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Mooney-Doyle K, Knafl KA, Huang L, Wallen GR, Ulrich CM. Participants' perceptions support the coexistence of benefits and burdens of cancer clinical trial participation. J Psychosoc Oncol 2024:1-17. [PMID: 38907623 DOI: 10.1080/07347332.2024.2366996] [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: 06/24/2024]
Abstract
BACKGROUND To advance oncology treatment for adults, comprehensive understanding of how and why people decide to enroll in, remain in, and withdraw from cancer clinical trials is needed. While quantitative findings provide insights into these benefits and burdens, they provide limited understanding of how adults with cancer appraise their situation and approach decisions to undertake a clinical trial. The goal of this mixed methods analysis was to conceptualize participants' assessment of benefits and burdens related to cancer clinical trial participation. MATERIALS AND METHODS This sub-group analysis of 21 participants was part of a larger sequential, explanatory mixed methods study. We used Creamer's integrated approach to linking quantitative and qualitative data to assess convergence, with qualitative data explaining quantitative results. Participants were grouped into four categories based on quantitative benefit/burden scores and thematic analysis of their qualitative data was used to describe these categories. RESULTS Across groups participants varied in descriptions of benefits and burdens of cancer clinical trial participation and reasons for participating. Those reporting high benefit/low burden described "seizing the opportunity to participate;" those reporting low benefit/low burden described "taking responsibility" through trial participation; those reporting low benefit/high burden described how they were "willing to endure," and those with high benefit/high burden emphasized "deciding to act." CONCLUSIONS Participants' qualitative descriptions of benefits and burdens were more nuanced and dynamic than reflected in their quantitative ratings. Thus, current measures may be missing important concepts, such as logistic challenges of trial participation. Our results have implications for consenting procedures and decisional support guidance offered to patients and their caregivers.
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Affiliation(s)
- Kim Mooney-Doyle
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Kathleen A Knafl
- School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Liming Huang
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities Branch, Bethesda, MD, USA
| | - Connie M Ulrich
- School of Nursing & School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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2
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Nouri S, Li L, Huang C, Chung A, Stokes SC, Pan S, Wong EC, Newman J, Woo JW, Cheng J, Tan CH, Wertz M, Wood-Hughes E, Quinn M, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "At the End I Have a Say": Engaging the Chinese Community in Advance Care Planning. J Pain Symptom Manage 2023; 66:551-560.e1. [PMID: 37536524 PMCID: PMC10593504 DOI: 10.1016/j.jpainsymman.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/22/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT Despite the association of advance care planning (ACP) with improved patient and caregiver outcomes, Chinese American elders have low rates of ACP. OBJECTIVES Assess ACP facilitators/barriers in the San Francisco (SF) Chinese community and codesign, implement, and test community-based ACP-promoting pilot events. METHODS A Chinese Community Committee (N = 19 community-based organization leaders, health system representatives, community members) conducted focus groups in Cantonese and English with Chinese older adults (age ≥55), caregivers, and community leaders. The Committee designed and implemented pilot events in-person and online. We analyzed focus group data using thematic analysis; assessed pre-to-post-event readiness to engage in ACP (validated survey; 14 scale, 4 = most ready); and assessed event acceptability. RESULTS A total of 34 people participated in six focus groups. Themes described Chinese community-specific importance of ACP (e.g., reduces family burden), barriers (e.g., younger generations lack tools to discuss ACP with elders and vice versa), and facilitators (e.g., intergenerational events, culturally/linguistically appropriate materials). Based on focus groups findings, the Committee developed a novel ACP tool and designed intergenerational events. A total of 195 participants attended 10 events; 95% were Chinese, 90% spoke Chinese languages, 80% were women. ACP readiness increased significantly (1.66 [SD 0.84] vs. 2.03 [SD 0.85]; P < 0.001); 94% of participants were comfortable attending and 96% would recommend events. CONCLUSION Community-developed intergenerational events that highlight the value of ACP and address barriers are acceptable and increase ACP engagement in the Chinese community.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA.
| | - Lingsheng Li
- Division of Geriatrics, Department of Medicine (L.L.), University of California San Francisco, San Francisco, California, USA
| | - Carrie Huang
- Thriving in Place (C.H.), San Francisco, California, USA
| | - Anni Chung
- Self-Help for the Elderly (A.C.), San Francisco, California, USA
| | - Sandy Chen Stokes
- Chinese American Coalition for Compassionate Care (S.C.S., S.P.), Cupertino, California, USA
| | - Shirley Pan
- Chinese American Coalition for Compassionate Care (S.C.S., S.P.), Cupertino, California, USA
| | - Elizabeth C Wong
- Independent community advocate (E.C.W.), San Francisco, California, USA
| | - Jeffrey Newman
- Institute for Health & Aging, University of California San Francisco (J.N.), San Francisco, California, USA
| | - Joseph W Woo
- Chinese Community Healthcare Association (J.W.W.), San Francisco, California, USA
| | - Joyce Cheng
- Chinese Community Health Resource Center (J.C.), San Francisco, California, USA
| | - Charissa H Tan
- John A. Burns School of Medicine, University of Hawai'i at Mānoa (C.H.T.), Honolulu, Hawaii, USA
| | - Molly Wertz
- Molly Wertz Consulting (M.W.), San Francisco, California, USA
| | - Elyse Wood-Hughes
- Richmond Senior Center, Golden Gate Senior Services (E.W.H.), San Francisco, California, USA
| | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine (C.R.L.), Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine (C.S.R.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine (R.L.S.), University of California San Francisco, San Francisco, California, USA
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3
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Nouri S, Quinn M, Doyle BN, McKissack M, Johnson N, Wertz M, Tan C, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "We've Got to Bring Information to Where People Are Comfortable": Community-Based Advance Care Planning with the Black Community. J Gen Intern Med 2023; 38:2478-2485. [PMID: 36894819 PMCID: PMC9998020 DOI: 10.1007/s11606-023-08134-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND People identifying as Black/African American are less likely to engage in advance care planning (ACP) compared to their White peers, despite the association of ACP with improved patient and caregiver outcomes. OBJECTIVES Assess facilitators/barriers to ACP in the San Francisco (SF) Black community and co-design/implement/test community-based ACP pilot events. DESIGN Community-based participatory research, including qualitative research, intervention development, and implementation. PARTICIPANTS In partnership with the SF Palliative Care Workgroup (which includes health system, city, and community-based organizations), we formed an African American Advisory Committee (n = 13). We conducted 6 focus groups with Black older adults (age ≥ 55), caregivers, and community leaders (n = 29). The Advisory Committee then selected 5 community-based organizations through a widespread request for proposal. These community-based organizations designed and implemented community-based pilot events to support ACP engagement. MAIN MEASURES Two authors analyzed recorded focus group transcripts using thematic analysis. We assessed pre- vs post-event readiness to engage in ACP (validated ACP Engagement Survey; 1-4 scale, 4 = most ready) using Wilcoxon signed rank tests and assessed event acceptability with open-ended questions. KEY RESULTS Themes included the importance of ACP to the Black community (sub-themes: strengthens families; preserves dignity, particularly for sexual/gender minorities; is tied to financial planning) and facilitators for increasing ACP engagement (sub-themes: culturally relevant materials; events in trusted community spaces including Black-owned businesses). A total of 114 participants attended 5 events; 74% identified as Black, and 16% as sexual/gender minorities. Readiness to engage in ACP was similar pre- vs post-events; 98% would recommend the events to others. CONCLUSIONS Community-based ACP events designed and led by and for the Black community are highly acceptable. Novel insights underscored the importance of financial planning as part of ACP and the role of Black-owned businesses as trusted spaces for ACP-related discussions.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Natalya Johnson
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Molly Wertz
- Molly Wertz Consulting, San Francisco, CA, USA
| | - Charissa Tan
- John A. Burns School of Medicine, University of Hawai'I at Mānoa, Honolulu, HI, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, USA
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4
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Santos Salas A, Bablitz C, Morris H, Vaughn L, Bardales O, Easaw J, Wildeman T, Duggleby W, Salami B, Watanabe SM. Improving access to palliative care for people experiencing socioeconomic inequities: findings from a community-based pilot research study. Health Promot Chronic Dis Prev Can 2023; 43:365-374. [PMID: 37584628 PMCID: PMC10516597 DOI: 10.24095/hpcdp.43.8.02] [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: 08/17/2023]
Abstract
INTRODUCTION In Canada, people experiencing socioeconomic inequities have higher rates of late diagnosis and lower survival rates than the general population. Palliative care services focussed on this population are scarce. We developed a community-based nursing intervention to improve access to palliative care for people experiencing socioeconomic inequities and living with life-limiting illnesses in an urban Canadian setting. METHODS This community-based, qualitative research study combined critical and participatory research methodologies. The study was conducted in partnership with the Palliative Care Outreach Advocacy Team (PCOAT) based in Edmonton, Alberta, a team dedicated to serving populations experiencing socioeconomic inequities who require palliative care. Following an exploratory phase that served to delineate the intervention, we undertook a one-year pilot implementation during which a part-time registered nurse (RN) joined PCOAT. The RN engaged in trust building, resolution of health and practical needs and complex care coordination. Twenty-five patients participated in the intervention. Participants were interviewed at least once to explore their experiences with the intervention. Data were analyzed through thematic analysis. RESULTS Most participants were men, were Indigenous and had advanced cancer. Participants had significant financial concerns, lived or had lived in precarious housing situations and had previously faced serious challenges accessing health care. Participants reported social and health needs including housing, finances, transportation, symptom control, harm reduction and end-of-life care. Participants reported improved access to health and social services and expressed satisfaction with the study intervention. CONCLUSION Study findings suggest the study intervention may have contributed to improved access to palliative care, improved experiences for participants and increased equity in the delivery of care.
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Affiliation(s)
- Anna Santos Salas
- Palliative Care Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Cara Bablitz
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Family Medicine, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Heather Morris
- Palliative Care Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Vaughn
- Palliative Care Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Olga Bardales
- Palliative Care Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Easaw
- Palliative Care Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy Wildeman
- Palliative Care Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon M Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, Alberta, Canada
- Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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5
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Rosa WE, Grant L. Palliative Justice Post-COP27. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2023; 96:257-260. [PMID: 37396979 PMCID: PMC10303251 DOI: 10.59249/rtyb9681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The climate crisis is a planetary existential threat, disproportionately affecting the poorest populations worldwide. People in low- and middle-income countries (LMICs) experience the most detrimental consequences of climate injustice, endangering their livelihoods, safety, overall wellbeing, and survival. Although the 2022 United Nations Climate Change Conference (COP27) put forth several internationally salient recommendations, the outcomes fall short to efficiently tackle the suffering that exists at the intersection of social and climate injustice. Individuals with serious illness living in LMICs have the highest burden of health-related suffering globally. In fact, more than 61 million people experience serious health-related suffering (SHS) each year that is amenable to palliative care. Despite this well-documented burden of SHS, an estimated 88-90% of palliative care need is unmet, the majority in LMICs. To equitably address suffering at individual, population, and planetary levels in LMICs, a palliative justice approach is crucial. The interplay of human and planetary suffering requires that current planetary health recommendations be expanded to incorporate a whole-person and whole-people perspective that recognizes the need for environmentally conscious and community-based research and policy initiatives. Conversely, palliative care efforts should incorporate planetary health considerations to ensure sustainability in capacity building and service provision. In sum, the optimal health of the planet will remain elusive until we can holistically recognize the value of relieving all suffering due to life-limiting conditions, as well as the value in preserving the natural resources of countries in which all people are born, live, age, suffer, die, and grieve.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences,
Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liz Grant
- Global Health Academy, University of Edinburgh,
Edinburgh, Scotland
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6
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Crooks J, Flemming K, Shulman C, Hudson B. Opportunities and challenges in involving people with lived experience of inclusion health as co-researchers in palliative and end of life research: a rapid review and thematic synthesis. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:25. [PMID: 37081580 PMCID: PMC10116696 DOI: 10.1186/s40900-023-00436-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Co-research is a collaborative approach to research, promoting involvement of individuals with lived experience of a research area as experts by experience. Recently, the importance of co-research within palliative and end of life care (PEoLC) has been highlighted, yet few recommendations exist regarding best practice for involving inclusion health groups (i.e., groups that are socially excluded, typically experiencing multiple disadvantages that contribute to poor health outcomes). AIMS To identify and synthesise qualitative literature outlining barriers and facilitators for involving four inclusion health groups (individuals with lived experience of: homelessness, substance use disorder, incarceration or exchanging sex for money) in PEoLC research, from the perspectives of both the researchers and individuals with lived experience. METHODS This report is a rapid review with thematic synthesis methodology. Three electronic databases were searched (2012-30th August 2022). Thematic synthesis was used to generate themes across qualitative studies. RESULTS Three qualitative studies were eligible for inclusion. Two involved individuals with lived experience of incarceration, and one lived experience of homelessness. No papers outlined best-practice guidance for co-research; all offered reflections on the co-research process. Challenges for involvement included: facilitating appropriate reimbursement; overcoming stigma; fear of tokenism; pre-conceived views and the emotional burden of research. Successes and benefits included: advanced level of insight, a two-way learning opportunity and relatability of lived experience co-researchers. CONCLUSIONS This review did not identify any best-practice guidance for co-production of PEoLC research with inclusion health groups. There are few, good quality, qualitative studies offering insight into challenges and facilitators for lived experience co-researcher involvement. Further research and formal policy development is required to produce formal best-practice guidance to support safe, impactful inclusion in PEoLC research. It is important that researchers work together with people who have lived experience of the topic they are researching. Palliative care is specialised medical care for people living with a terminal illness. There is some collaboration between researchers and people with lived experience in palliative and end-of-life care research. However, some groups of people have been excluded. This includes people experiencing homelessness, or people with drug or alcohol addictions. This review aimed to understand what works and what doesn't work when involving four excluded groups in palliative and end-of-life research. These groups were people experiencing homelessness, those who had spent time in prison, people with drug or alcohol disorders, and people who exchanged sex for money. This review used a shortened methodology, which allowed it to be done quickly. Three online academic databases (Medline, PubMed, PsychINFO) were searched for research projects: three papers were included in the review. No clear guidance for working with these groups was found. Analysis identified themes across papers. Challenges for collaboration included: appropriate payment methods; overcoming stigma; fear of being talked down to,; assumptions made before meeting people, and the potential of becoming upset. Successes and benefits included: better understanding of the research topic, the opportunity to learn from one another, and how research participants could relate to lived experience co-researchers. There are few, good quality papers, but more research is needed to produce guidance to support safe, impactful collaboration.
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Affiliation(s)
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Caroline Shulman
- Pathway, London, UK
- Healthy London Partnership, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Briony Hudson
- Research and Policy, Marie Curie, London, UK
- Pathway, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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7
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Namukwaya E, Nabirye E, Dandadzi A, Akeju D, Adejoh S, Namisango E, Nkhoma K, Ebenso B, Allsop MJ. "From the Time You Start With them Until the Lord Calls You": A Qualitative Study on the Experiences and Expectations of People Living with Advanced Cancer Interacting With Palliative Care Services in Uganda, Nigeria and Zimbabwe. J Pain Symptom Manage 2022; 64:588-601. [PMID: 36089175 DOI: 10.1016/j.jpainsymman.2022.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT A challenge facing the provision of palliative care in sub-Saharan Africa is a means of increasing coverage of services whilst maintaining quality. Developing an evidence base that reflects patients' experiences and expectations of palliative care services, the context within which services are provided, and the approaches adopted by services in caring for patients, could facilitate and inform the planning and development of patient-centered and responsive services. OBJECTIVES To explore the experiences and expectations of palliative care for people living with advanced cancer in Nigeria, Uganda, and Zimbabwe. METHODS A secondary qualitative analysis of in-depth interviews with 62 people with advanced cancer in Nigeria, Uganda, and Zimbabwe. Framework approach to thematic analysis of transcripts was adopted, focusing on patients' experiences and expectations when interacting with palliative care services, aligning reporting with the COnsolidated criteria for REporting Qualitative research (COREQ). RESULTS Four main themes were generated from the analysis: 1) Condition and community as drivers of a multidimensional burden when living with advanced cancer; 2) The expectations and endeavors of palliative care to ameliorate the impact of cancer on physical, psychological and basic needs; 3) Processes and preferences for interacting and communicating with palliative care services, and; 4) Restoration of hope in the context of limited resources. CONCLUSION Wide-ranging physical, psychological, social and financial impacts on participants were outlined. These concerns were largely met with compassionate and responsive care in the context of constrained resources. Study findings can inform evolving notions of patient-centred care for serious illnesses in the participating countries.
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Affiliation(s)
| | - Elizabeth Nabirye
- Department of Internal Medicine, Makerere University, Kampala, Uganda
| | - Adlight Dandadzi
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - David Akeju
- Department of Social Work, University of Lagos, Lagos, Nigeria
| | - Samuel Adejoh
- Department of Social Work, University of Lagos, Lagos, Nigeria
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK.
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8
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Ozdemir S, Lee JJ, Yang GM, Malhotra C, Teo I, Pham NT, Manalo MF, Hapuarachchi T, Mariam L, Rahman R, Finkelstein E. Awareness and Utilization of Palliative Care Among Advanced Cancer Patients in Asia. J Pain Symptom Manage 2022; 64:e195-e201. [PMID: 35705117 DOI: 10.1016/j.jpainsymman.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/09/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia. OBJECTIVES This study aimed to investigate PC awareness and its predictors, utilization of PC services, and perceived utilization barriers among advanced cancer patients from select hospitals in Asian LMICs. METHODS This cross-sectional study analyzed data of 759 advanced cancer patients at major hospitals of four LMICs in Asia (i.e., Bangladesh, Philippines, Sri Lanka, and Vietnam). The predictors of PC awareness were investigated using multivariable logistic regression. RESULTS Overall PC awareness was 30.8% (n = 234). Patients with higher education (OR = 1.0; CI = 1.0,1.1), from upper-middle or high-income households (compared to low-income) (OR = 2.0; CI = 1.2,3.3), awareness of disease severity (OR = 1.5; CI = 1.0,2.2), and higher pain severity (OR = 1.1; CI = 1.0,1.2) had higher odds of PC awareness. Compared to patients who perceived themselves as being very informed about disease trajectory, those who were unsure (OR = 0.5; CI = 0.3,0.8) or uninformed (OR = 0.5; CI = 0.3,0.9) had lower odds of PC awareness. The PC utilization rate was 35.0% (n = 82) among those with PC awareness, and 47.8% (n = 66) among patients recommended PC by a healthcare professional (n = 138). The most cited PC utilization barriers were currently receiving anti-cancer treatment (n = 43; 33.9%), and having insufficient information about PC (n = 41; 32.3%). CONCLUSION The low awareness of PC services in these major hospitals in Asian LMICs highlights that more effort may be required to promote the awareness of PC in this region. The efforts should especially focus on those from disadvantaged groups to reduce the gap in PC awareness.
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Affiliation(s)
- Semra Ozdemir
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore.
| | - Jia Jia Lee
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | - Grace Meijuan Yang
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Division of Palliative and Supportive Care (M.Y.), National Cancer Centre Singapore, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | | | | | | | - Lubna Mariam
- Department of Radiation Oncology (L.M.), National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
| | - Rubayat Rahman
- Department of Palliative Medicine (R.R.), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Eric Finkelstein
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
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9
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Rosa WE, Ahmed E, Chaila MJ, Chansa A, Cordoba MA, Dowla R, Gafer N, Khan F, Namisango E, Rodriguez L, Knaul FM, Pettus KI. Can You Hear Us Now? Equity in Global Advocacy for Palliative Care. J Pain Symptom Manage 2022; 64:e217-e226. [PMID: 35850443 PMCID: PMC9482940 DOI: 10.1016/j.jpainsymman.2022.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York, USA; Institute for Advanced Study of the Americas, University of Miami (W.E.R. and F.M.K.), Coral Gables, Florida, USA.
| | - Ebtesam Ahmed
- Department of Clinical Health Professions (E.A.), St. John's University College of Pharmacy and Health Sciences, Queens, New York, USA; MJHS Institute for Innovation in Palliative Care (E.A.), New York, New York, USA
| | | | - Abidan Chansa
- National Palliative Care Program (A.C.), Ministry of Health, Lusaka, Zambia
| | - Maria Adelaida Cordoba
- Pediatric Palliative Section (M.A.C.), Fundación Hospital Pediátrico de La Misericordia, Bogotá, Colombia; Department of Pediatrics (M.A.C.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rumana Dowla
- Palliative Medicine Cancer Care Centre (R.D.), United Hospital, Dhaka, Bangladesh
| | - Nahla Gafer
- Integrated Palliative and Oncology Unit (N.G.), Khartoum Oncology Hospital, Khartoum, Sudan
| | - Farzana Khan
- Fasiuddin Khan Research Foundation (F.K.), Uttara, Dhaka, Bangladesh; Global Health Academy (F.K.), University of Edinburgh, Scotland, United Kingdom
| | - Eve Namisango
- African Palliative Care Association (E.N.), Kampala, Uganda; Department of Palliative Care and Rehabilitation (E.N.), Cicely Saunders Institute, King's College, London, United Kingdom
| | - Luisa Rodriguez
- Department of Anesthesia (L.R.), Pain and Palliative Medicine, Universidad de La Sabana, Chia, Colombia; Asociación Colombiana de Cuidados Paliativos (L.R.), Bogotá, Colombia
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami (W.E.R. and F.M.K.), Coral Gables, Florida, USA; Department of Public Health Sciences (F.M.K.), University of Miami Miller School of Medicine, Miami, Florida, USA; Tómatelo a Pecho, Mexico City (F.M.K.), Mexico; Fundación Mexicana para la Salud (F.M.K.), Mexico City, Mexico
| | - Katherine I Pettus
- International Association for Hospice and Palliative Care (K.I.P.), Houston, Texas, USA
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Rosa WE, Banerjee SC, Maingi S. Family caregiver inclusion is not a level playing field: toward equity for the chosen families of sexual and gender minority patients. Palliat Care Soc Pract 2022; 16:26323524221092459. [PMID: 35462621 PMCID: PMC9021511 DOI: 10.1177/26323524221092459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- William E Rosa
- Assistant Attending Behavioral Scientist, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th fl., New York, NY 10022, USA
| | - Smita C Banerjee
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shail Maingi
- Dana-Farber, South Shore Hospital, South Weymouth, MA, USA
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