijn
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain
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13
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Clark J, Gnanapragasam S, Greenley S, Pearce J, Johnson M. Perceptions and experiences of laws and regulations governing access to opioids in South, Southeast, East and Central Asia: A systematic review, critical interpretative synthesis and development of a conceptual framework. Palliat Med 2021; 35:59-75. [PMID: 33118448 PMCID: PMC7797616 DOI: 10.1177/0269216320966505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Opioids are essential medicines. Despite international and national laws permitting availability, opioid access remains inadequate, particularly in South, Southeast, East and Central Asia. AIM To review evidence of perceptions and experiences of regulatory enablers and barriers to opioid access in South, Southeast, East and Central Asia. DESIGN Systematic review of post-2000 research according to PRISMA guidelines. Data were subjected to critical interpretive synthesis. International, national and sub-national barriers were organised developing a conceptual framework of opioid availability. DATA SOURCES PsycINFO, Medline, Embase, The Cochrane Library. CINAHL, Complete and ASSIA from 2000 until 20th May 2019. RESULTS 21/14097 studies included: quantitative n = 15, qualitative n = 3 and mixed-methods n = 3. Four barrier/enabler themes were developed: Legal, regulatory, socio-political; lack of laws explicitly enabling opioid access, restrictive international controls and clinician prescribing concerns. Opioid availability; limited availability, poor policymaker and clinician education regarding opioid benefits, poor continuity of supply. Opioid Accessibility; medicine costs, distance to prescribing centres. Prescribing; extensive bureaucratic barriers, lack of human resources for prescribing. We present a novel framework of a self-perpetuating model of inadequate opioid provision. The Single Convention on Narcotics provides the context of restrictive laws and negative attitudes amongst policymakers. A consequent lack of prescribers and clinicians' negative attitudes at sub-national levels, results in inadequate access to and use of opioids. Data of inadequate consumption informs annual requirement estimates used by the International Narcotics Control Board to determine future opioid availability. CONCLUSIONS Regulatory and socio-political actions unintentionally limit opioid access. International and national laws explicitly enabling opioid access are required, to assuage concerns, promote training and appropriate prescribing.
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Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Sam Gnanapragasam
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Jessica Pearce
- Leeds Teaching Hospitals, University of Leeds, Leeds, UK
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
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14
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Nguyen M, Fujioka J, Wentlandt K, Onabajo N, Wong I, Bhatia RS, Bhattacharyya O, Stamenova V. Using the technology acceptance model to explore health provider and administrator perceptions of the usefulness and ease of using technology in palliative care. BMC Palliat Care 2020; 19:138. [PMID: 32895060 PMCID: PMC7476427 DOI: 10.1186/s12904-020-00644-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have shown that telehealth applications in palliative care are feasible, can improve quality of care, and reduce costs but few studies have focused on user acceptance of current technology applications in palliative care. Furthermore, the perspectives of health administrators have not been explored in palliative care and yet they are often heavily involved, alongside providers, in the coordination and use of health technologies. The study aim was to explore both health care provider and administrator perceptions regarding the usefulness and ease of using technology in palliative care. METHODS The Technology Acceptance Model (TAM) was used as the guiding theoretical framework to provide insight into two key determinants that influence user acceptance of technology (perceived usefulness and ease of use). Semi-structured interviews (n = 18) with health providers and administrators with experience coordinating or using technology in palliative care explored the usefulness of technologies in palliative care and recommendations to support adoption. Interview data were analyzed using inductive thematic analysis to identify common, meaningful themes. RESULTS Four themes were identified; themes related to perceived usefulness were: enabling remote connection and information-sharing platform. Themes surrounding ease of use included: integration with existing IT systems and user-friendly with ready access to technical support. Telehealth can enable remote connection between patients and providers to help address insufficiencies in the current palliative care environment. Telehealth, as an information sharing platform, could support the coordination and collaboration of interdisciplinary providers caring for patients with palliative needs. However, health technologies need to passively integrate with existing IT systems to enhance providers' workflow and productivity. User-friendliness with ready access to technical support was considered especially important in palliative care as patients often experience diminished function. CONCLUSION Participants' perspectives of technology acceptance in palliative care were largely dependent on their potential to help address major challenges in the field without imposing significant burden on providers and patients.
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Affiliation(s)
- M Nguyen
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada.
| | - J Fujioka
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - K Wentlandt
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - N Onabajo
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - I Wong
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - R S Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - O Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - V Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
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McNeil MJ, Namisango E, Hunt J, Powell RA, Baker JN. Grief and Bereavement in Parents After the Death of a Child in Low- and Middle-Income Countries. CHILDREN-BASEL 2020; 7:children7050039. [PMID: 32369937 PMCID: PMC7278603 DOI: 10.3390/children7050039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/20/2020] [Accepted: 04/26/2020] [Indexed: 11/23/2022]
Abstract
While great strides have been made in improving childhood mortality, millions of children die each year with significant health-related suffering. More than 98% of these children live in low- and middle-income countries (LMICs). Efforts have been made to increase access to pediatric palliative care (PPC) services to address this suffering in LMICs through policy measures, educational initiatives, and access to essential medicines. However, a core component of high-quality PPC that has been relatively neglected in LMICs is grief and bereavement support for parents after the death of their child. This paper reviews the current literature on parental grief and bereavement in LMICs. This includes describing bereavement research in high-income countries (HICs), including its definition, adverse effect upon parents, and supportive interventions, followed by a review of the literature on health-related grief and bereavement in LMICs, specifically around: perinatal death, infant mortality, infectious disease, interventions used, and perceived need. More research is needed in grief and bereavement of parents in LMICs to provide them with the support they deserve within their specific cultural, social, and religious context. Additionally, these efforts in LMICs will help advance the field of parental grief and bereavement research as a whole.
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Affiliation(s)
- Michael J. McNeil
- Department of Hospice and Palliative Medicine, University of Tennessee Health Science Center, Memphis, TN 38103, USA
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Correspondence: ; Tel.: +38-672-(901)-595-3300
| | - Eve Namisango
- African Palliative Care Association, P.O. Box 72518, Kampala, Uganda;
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London WC2R 2LS, UK
| | | | | | - Justin N. Baker
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
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Taylor GH, Krakauer EL, Sanders JJ. "Find Out What They Lack, Try to Provide": A Qualitative Investigation of Palliative Care Services Adapted to Local Need in a Low-Resource Setting. J Palliat Med 2020; 23:792-800. [PMID: 31910351 DOI: 10.1089/jpm.2019.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: People in low- and middle-income countries with serious health problems rarely have access to palliative care. Promising models of palliative care delivery have emerged in India despite widespread poverty and poor health care infrastructure. Objective: To explore structural and philosophical aspects of palliative care delivery in a low-resource setting. Design: One author spent six months as a participant observer at Pallium India (PI), a nongovernmental organization recognized for leadership in palliative care delivery in Kerala, India. We collected administrative data, conducted semistructured interviews with key stakeholders, and observed clinical encounters and other organization-led events. Results: We performed 73 interviews with patients, families, clinicians, staff, and volunteers, and observed 180 patient encounters. The majority of palliative care patients did not have cancer. Many had chronic diseases that were not immediately life threatening. Services addressed a broad range of patients' medical, psychological, social, and/or financial needs. PI's care delivery maximizes accessibility. Conclusions: PI employs an expansive definition of palliative care and adapts services to respond to patients' diverse needs. This accessible, people-centered care is necessary in low-resource settings to alleviate multifaceted suffering caused by gaps in the health care system, poor social support, and poverty.
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Affiliation(s)
- Grace H Taylor
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Eric L Krakauer
- Department of Global Health and Social Medicine, Harvard Medical School, Global Palliative Care Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Justin J Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Ariadne Labs, Boston, Massachusetts, USA
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17
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Chan HYL, Lee DTF, Woo J. Diagnosing Gaps in the Development of Palliative and End-of-Life Care: A Qualitative Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010151. [PMID: 31878235 PMCID: PMC6982034 DOI: 10.3390/ijerph17010151] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022]
Abstract
A global report found that the quality of dying in Hong Kong lagged behind that of other high-income economies. This study aims to examine the service gaps by conducting a qualitative exploratory study from multiple stakeholders’ perspectives. Purposive and snowball sampling strategies were used to maximize variation in the sample. We interviewed 131 participants, including patients, family members, health care providers, administrators, lawyers, and policy makers. The situation analysis helped identify the facilitators and barriers at individual, organizational, and socio-cultural levels that affect service development. Findings showed that awareness on palliative and end-of-life care is growing, but the existing care is limited in terms of acceptability, coverage, variation in practices, continuity, and sustainability. A number of policy, economic, socio-cultural, environmental, and legal factors were also found to hinder service development. Findings of this study demonstrated that the development of palliative and end-of-life care services involved a paradigm shift relating to society as a whole. The overarching theme is to formulate a government-led policy framework. Furthermore, a public health approach has been advocated to create a supportive environment for service development.
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Affiliation(s)
- Helen Y. L. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Correspondence:
| | - Diana T. F. Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jean Woo
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, China
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18
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Clark J, Barnes A, Campbell M, Gardiner C. A Life or "Good Death" Situation? A Worldwide Ecological Study of the National Contexts of Countries That Have and Have Not Implemented Palliative Care. J Pain Symptom Manage 2019; 57:793-801.e11. [PMID: 30594568 DOI: 10.1016/j.jpainsymman.2018.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 11/26/2022]
Abstract
CONTEXT Palliative care advocates argue that service implementation is feasible in all settings. Yet, services have developed patchily in low- and middle-income settings. Beyond Human Development Index indicators, there has been limited engagement with the broader development challenges facing nations tasked with implementing palliative care. OBJECTIVE The objective of this study was to describe how indicators of national development relate to levels of palliative care services in 207 countries around the world. METHODS We conducted a ecological study to identify relationships between potential predictor variables and the level of national palliative care development. A total of 28 predictor variables from the following six domains were selected using hypothesized relationships with levels of palliative care development: disease demographics, socioeconomics, health systems, politics, demographics, and economics. The outcome variable was level of national palliative care development on a six-point scale. Spearman's correlation was used to measure the strength of the association. RESULTS Twenty-six of 28 variables were statistically significantly associated with levels of palliative care development in 207 countries. Palliative care is more developed in countries with high-percentage of deaths from noncommunicable disease, population proportion aged 65+ years, gross national income, and tourism. Development is lower in countries with high levels of political corruption, infant mortality, deaths by infectious diseases, and weak democracy. Prevalence of undernourishment and levels of private health expenditure were not significantly associated with palliative care development. CONCLUSION Palliative care development is highly consistent with broader national development indicators. It is less in countries where sudden deaths are more likely and benefits from palliative care provision are likely to be very limited. In such countries, resources may be prioritized toward life-prolonging therapies and key aspects of palliative care need only be implemented before fully integrated palliative services. Findings suggest that there may be a "tipping point" in societies, where the relative need for life-prolonging therapies becomes less than the need for integrated palliative care services.
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Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom.
| | - Amy Barnes
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Mike Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Clare Gardiner
- School of Nursing and Midwifery, University of Sheffield, Sheffield, United Kingdom
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