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Gallo Marin B, Oliva R, Anandarajah G. Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study. Am J Hosp Palliat Care 2024; 41:508-515. [PMID: 37408485 DOI: 10.1177/10499091231188693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Context: Hospice services are underutilized by the Latino community in the United States. Previous research has identified that language is a key barrier contributing to disparities. However, very few studies have been conducted in Spanish to specifically explore other barriers to hospice enrollment or values related to end-of-life (EOL) care in this community. Here, we remove the language barrier in order to gain an in-depth understanding of what members of the diverse Latino community in one state in the USA considers high quality EOL and barriers to hospice. Methods: This exploratory semi-structured individual interview study of Latino community members was conducted in Spanish. Interviews were audio-recorded, transcribed verbatim and translated to English. Transcripts were analyzed by three researchers, using a grounded-theory approach to identify themes and sub-themes. Main Findings: Six major themes emerged: (1) concept of "a good death"-spiritual peace, family/community connection, no burdens left behind; (2) centrality of family; (3) lack of knowledge about hospice/palliative care; (4) Spanish language as critical; (5) communication style differences; and (6) necessity for cultural understanding. The central theme of "a good death" was closely linked to having the entire family physically and emotionally present. The four other themes represent interrelated, compounding barriers to achieving this "good death." Principal Conclusions: Healthcare providers and the Latino community can work together to decrease hospice utilization disparities by: actively involving family at every step; addressing misconceptions regarding hospice; conducting important conversations in Spanish; and improving provider skills in culturally sensitive care, including communication style.
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Affiliation(s)
| | - Rocío Oliva
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gowri Anandarajah
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Hope Hospice and Palliative Care Rhode Island, Providence, RI, USA
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2
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Pergolizzi J, LeQuang JAK, Wagner M, Varrassi G. Challenges in Palliative Care in Latin America: A Narrative Review. Cureus 2024; 16:e60698. [PMID: 38899235 PMCID: PMC11186623 DOI: 10.7759/cureus.60698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
In "graying" populations with extended lifespans and survivable forms of cancer, palliative services become increasingly important but may be difficult to introduce into public discourse, public policy, and healthcare systems. Latin America (LATAM) faces many challenges as it introduces and, in some cases, develops its palliative care programs; though the challenges faced here are in many ways universal ones, LATAM approaches may be unique and based on the region's specific culture, politics, and economics. This narrative review based on a literature search identified 10 main themes that can be interpreted as challenges and opportunities for palliative care in LATAM. These challenges are integrating palliation into healthcare systems; public policy and funding; therapeutic obstinacy; changing demographics; access to services; analgesia; the role of religion, spirituality, and folk medicine; social determinants of palliative care; low health literacy; and limited clinician training. Some of the LATAM nations have palliative programs and palliative care training in place while others are developing these systems. Integrating this care into existing healthcare and reimbursement systems has been a challenge. A notable challenge in LATAM is also access to care since palliative programs tend to cluster in metropolitan areas and create hardships for rural citizens to access them. The better-defined role of familial caregivers and telehealth may be important factors in the expansion of palliative care in LATAM and beyond.
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Affiliation(s)
- Joseph Pergolizzi
- Anesthesiology - Pain Medicine and Critical Care Medicine, NEMA Research, Inc., Naples, USA
| | | | - Morgan Wagner
- Entrepreneur Program, NEMA Research, Inc., Naples, USA
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Riano I, Velazquez AI, Viola L, Abuali I, Jimenez K, Abioye O, Florez N. State of Cancer Control in South America: Challenges and Advancement Strategies. Hematol Oncol Clin North Am 2024; 38:55-76. [PMID: 37353378 DOI: 10.1016/j.hoc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Cancer is a major public health problem in South America. The cancer mortality burden is increasing in the region due to its presentation at later stages, which is related to limited access to cancer care. This results in a noticeable inequity in provisions of cancer care including specialized screening programs, as well as cancer-related treatments such as personalized medicine, radiation therapy, palliative care, and survivorship services. Consequently, South America faces many challenges for cancer control, most of them deriving from a lack of funding and unequal distribution of resources and cancer services, affecting mostly the underserved populations in the region.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, One Medical Drive, Lebanon, NH 03766, USA.
| | - Ana I Velazquez
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. https://twitter.com/AnaVManana
| | - Lucia Viola
- Fundación Neumológica Colombiana, Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Cra. 13b #161 - 85, Bogotá, Colombia. https://twitter.com/LuciaViola9
| | - Inas Abuali
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. https://twitter.com/Inas_md
| | - Kathya Jimenez
- Universidad Evangelica de El Salvador, El Salvador. https://twitter.com/KathyaJimenezMD
| | - Oyepeju Abioye
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa. https://twitter.com/AbioyeOyepeju
| | - Narjust Florez
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA. https://twitter.com/NarjustFlorezMD
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Stoltenberg M, Leiva-Vásquez O, Pérez-Cruz PE, Daubman BR. The development of an advanced diploma program for palliative care leaders in Chile. Palliat Care Soc Pract 2023; 17:26323524231209057. [PMID: 38144972 PMCID: PMC10748680 DOI: 10.1177/26323524231209057] [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] [Received: 06/09/2023] [Accepted: 10/04/2023] [Indexed: 12/26/2023] Open
Abstract
Context The majority of people with serious health-related suffering in low- and middle-income countries lack access to palliative care (PC). Increased access to PC education is greatly needed. Objectives This paper describes the process to adapt an advanced PC training course for a Chilean context. Methods A joint team of intercultural PC educators from the US and Chile conducted a series of key informant interviews and a target audience survey to iteratively design a PC training course in Chile. Results Eight key informant interviews identified a strong need for formal PC education pathways, confirmed the five central learning domains, and helped to identify potential course sub-topics. A target audience survey of 59 PC providers from across Chile confirmed a strong desire to participate in such a course. Conclusion Our team of intercultural PC educators adapted an advanced PC course to the unique context of Chilean providers.
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Affiliation(s)
- Mark Stoltenberg
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Ofelia Leiva-Vásquez
- Sección Medicina Paliativa - Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro E. Pérez-Cruz
- Sección Medicina Paliativa - Escuela de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Of 523, Santiago 8330077, Chile
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Sánchez-Cárdenas MA, León-Delgado MX, Rodríguez-Campos LF, Correa-Morales JE, González-Salazar LV, Cañón Piñeros ÁM, Fuentes-Bermúdez GP, María Vargas-Escobar L. Building an action plan to tackle palliative care inequality through multi-stakeholder platforms. Palliat Care Soc Pract 2023; 17:26323524231189520. [PMID: 37584058 PMCID: PMC10424546 DOI: 10.1177/26323524231189520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023] Open
Abstract
Background To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care. Objective Build up Colombia's palliative care plan through stakeholder consensus. Method Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities). Results The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers. Conclusions The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.
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McNeil MJ, Godfrey A, Loggetto P, de Oliveira Junior A, Job G, Boldrini E, Regina Costa Murra G, Antunes Geronutti Ayub D, Francisco Oliveira de Lima A, Esmeraldo Andrade de Almeida A, Lopes Garcia J, Beatriz Costa Neves do Amaral A, Cristina Cunha Ferreira e Fonseca I, Friedrich P, Metzger ML, Devidas M, Agulnik A, Baker JN. Physician Perceptions of and Barriers to Pediatric Palliative Care for Children With Cancer in Brazil. JCO Glob Oncol 2023; 9:e2300057. [PMID: 37535886 PMCID: PMC10581636 DOI: 10.1200/go.23.00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/02/2023] [Accepted: 06/13/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE Early integration of pediatric palliative care (PPC) for children with cancer is critical to improving the quality of life of both the patient and family. Understanding physician perceptions of palliative care and perceived barriers to early integration is necessary to develop PPC in Brazil. METHODS The Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in Brazil. The survey was open from January 2022 to June 2022 and distributed to physicians of all specialties from participating institutions who treat children with cancer. Statistical analysis was complemented by qualitative analysis of open-ended responses. RESULTS A total of 272 respondents participated. Most respondents reported access to PPC experts for consultation (77.2%) and 34.5% indicated previous palliative care training. Physician knowledge of PPC was generally aligned with WHO guidance (median alignment, 93.0%; range, 80.5%-98.2%). However, about half (53.3%) felt comfortable addressing physical needs of patients receiving PPC, 35.3% addressing emotional needs, 25.8% addressing spiritual needs, and 33.5% addressing grief and bereavement needs. Most respondents (65.4%) felt palliative care should be involved from diagnosis, but only 10.3% stated that this occurred in their setting. The most important barriers identified were physician discomfort (89.0%), limited physician knowledge (88.6%), and lack of home-based services (83.8%). CONCLUSION Despite a strong understanding of the role of palliative care, physicians in Brazil reported low confidence delivering PPC to children with cancer. Additionally, physicians generally believed that PPC should be integrated earlier in the disease trajectory of children with cancer. This work will direct educational and capacity building initiatives to ensure greater access to high-quality PPC for children with cancer in Brazil to address patient and family suffering.
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Affiliation(s)
- Michael J. McNeil
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Patricia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | | | - Godwin Job
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Erica Boldrini
- Hospital de Câncer Infantojuvenil de Barretos, Barretos, Brazil
| | | | | | | | | | - Julia Lopes Garcia
- Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - 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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Maher F, Mammas IN, Spandidos DA. Challenges and perspectives of palliative medicine: A webinar by the Paediatric Virology Study Group. MEDICINE INTERNATIONAL 2023; 3:24. [PMID: 37153162 PMCID: PMC10155253 DOI: 10.3892/mi.2023.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
Palliative medicine focuses on the quality of life of patients with incurable conditions, who require the adequate relief of physical symptoms, adequate information to make decisions and spiritual wellbeing. Generalist palliative care is provided by family members, general practitioners, care home workers, community nurses and social care providers, as well as non-specialist hospital doctors and nurses. Patients with more complex, physical or psycho-social problems require the shared work of specialized doctors in palliative medicine, nurses, social workers and allied professionals. It is estimated that ~40 million patients require palliative care annually, worldwide; of these, 8 out of 10 patients reside in low- or middle-income countries, and only ~14% are able to access this type of care. Palliative medicine was recognised as a distinct medical specialty in the UK in 1987, with its own specialist curriculum and training pathway, which was recently revised in 2022. The main obstacles that palliative medicine had to overcome in order to be accepted as a separate specialization were the following: i) Defining a unique body of knowledge; ii) standardisation of training; and iii) proving that it warranted being a specialty in its own right. Over the past decade, it has been accepted as more than end-of-life care, supporting patients with an incurable illness at much earlier stages. Given the current absence of specialized palliative care in low- or middle-income countries, as well as the aging population across most European countries and the USA, it is estimated that there may be an increasing need and demand for specialists in palliative medicine in the ensuing years. This article is based on a webinar on palliative medicine, which was performed on October 20, 2022 in the context of the '8th Workshop of Paediatric Virology' organized by the Institute of Paediatric Virology based on the island of Euboea (Greece).
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Affiliation(s)
- Fergus Maher
- Department of Palliative Medicine, Norfolk and Norwich University Hospitals, NHS Foundation Trust, NR4 7UY Norwich, UK
- Norwich Medical School, University of East Anglia, NR4 7TJ Norwich, UK
| | - Ioannis N. Mammas
- Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
- Correspondence to: Professor Demetrios A. Spandidos, Laboratory of Clinical Virology, Medical School, University of Crete, Voutes, 71003 Heraklion, Greece
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Liñeiro MG, Santos Garcia JB, Narváez Tamayo MA, Gómez López MP, Martineau DB, Castroman PJ, Molina-Muñiz HG, Del Villar BM. Map of Pain Education in Latin America: current state and perspectives. Pain Manag 2023; 13:193-199. [PMID: 36970884 DOI: 10.2217/pmt-2022-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
The Latin American Map of Pain Education initiative has developed steadily in recent years. A recent survey yields important new data on the current state and allows outlining of the next steps to improve pain education in Latin American countries. A survey conducted by Federación Latinoamericana de Asociaciones para el Estudio del Dolor (FEDELAT) with data from 19 Latin American countries showed that a generally observed barrier is the lack of adequately trained pain professionals and the insufficient number of pain centers. There is a need for formal programs of pain education and palliative care in undergraduate and graduate programs. These programs should be accessible not only to physicians but to all types of healthcare professionals involved in the management of pain patients. The article includes some recommendations that will certainly be helpful in improving pain education over the next decade in Latin America.
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Vahos J, Rojas-Cortés R, Daza D, Osorio-Florez LC, Macías Saint-Gerons D, Pastrana T, Muñoz S, Fitzgerald J, Porrás A, Luciani S, Castro JL. Barriers of Access to Opioid Medicines within the Context of Palliative Care in Latin America: The Perception of Health Professionals. J Palliat Med 2023; 26:199-209. [PMID: 36040320 PMCID: PMC9894602 DOI: 10.1089/jpm.2022.0122] [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: 02/05/2023] Open
Abstract
Background: Different sets of barriers have been identified to explain the difficulties in the access and availability of opioid analgesics in palliative care, particularly in low- and middle-income countries, including Latin America. Objective: To validate a structured questionnaire for the access to opioid medicines and to investigate the perception of health professionals regarding access barriers to opioid analgesics in 17 countries of the Latin American Region. Design: Survey to identify the domains and barriers of access to opioid medicines according to health professionals, including physicians, nurses, and pharmacists affiliated to institutions that provide palliative care in Latin America between August 2019 and October 2020. Results: We analyzed responses from 426 health professionals. The median age was 44 years old (ranging from 23 to 73 years) with an average experience in palliative care of 10 years (range: 1-35), 71.8% were women, and 49.8% were affiliated to specialized health care facilities of urban areas (94.6%). The main barriers perceived to be extremely relevant by the respondents were "belief that patients can develop addiction" and "financial limitations of patients" for the patient's domain and the "appropriate education, instruction, and training of professionals" for health professional's domain. Conclusions: It is necessary to develop strategies to strengthen less-developed health systems of the region to review legal frameworks, ensure integrated palliative care systems, and deploy multidisciplinary strategies for sensitizing, training, and raising the awareness of patients, caregivers and, particularly, health professionals regarding appropriate prescription and rational use of opioid analgesics.
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Affiliation(s)
- Juanita Vahos
- Department of Pharmacy, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Robin Rojas-Cortés
- Pan American Health Organization, Washington, DC, USA.,Address correspondence to: Robin Rojas-Cortés, MS, Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037, USA
| | - Daniela Daza
- Pharmaceutical Chemist, MSc Epidemiology, Bogota, Colombia
| | | | - Diego Macías Saint-Gerons
- Pan American Health Organization, Washington, DC, USA.,Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sergio Muñoz
- Department of Public Health-CIGES, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
| | | | - Analía Porrás
- Pan American Health Organization, Washington, DC, USA
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Gallastegui-Brana A, Rodríguez-Nunez A, Palacios J, Soto-Soto F, Castellano J, Soto-Guerrero S, Pérez-Cruz PE. Development and Validation of a Tool to Assess the Structural Quality of Palliative Care Services. J Pain Symptom Manage 2023; 65:490-499.e50. [PMID: 36702392 DOI: 10.1016/j.jpainsymman.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
CONTEXT The current gap in access to palliative care requires the expansion of palliative care services worldwide. There is little information about the structural components required by palliative care services to provide adequate end-of-life care. No specific tools have been developed to assess the structural quality of these services. OBJECTIVE To develop and validate a tool to assess the structural quality of palliative care services. METHODS A scoping review of literature was performed to identify structural quality indicators of palliative care services. National experts participated in a two-round Delphi method to reach consensus regarding the importance and measurement feasibility of each proposed indicator. Consensus was reached for each indicator if 60% or more considered them both important and feasible. The selected indicators were tested among Chilean palliative care services to assess instrument psychometric characteristics. RESULTS Thirty-one indicators were identified. Thirty-five experts participated in a two-round Delphi survey. Twenty-one indicators reached consensus and were included in the structural quality of palliative care services tool (SQPCS-21). This instrument was applied to 201 out of 250 palliative care services in Chile. Achievement for each indicator varied between 8% and 96% (mean 52%). The total SQPCS-21 score varied between 3 and 21 points (mean 11 points). CONCLUSION The SQPCS-21 tool to assess structural quality of palliative care services, has good content and construct validity and its application provides information about institutions at the individual and aggregated level. This tool can provide guidance to monitor the structural quality of palliative care worldwide.
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Affiliation(s)
- Aintzane Gallastegui-Brana
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Escuela de Enfermería (A.G.B.), Pontificia Universidad Católica de Chile, Centro Colaborador OPS/OMS, Santiago, Chile
| | - Alfredo Rodríguez-Nunez
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Sección Medicina Paliativa, Escuela de Medicina (A.R.N., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Instituto Nacional del Cáncer (A.R.N., F.S.S.), Santiago, Chile
| | - Josefa Palacios
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Joel Castellano
- Programa Farmacología y Toxicología (J.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Soto-Guerrero
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro E Pérez-Cruz
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Sección Medicina Paliativa, Escuela de Medicina (A.R.N., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile.
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11
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Daubman BR, Pérez-Cruz PE, Leiva O, Wong AW, Stoltenberg M. Furthering Palliative Care Training in Latin America: Development and Assessment of an Advanced Diploma Course in Palliative Care in Chile. J Pain Symptom Manage 2022; 64:128-136. [PMID: 35523387 DOI: 10.1016/j.jpainsymman.2022.04.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT The vast majority of people with serious health-related suffering in low- and middle-income countries lack access to palliative care (PC). In Latin America, this shortage is critical, and PC education is greatly needed. OBJECTIVES This study aims to assess the effects of an advanced PC diploma course in Chile through assessment of participants' satisfaction, knowledge, behavior, and self-efficacy. METHODS We developed and implemented a 12-day, hybrid-setting, advanced PC diploma course for Latin American clinicians and collected and analyzed pre course, immediate post course, and 6-month post course quantitative and qualitative data on satisfaction, knowledge, behaviors, and self-efficacy. RESULTS Thirteen Latin American doctors participated in this advanced PC diploma course. Overall knowledge and self-efficacy increased post course. One hundred percent of participants described the course as "very high quality" or "high quality," described the course's teaching methods as "very easy to understand" or "easy to understand," and ranked role-play as a "very useful" tool. CONCLUSION There is a critical shortage of PC in Latin America where PC education is greatly needed. The lessons learned from this pilot advanced PC diploma course will inform further PC educational development in Latin America. The results of our course assessments show that an advanced diploma course can increase participants' PC knowledge, behaviors, and self-efficacy with a goal of leveraging the Train the Trainer model to increase PC educational leadership and enable training at participants' home institutions.
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Affiliation(s)
- Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics (B.R.D., M.S.), Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School (B.R.D., M.S.), Boston, Massachusetts, USA
| | - Pedro E Pérez-Cruz
- Programa Medicina Paliativa y Cuidados Continuos (P.E.P.C., O.L.), Departamento de Medicina Interna - Facultad de Medicina - Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ofelia Leiva
- Programa Medicina Paliativa y Cuidados Continuos (P.E.P.C., O.L.), Departamento de Medicina Interna - Facultad de Medicina - Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Allen W Wong
- School of Sciences and Humanities (A.W.W.), Wentworth Institute of Technology, Boston, Massachusetts, USA
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatrics (B.R.D., M.S.), Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School (B.R.D., M.S.), Boston, Massachusetts, USA
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12
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Pastrana T, De Lima L, Knaul F, Arreola-Ornelas H, Rodriguez NM. How Universal Is Palliative Care in Colombia? A Health Policy and Systems Analysis. J Pain Symptom Manage 2022; 63:e124-e133. [PMID: 34363955 DOI: 10.1016/j.jpainsymman.2021.07.007] [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: 05/29/2021] [Revised: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 11/22/2022]
Abstract
Colombia's health sector reform has been recognized for its universal health (UHC) coverage scheme. However, this reform evolved without palliative care (PC), thereby omitting a core element of UHC. In this paper, we analyze the Colombian health system reform and health policies in relation to PC. We present the history, innovations, successes, and shortcomings of the reform and summarize the lessons learned to strengthen efforts leading to PC integration. Our analysis is based on the WHO public health framework for PC (policy, access to medicines, education, service provision). For several years and especially during the last decade, the government enacted laws and regulations to improve access to essential medicines and to integrate PC. Relative to other countries in Latin America, Colombia was the first to launch a PC service and to accredit palliative medicine as a specialty, the second to establish a national PC association and one of the few countries with a specific PC law. However, data shows that there are still too few services to meet the PC needs of approximately 250,000 adult patients annually. Our analysis shows that the country's failure to integrate PC most likely is a result of limited health worker education. Advocacy efforts should include deans of schools and provosts, in addition to policy makers and regulators. Other possible factors affecting uptake and implementation of existing national policies are civil unrest and limited collaboration between government offices. Additional research is needed to evaluate the impact of these and other related factors on PC integration in Colombia.
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Affiliation(s)
- Tania Pastrana
- Department of Palliative Medicine (T.P.), RWTH Aachen University Aachen, Germany; International Association for Hospice and Palliative Care (IAHPC) (T.P., L.L., F.K.), Houston, Texas, USA; University of Miami Institute for Advanced Study of the Americas (F.K.), Miami, Florida, USA; Tomatelo a Pecho AC (F.K., H.A.O.), Mexico City, Mexico; Department of Public Health (N.M.R.), College of Health and Human Sciences, Purdue University West Lafayette, Indiana, USA
| | - Liliana De Lima
- Department of Palliative Medicine (T.P.), RWTH Aachen University Aachen, Germany; International Association for Hospice and Palliative Care (IAHPC) (T.P., L.L., F.K.), Houston, Texas, USA; University of Miami Institute for Advanced Study of the Americas (F.K.), Miami, Florida, USA; Tomatelo a Pecho AC (F.K., H.A.O.), Mexico City, Mexico; Department of Public Health (N.M.R.), College of Health and Human Sciences, Purdue University West Lafayette, Indiana, USA.
| | - Felicia Knaul
- Department of Palliative Medicine (T.P.), RWTH Aachen University Aachen, Germany; International Association for Hospice and Palliative Care (IAHPC) (T.P., L.L., F.K.), Houston, Texas, USA; University of Miami Institute for Advanced Study of the Americas (F.K.), Miami, Florida, USA; Tomatelo a Pecho AC (F.K., H.A.O.), Mexico City, Mexico; Department of Public Health (N.M.R.), College of Health and Human Sciences, Purdue University West Lafayette, Indiana, USA
| | - Hector Arreola-Ornelas
- Department of Palliative Medicine (T.P.), RWTH Aachen University Aachen, Germany; International Association for Hospice and Palliative Care (IAHPC) (T.P., L.L., F.K.), Houston, Texas, USA; University of Miami Institute for Advanced Study of the Americas (F.K.), Miami, Florida, USA; Tomatelo a Pecho AC (F.K., H.A.O.), Mexico City, Mexico; Department of Public Health (N.M.R.), College of Health and Human Sciences, Purdue University West Lafayette, Indiana, USA
| | - Natalia M Rodriguez
- Department of Palliative Medicine (T.P.), RWTH Aachen University Aachen, Germany; International Association for Hospice and Palliative Care (IAHPC) (T.P., L.L., F.K.), Houston, Texas, USA; University of Miami Institute for Advanced Study of the Americas (F.K.), Miami, Florida, USA; Tomatelo a Pecho AC (F.K., H.A.O.), Mexico City, Mexico; Department of Public Health (N.M.R.), College of Health and Human Sciences, Purdue University West Lafayette, Indiana, USA
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Implementation and Knowledge of the Clinical Practice Guide for Palliative Care in the Ecuadorian Primary Care Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111573. [PMID: 34770088 PMCID: PMC8583406 DOI: 10.3390/ijerph182111573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022]
Abstract
Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.
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