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Downing J, Namukwaya E, Nakawesi J, Mwesiga M. Shared-decision-making and communication in paediatric palliative care within Uganda. Curr Probl Pediatr Adolesc Health Care 2024; 54:101556. [PMID: 38272741 DOI: 10.1016/j.cppeds.2024.101556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The first palliative care services were started in Uganda 30 years ago with services continuing to develop since then. The Ministry of Health and the Palliative Care Association of Uganda have played key roles in the development of paediatric palliative care in the country. There are a range of paediatric palliative care service providers in Uganda, and these have developed alongside educational programmes and research in PPC. Care is provided across the Uganda health system and across the age range from neonates through to adolescents and young adults. Whilst recognising the importance of shared decision-making there is little literature with regards to this in the Ugandan context. However, a variety of factors have been shown to influence decision-making, along with the challenges and recommendations for the future. Uganda has made significant strides in the provision of paediatric palliative care although there is still a way to go before all children with palliative care needs, and their families, can access palliative care.
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Affiliation(s)
- J Downing
- International Children's Palliative Care Network, Makerere/ Mulago Palliative Care Unit, Kampala, Uganda.
| | - E Namukwaya
- Makerere/ Mulago Palliative Care Unit, Kampala, Uganda
| | | | - M Mwesiga
- Palliative Care Association of Uganda (PCAU), Kampala, Uganda
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Perrins Gendron MMC, Van Niekerk L, Cloete L. The use and value of play: Perspectives from the continent of Africa - a scoping review. Scand J Occup Ther 2023; 30:1394-1414. [PMID: 35293835 DOI: 10.1080/11038128.2022.2043433] [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] [Received: 05/13/2021] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Published play knowledge predominantly originates outside Africa. This review was undertaken to summarize sources on play originating from the continent of Africa. OBJECTIVE To locate and summarize sources on the use and value of play in human development and learning from the African continent. MATERIAL AND METHOD Following the PRISMA Extension - Scoping Reviews guidelines, the initial search yielded 17,004 sources. Title and abstract screening identified 263 sources which were evaluated for eligibility namely; sources originating from the African continent, in any language, focussing on play as occupation. RESULTS A total of 127 sources were included; 76 qualitative, 28 quantitative and 23 mixed design sources; 100 from Southern Africa. Nine themes emerged: Who plays, why, where and how individuals play, intentional use of play, play and adult-related work skills, what is used in play, time/duration of play and barriers to play. CONCLUSIONS Play was used effectively in human development and learning. Withholding play as a form of discipline, emphasized how adults and children valued play. Adults still loved playing. Safety concerns contributed to the reasons play occurred indoors more than outdoors, despite outdoor play being preferred. SIGNIFICANCE The review provides a reference for play as an occupation which may promote learning and development.
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Affiliation(s)
| | - Lana Van Niekerk
- Division of Occupational Therapy; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape-Town, South Africa
| | - Lizahn Cloete
- Division of Occupational Therapy; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape-Town, South Africa
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Kenneson SA, Hughes-Visentin A, Wrigley J, Gujral P, Lodhi S, Phadke S, Rayala S, Gentica X, Malipeddi D, Sarvode S, Kaye EC, Doherty M. Pediatric Palliative Care Program Implementation in LMICs: A Systematic Review using SWOT Analysis. J Pain Symptom Manage 2023; 66:338-350.e11. [PMID: 37414349 DOI: 10.1016/j.jpainsymman.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
CONTEXT Of the estimated 21 million children world-wide who need access to pediatric palliative care (PPC), about 97% currently reside in low-and middle-income countries (LMIC). Access to PPC programs in LMIC are limited, and successful strategies and barriers to program implementation remain understudied. OBJECTIVES We conducted a systematic review to characterize the strengths, weaknesses, opportunities, and threats (SWOT) of PPC program implementation in LMIC. METHODS Using PRISMA guidelines, we searched key databases from inception to April 2022 and reviewed references manually. Eligible abstracts and articles included content related to composition, role, function, purpose, development, or implementation of PPC programs in LMIC. RESULTS From 7,846 titles and abstracts and 229 full-text articles, we identified 62 eligible abstracts and articles; 16 articles were added following manual searching of references, resulting in 78 items (28 abstracts, 50 articles). A total of 82 unique programs were described, including nine from low-income, 27 from lower-middle income, and 44 from upper-middle income countries. Common strengths included presence of multidisciplinary teams and psychosocial care. Common weaknesses included lack of PPC training and research infrastructure. Common opportunities involved collaboration between institutions, government support, and growth of PPC education. Common threats comprised limited access to PPC services, medications, and other resources. CONCLUSION PPC programs are being successfully implemented in resource limited settings. Hospice and palliative medicine organizations should sponsor PPC clinicians to describe and disseminate more detailed descriptions of successes and challenges with program implementation to help build and grow further PPC initiatives in LMICs.
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Affiliation(s)
- Sarah Ann Kenneson
- College of Medicine (S.A.K., D.M.), University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Jordan Wrigley
- Biomedical Library (J.W.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; University of Colorado (J.W.), Boulder, Colorado, USA
| | - Preet Gujral
- Faculty of Medicine (A.H-V., P.G., S.L., S.P., M.D.), University of Ottawa, Ottawa, Ontario, Canada
| | - Sumiya Lodhi
- Faculty of Medicine (A.H-V., P.G., S.L., S.P., M.D.), University of Ottawa, Ottawa, Ontario, Canada
| | - Saloni Phadke
- Faculty of Medicine (A.H-V., P.G., S.L., S.P., M.D.), University of Ottawa, Ottawa, Ontario, Canada
| | - Spandana Rayala
- Two Worlds Cancer Collaboration Foundation (S.R., M.D.), Kelowna, Canada; Department of Pain and Palliative Care (S.R.), MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | - Xiohara Gentica
- National Children's Hospital (X.G.), Quezon City, Philippines
| | - Dhatri Malipeddi
- College of Medicine (S.A.K., D.M.), University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Supriya Sarvode
- Department of Oncology (S.S., E.C.K.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Erica C Kaye
- Department of Oncology (S.S., E.C.K.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Megan Doherty
- Faculty of Medicine (A.H-V., P.G., S.L., S.P., M.D.), University of Ottawa, Ottawa, Ontario, Canada; Two Worlds Cancer Collaboration Foundation (S.R., M.D.), Kelowna, Canada; Children's Hospital of Eastern Ontario (M.D.), Ottawa, Canada.
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Yao JS, Kibu OD, Asahngwa C, Ngo NV, Ngwa W, Jasmin HM, Gobina RM, Foretia DA. A scoping review on the availability and utilization of essential opioid analgesics in Sub-Saharan Africa. Am J Surg 2023; 226:409-421. [PMID: 37024407 DOI: 10.1016/j.amjsurg.2023.03.013] [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] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Management of acute, post-operative, and chronic pain requires access to and availability of opioids. While often oversupplied in high-income countries, significant shortages exist in low- and middle-income countries. We conducted a scoping review on availability and usage of opioids in Sub-Saharan Africa (SSA). METHODS The five-stage approach of Arksey and O'Malley (2005) was used. MEDLINE via PubMed, EMBASE, and SCOPUS were search and results categorized into themes: 1) Local/regional availability and supply, 2) Consumption patterns, 3) Legislation and policy, 4) Costs and financing, 5) Knowledge and cultural beliefs, and 6) Education and training. RESULTS 6923 studies were identified from which 69 (1%) met inclusion criteria. Five key findings were: 1) Significant shortages exist, especially in rural areas, 2) Non-opioid analgesics commonly used as first-line acute pain management, 3) Barriers to market entry and bureaucratic processes prevent local production, 4) Significant knowledge gaps/myths exist amongst healthcare practitioners on opioid use, and 5) Continuous education and short courses will be critical. CONCLUSIONS Major challenges significantly limit availability and utilization of essential opioids in SSA. Reforms needed to upscale training and education, increase uptake by professionals, and increase market entry.
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Affiliation(s)
- Jane S Yao
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Odette D Kibu
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Department of Public Health, University of Buea, Cameroon; Faculty of Health Science, University of Buea, Cameroon
| | - Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Department of Anthropology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Ngo V Ngo
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | - Wilfred Ngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | - Hilary M Jasmin
- Health Science Library, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ronald M Gobina
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Health Science Library, University of Tennessee Health Science Center, Memphis, TN, USA; Buea Regional Hospital, Buea, Cameroon
| | - Denis A Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, USA; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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Abayneh M, Rent S, Ubuane PO, Carter BS, Deribessa SJ, Kassa BB, Tekleab AM, Kukora SK. Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development. Front Pediatr 2023; 11:1217209. [PMID: 37435165 PMCID: PMC10331424 DOI: 10.3389/fped.2023.1217209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.
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Affiliation(s)
- Mahlet Abayneh
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sharla Rent
- Duke Department of Pediatrics, Duke School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
| | - Peter Odion Ubuane
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
| | - Brian S. Carter
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Solomie Jebessa Deribessa
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Betelehem B. Kassa
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atnafu Mekonnen Tekleab
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie K. Kukora
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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Watch V, Anga G, Kilalang C, Pulsan F, Vince JD, Duke T. Children with palliative care needs in Papua New Guinea, and perspectives from their parents and health care workers: a qualitative study. BMC Palliat Care 2023; 22:68. [PMID: 37291511 DOI: 10.1186/s12904-023-01177-6] [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: 12/06/2022] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION The World Health Organisation defines paediatric palliative care (PPC) as caring for the child's body, mind, and spirit, and giving support to the family. In life-limiting conditions it is important that palliative support can be provided even when curative attempts are being utilised. In Papua New Guinea, as in other low- and middle-income countries there is a lack of services and training on PPC. This study aims to describe the characteristics of children with palliative care needs and to assess the perspectives of their parents and health care workers. METHODS A descriptive qualitative study was carried out over 5 months in 2022 at the Port Moresby General Hospital children's wards. Clinical information was gathered from the admission charts of children with life threatening and life limiting conditions and a recorded interview was carried out with the children's parents. A focus group interview with 10 experienced nurses caring for these children was video recorded. The recorded interviews were subjected to thematic analysis. RESULTS Twenty children and their parents were included in this study. Nine had a cancer diagnosis and 11 had a chronic progressive condition. The common clinical characteristics of children with palliative care needs were pain (n = 9) and shortness of breath (n = 9), and most children had more than one symptom. Several themes were identified in the parent interviews. Most parents could not name their child's diagnosis, but they were able to correctly describe their child's condition using their own terms. Most parents felt involved in their child's management and were satisfied with the care provided. Parents were psychologically affected by their child's situation but were hopeful that God and the medicines would heal their child. Ten nurses were involved in a focus-group interview. Most nurses' understanding of palliative care was from experience not from formal training, but most felt confident in identifying the physical, emotional, and spiritual needs of the children. Understanding of analgesia was limited, as was the availability of appropriate medications included in the WHO Analgesic Ladder. CONCLUSION There is a need for a systematic approach to palliative care in Papua New Guinea. Palliative care can be integrated into an overall approach to quality of paediatric care. It is relevant to a broad section of children with severe chronic or malignant conditions and can be carried out with limited resources. It does require some resources, further training and education, and increased provision of basic drugs for symptom control.
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Affiliation(s)
- Villa Watch
- Paediatrician, Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea
| | - Gwenda Anga
- Paediatrician - Oncology, Paediatric Clinical Coordinator, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Cornelia Kilalang
- Chief Paediatrician, National Department of Health, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Francis Pulsan
- Paediatrician and Senior Lecturer, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - John D Vince
- Deputy Dean and Head of Research and Post-graduate studies School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua, New, Guinea
| | - Trevor Duke
- Paediatrician and Senior Lecturer, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
- Department of Paediatrics and Intensive Care, Royal Children's Hospital, Melbourne, Australia.
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Doherty M, Power L, Thabet C. Delivering Hospital-Based Pediatric Palliative Care: The Symptoms, Interventions, and Outcomes for Children With Cancer in Bangladesh. JCO Glob Oncol 2021; 6:884-891. [PMID: 32589466 PMCID: PMC7328118 DOI: 10.1200/go.20.00076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The majority of pediatric cancer deaths occur in low- and middle-income countries (LMICs). Pediatric palliative care (PPC) focuses on relieving physical, psychosocial, and spiritual suffering throughout the continuum of cancer care and is considered integral to cancer care for children in all settings. There is limited evidence from LMICs about the characteristics, symptoms, and outcomes of children with cancer who receive PPC, which is needed to define the global need and guide the development of these services. METHODS This retrospective review of clinical records of children who received PPC was conducted during a pilot project (January 2014-August 2015) that implemented a PPC team at a tertiary hospital in Dhaka, Bangladesh. Clinical data on diagnosis, symptoms, treatment status, deaths, and key palliative care interventions were collected and analyzed using descriptive statistics. RESULTS There were 200 children who received PPC during the pilot project. The most common diagnoses were acute lymphoblastic leukemia (62%) and acute myeloid leukemia (11%). Psychosocial support for children (n = 305; 53%) and management of physical symptoms (n = 181; 31%) were the most common types of interventions provided. The most frequently recorded symptoms were pain (n = 60; 30%), skin wounds (n = 16; 8%), and weakness (n = 9; 5%). The most common medications prescribed were morphine (n = 32) and paracetamol (n = 21). CONCLUSION A hospital-based PPC service addresses pain and symptom concerns as well as psychosocial needs for children with cancer and their families in a setting where resources are limited. Health care facilities should incorporate palliative care into the care of children with cancer to address the needs of children and their families.
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Affiliation(s)
- Megan Doherty
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Liam Power
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chloé Thabet
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Kaye EC, Weaver MS, DeWitt LH, Byers E, Stevens SE, Lukowski J, Shih B, Zalud K, Applegarth J, Wong HN, Baker JN, Ullrich CK. The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review. J Pain Symptom Manage 2021; 61:1060-1079.e2. [PMID: 33348034 PMCID: PMC9896574 DOI: 10.1016/j.jpainsymman.2020.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Children with cancer and their families have complex needs related to symptoms, decision-making, care planning, and psychosocial impact extending across the illness trajectory, which for some includes end of life. Whether specialty pediatric palliative care (SPPC) is associated with improved outcomes for children with cancer and their families is unknown. OBJECTIVE We conducted a systematic review following PRISMA guidelines to investigate outcomes associated with SPPC in pediatric oncology with a focus on intervention delivery, collaboration, and alignment with National Quality Forum domains. METHODS We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until April 2020 and reviewed references manually. Eligible articles were published in English, involved pediatric patients aged 0-18 years with cancer, and contained original data regarding patient and family illness and end-of-life experiences, including symptom management, communication, decision-making, quality of life, satisfaction, and healthcare utilization. RESULTS We screened 6682 article abstracts and 82 full-text articles; 32 studies met inclusion criteria, representing 15,635 unique children with cancer and 342 parents. Generally, children with cancer who received SPPC had improved symptom burden, pain control, and quality of life with decreased intensive procedures, increased completion of advance care planning and resuscitation status documentation, and fewer end-of-life intensive care stays with higher likelihood of dying at home. Family impact included satisfaction with SPPC and perception of improved communication. CONCLUSION SPPC may improve illness experiences for children with cancer and their families. Multisite studies utilizing comparative effectiveness approaches and validated metrics may support further advancement of the field.
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Affiliation(s)
- Erica C Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Leila Hamzi DeWitt
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Elizabeth Byers
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah E Stevens
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joe Lukowski
- The University of Nebraska, Omaha, Nebraska, USA
| | - Brandon Shih
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristina Zalud
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob Applegarth
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christina K Ullrich
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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Court L, Olivier J. Approaches to integrating palliative care into African health systems: a qualitative systematic review. Health Policy Plan 2020; 35:1053-1069. [PMID: 32514556 PMCID: PMC7553764 DOI: 10.1093/heapol/czaa026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2020] [Indexed: 12/28/2022] Open
Abstract
Africa is characterized by a high burden of disease and health system deficits, with an overwhelming and increasing demand for palliative care (PC). Yet only one African country is currently considered to have advanced integration of palliative care into medical services and generalized PC is said to be available in only a handful of others. The integration of PC into all levels of a health system has been called for to increase access to PC and to strengthen health systems. Contextually appropriate evidence to guide integration is vital yet limited. This qualitative systematic review analyses interventions to integrate PC into African health systems to provide insight into the 'how' of PC integration. Forty articles were identified, describing 51 different interventions. This study found that a variety of integration models are being applied, with limited best practices being evaluated and repeated in other contexts. Interventions typically focused on integrating specialized PC services into individual or multiple health facilities, with only a few examples of PC integrated at a population level. Four identified issues could either promote integration (by being present) or block integration (by their absence). These include the provision of PC at all levels of the health system alongside curative care; the development and presence of sustainable partnerships; health systems and workers that can support integration; and lastly, placing the client, their family and community at the centre of integration. These echo the broader literature on integration of health services generally. There is currently a strong suggestion that the integration of PC contributes to health system strengthening; however, this is not well evidenced in the literature and future interventions would benefit from placing health systems strengthening at the forefront, as well as situating their work within the context of integration of health services more generally.
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Affiliation(s)
- Lara Court
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
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Daniels-Howell C. Caring for Children With Life-Limiting Illness in Bloemfontein, South Africa: Challenging the Assumptions of the 'Good Death'. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:317-344. [PMID: 32703072 DOI: 10.1177/0030222820944099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Theories of good death focused on acceptance, control, and meaning-making inform adult palliative care in high-resource settings. As children's palliative and hospice care (CPHC) develops in resource-limited settings, critical conceptualisations of a good death for children across these diverse settings are unknown. Assessed against high-resource setting tenets of good death from carer perspectives, results suggest: carer agency is limited; advanced discussion of death does not occur; distress results from multiple burdens; basic survival is prioritised; physical pain is not an emphasised experience; and carers publicly accept death quickly while private grief continues. Hegemonic conceptions of 'good death' for children do not occur in contexts where agency is constrained and discussing death is taboo, limiting open discussion, acceptance, and control of dying experiences. Alternate forms of discourse and good death could still occur. Critical, grounded conceptualisations of good death in individual resource-limited settings should occur in advance of CPHC development to effectively relieve expansive suffering in these contexts.
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MacRae MC, Fazal O, O'Donovan J. Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health 2020; 5:e002368. [PMID: 32457030 PMCID: PMC7252978 DOI: 10.1136/bmjgh-2020-002368] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) are currently deployed in improving access to palliative care in a limited number of low-income or middle-income countries (LMICs). This review therefore aimed to document evidence from LMICs regarding (1) where and how CHWs are currently deployed in palliative care delivery, (2) the methods used to train and support CHWs in this domain, (3) the evidence surrounding the costs attached with deploying CHWs in palliative care provision and (4) challenges and barriers to this approach. METHODS We conducted a systematic scoping review of the literature, adhering to established guidelines. 11 major databases were searched for literature published between 1978 and 2019, as well as the grey literature. FINDINGS 13 original studies were included, all of which were conducted in sub-Saharan African countries (n=10) or in India (n=3). Ten described a role for CHWs in adult palliative care services, while three described paediatric services. Roles for CHWs include raising awareness and identifying individuals requiring palliative care in the community, therapeutic management for pain, holistic home-based care and visitation, and provision of psychological support and spiritual guidance. Reports on training context, duration and outcomes were variable. No studies conducted a formal cost analysis. Challenges to this approach include training design and sustainability; CHW recruitment, retention and support; and stigma surrounding palliative care. CONCLUSION Despite relatively limited existing evidence, CHWs have important roles in the delivery of palliative care services in LMIC settings. There is a need for a greater number of studies from different geographical contexts to further explore the effectiveness of this approach.
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Affiliation(s)
| | - Owais Fazal
- Division of Research, Rice University, Houston, Texas, USA
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Researching children's perspectives in pediatric palliative care: A systematic review and meta-summary of qualitative research. Palliat Support Care 2018; 17:107-118. [DOI: 10.1017/s1478951518000172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveQualitative research is pivotal in gaining understanding of individuals’ experiences in pediatric palliative care. In the past few decades, the number of qualitative studies on pediatric palliative care has increased slightly, as has interest in qualitative research in this area. Nonetheless, a limited number of such studies have included the first-person perspective of children. The aim of this article is to understand the contribution of previous qualitative research on pediatric palliative care that included the voices of children.MethodA systematic review of qualitative studies and a meta-summary were conducted. MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and ERIC were searched without limitations on publication date or language. Eligible articles were qualitative research articles in which the participants were children ranging in age from 3 to 18 years.ResultWe retrieved 16 qualitative research articles reporting on 12 unique studies, and we selected two mixed-method articles. The meta-summary shows eight themes: the relationship with professional caregivers, pain and its management, “living beyond pain,” the relationship between pediatric patients and their families, children's view on their treatment and service provision, meanings children give to their end-of-life situation, consequences of clinical decisions, and the relationships among children in pediatric palliative care and their peers.Significance of resultsThis meta-summary presents the “state of the art” of pediatric palliative care qualitative research on children and highlights additional research areas that warrant qualitative study.
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Potts M, Cartmell KB, Nemeth L, Bhattacharjee G, Qanungo S. A Systematic Review of Palliative Care Intervention Outcomes and Outcome Measures in Low-Resource Countries. J Pain Symptom Manage 2018; 55:1382-1397.e7. [PMID: 29305322 DOI: 10.1016/j.jpainsymman.2017.12.487] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Abstract
CONTEXT To meet the growing need for palliative care in low-resource countries, palliative care programs should be evidence based and contextually appropriate. This study was conducted to synthesize the current evidence to guide future programmatic and research efforts. OBJECTIVES This systematic review evaluated palliative care outcome measures, outcomes, and interventions in low-resource countries. METHODS After title searches, abstracts and full-text articles were screened for inclusion. Data were extracted to report on intervention models, outcome measures used, and intervention outcomes. RESULTS Eighteen papers were reviewed, reporting on interventions conducted across nine low-resource countries. These interventions evaluated home-based palliative care models; a community-managed model; palliative care integrated with hospitals, hospices, or HIV clinics; and models focused on patients' self-management. Three studies were randomized controlled trials. Other studies used nonrandomized trials, cohort studies, mixed methods, pre-post test evaluation, cost-accounting evaluation, and cross-sectional surveys. Thirteen studies measured physical outcomes, 10 using multidimensional instruments. Nine studies measured psychological outcomes, eight using multidimensional instruments. Nine studies measured social outcomes, seven using multidimensional instruments. Nine studies measured outcomes across multiple domains. Across outcomes evaluated, results were reported in the direction of benefit associated with palliative care interventions. CONCLUSION Many palliative care intervention models exist to serve patients in low-resource countries. Yet, limited high-quality evidence from low-resource countries is available to document intervention outcomes. Rigorous experimental studies and greater measurement of multidimensional aspects of palliative care are needed to advance the science of palliative care in low-resource settings.
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Affiliation(s)
- Maryellen Potts
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Kathleen B Cartmell
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lynne Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Sasaki H, Bouesseau MC, Marston J, Mori R. A scoping review of palliative care for children in low- and middle-income countries. BMC Palliat Care 2017; 16:60. [PMID: 29178866 PMCID: PMC5702244 DOI: 10.1186/s12904-017-0242-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ninety-eight percent of children needing palliative care live in low- and middle-income countries (LMICs), and almost half of them live in Africa. In contrast to the abundance of data on populations in high income countries, the current data on populations in LMICs is woefully inadequate. This study aims to identify and summarize the published literature on the need, accessibility, quality, and models for palliative care for children in LMICs. METHODS A scoping review was performed following the method of Arksey and O'Malley. Systematic searches were conducted on PubMed and Google Scholar using the main keywords, 'children AND palliative care OR terminal care OR hospice OR end of life AND developing countries OR LMICs.' Additional publications were obtained by handsearching. Papers were only included if they reported on the need, accessibility, quality, and models for palliative care for children in LMICs. RESULTS Fifteen papers met the inclusion criteria for review. Of these, 10 assessed need, seven examined availability and/or accessibility, one assessed quality, and one examined the models. We found an urgent need for palliative care, particularly in the training for health workers and improving poor availability and/or accessibility to palliative care in terms of factors such as medication and bereavement support. The best practice models demonstrated feasibility and sustainability through cooperation with governments and community organizations. The quality of pain management and emotional support was lower in LMICs compared to HICs. CONCLUSION Although we found limited evidence in this review, we identified common challenges such as the need for further training for health workers and greater availability of opioid analgesics. While efforts to change the current systems and laws applying to children in LMICs are important, we should also tackle underlying factors including the need to raise awareness about palliative care in public health and improve the accuracy of data collection.
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Affiliation(s)
- Hatoko Sasaki
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535 Japan
| | - Marie-Charlotte Bouesseau
- Service Delivery and Safety, World Health Organization, 20 Avenue Appia, 1211, 27 Geneva, Switzerland
| | - Joan Marston
- International Children’s Palliative Care Network, 2 Langenhoven Street, Dan Pienaar, Bloemfontein, 9301 South Africa
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535 Japan
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Mojen LK, Rassouli M, Eshghi P, Sari AA, Karimooi MH. Palliative Care for Children with Cancer in the Middle East: A Comparative Study. Indian J Palliat Care 2017; 23:379-386. [PMID: 29123342 PMCID: PMC5661338 DOI: 10.4103/ijpc.ijpc_69_17] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: High incidence rates of childhood cancer and the consequent deaths in the Middle East is one of the major reasons for the need for palliative care in these countries. Using the experiences and innovations of the other countries can provide a pattern for the countries of the region and lead to the development of palliative care in children. Therefore, the aim of this study is to compare the status of pediatric palliative care in Egypt, Lebanon, Jordan, Turkey, and Iran. Materials and Methods: This is a comparative study in which the information related to pediatric palliative care system in the target countries (from 2000 to 2016) has been collected, summarized, and classified by searching in databases, such as “PubMed, Scopus, Google scholar, Ovid, and science direct.” Results: Palliative care in children in the Middle East is still in its early stages and there are many obstacles to its development, namely, lack of professional knowledge, inadequate support of policy-makers, and lack of access to opioids and financial resources. Despite these challenges, providing services at the community level, support of nongovernmental organizations (NGOs), using trained specialists and multi-disciplinary approach is an opportunity in some countries. Conclusion: Considering the necessity of the development of pediatric palliative care in the region, solutions such as training the human resources, integrating palliative care programs into the curriculum of the related fields, establishing facilitating policies in prescription and accessibility of opioids, providing the necessary support by policy-makers, doing research on assessment of palliative care quality, as well as NGOs' participation and public education are suggested.
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Affiliation(s)
- Leila Khanali Mojen
- Department of Pediatric Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Head of pediatric Hematology and Oncology Department of Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Eshghi
- Head of pediatric Hematology and Oncology Department of Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health and Knowledge Utilization, Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Majideh Heravi Karimooi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahed University, Tehran, Iran
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Hillis R, Ling J, Quinn C, Brenner M. Evaluating a pilot paediatric hospice-at-home service: a literature review. Int J Palliat Nurs 2016; 22:90-7. [PMID: 26926349 DOI: 10.12968/ijpn.2016.22.2.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: This literature review aims to offer practitioners an overview of the key components involved in designing the evaluation of a paediatric hospice-at-home pilot that will assess the effectiveness, efficiency and sustainability of the programme. The literature was reviewed in two stages: the first examined existing literature in the area of paediatric palliative care. The second looked at the wider field of adult palliative care to gain further insights into evaluation tool design. The findings are presented as a conceptual model to highlight each component of the pilot development stage as identified for evaluation purposes, emphasising their role and impact on the resultant delivery of integrated care. The clarity and transparency of this model offers a comprehensive overview of the evaluation process to all involved in the pilot.
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Affiliation(s)
- Rowan Hillis
- Research Assistant, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Julie Ling
- Chief Executive Officer, European Association for Palliative Care, Dublin
| | - Claire Quinn
- Head of Research, LauraLynn, Ireland's Children's Hospice, Dublin
| | - Maria Brenner
- Lecturer and Programme Coordinator Critical Care Nursing (Children), School of Nursing, Midwifery and Health Systems, University College Dublin
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Naicker SN, Richter L, Stein A, Campbell L, Marston J. Development and pilot evaluation of a home-based palliative care training and support package for young children in southern Africa. BMC Palliat Care 2016; 15:41. [PMID: 27061570 PMCID: PMC4826506 DOI: 10.1186/s12904-016-0114-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 04/01/2016] [Indexed: 11/16/2022] Open
Abstract
Background The leading cause of death among young children in southern Africa is complications due to HIV infection and, in South Africa, over a third of all deaths of children younger than five are associated with HIV infection. There is a great and urgent need for children’s palliative care in Africa, whether HIV-related or not. It is often not possible for sick children and their carers to attend clinics and hospitals cannot accommodate children for long periods of time. As a result children are often cared for in their own homes where caregivers require support to provide informed and sensitive care to reduce children’s suffering. Home-care places a heavy burden on families, communities and home- and community-based care workers. Methods This project involved the development and pilot evaluation of a training and support package to guide home and community-based care workers to help caregivers of seriously ill young children at home in southern Africa. A number of research methods were used, including a cross-sectional survey of content experts using the Delphi technique, participatory action research with photo elicitation and qualitative thematic analysis. Results Because the palliative care needs of these children are complex, the package focuses on delivering 9 key messages essential to improving the quality of care provided for young children. Once the key messages were developed, culturally relevant stories were constructed to enhance the understanding, retention and enactment of the messages. The various research methods used, including literature reviews, the Delphi technique and photo-elicitation ensured that the content included in the package was medically sound and culturally relevant, acceptable, feasible, and comprehensive. The end product is a home-based paediatric palliative care training and support package in English designed to help train community workers who are in a position to support families to care for very sick young children at home as well as to support families in looking after a very sick child. Conclusion A pilot study to assess the training and support package found it to be useful in delivering the key messages to caregivers. The training component was found to be feasible. It is concluded that the package offers a practical means of integrating palliative care with home-based care. Further implementation and evaluation is needed to establish its utility and impact. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0114-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Naomi Naicker
- Human Sciences Research Council, Human & Social Development Programme, 5th Floor, The Atrium, 430 Peter Mokaba Ridge, Berea, Durban, South Africa. .,WITS/MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Linda Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, 1 York Road, Parktown, Johannesburg, South Africa.,Human Sciences Research Council, 5th Floor, The Atrium 430 Peter Mokaba Ridge, Berea, Durban, South Africa
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.,Wits/MRC Rural Public Health and Health Transitions Research Unit [Agincourt], School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura Campbell
- School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Joan Marston
- International Children's Palliative Care Network, Assagay, KwaZulu-Natal, South Africa
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Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, Harding R. Children's palliative care in low- and middle-income countries. Arch Dis Child 2016; 101:85-90. [PMID: 26369576 DOI: 10.1136/archdischild-2015-308307] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/27/2015] [Indexed: 11/03/2022]
Abstract
One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, London, UK Makerere University, Kampala, Uganda
| | | | - Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa
| | - Cornelius Huwa
- Palliative Care Support Trust, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Virdun C, Brown N, Phillips J, Luckett T, Agar M, Green A, Davidson PM. Elements of optimal paediatric palliative care for children and young people: An integrative review using a systematic approach. Collegian 2015; 22:421-31. [DOI: 10.1016/j.colegn.2014.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caruso Brown AE, Howard SC, Baker JN, Ribeiro RC, Lam CG. Reported availability and gaps of pediatric palliative care in low- and middle-income countries: a systematic review of published data. J Palliat Med 2015; 17:1369-83. [PMID: 25225748 DOI: 10.1089/jpm.2014.0095] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The majority of young people in need of palliative care live in low- and middle-income countries, where curative treatment is less available. OBJECTIVE We systematically reviewed published data describing palliative care services available to young people with life-limiting conditions in low- and middle-income countries and assessed core elements with respect to availability, gaps, and under-reported aspects. METHODS PubMed, CINAHL, EMBASE (1980-2013), and secondary bibliographies were searched for publications that included patients younger than 25 years with life-limiting conditions and described palliative care programs in low- and middle-income countries. A data extraction checklist considered 15 items across seven domains: access, education/capacity building, health system support, pain management, symptom management, end-of-life care, and bereavement. Data were aggregated by program and country. RESULTS Of 1572 records, 238 met criteria for full-text review; 34 qualified for inclusion, representing 30 programs in 21 countries. The median checklist score was 7 (range, 1-14) of 10 reported (range, 3-14). The most pervasive gaps were in national health system support (unavailable in 7 of 17 countries with programs reporting), specialized education (unavailable in 7 of 19 countries with programs reporting), and comprehensive opioid access (unavailable in 14 of 21 countries with programs reporting). Underreported elements included specified practices for pain management and end-of-life support. CONCLUSION Comprehensive pediatric palliative care provision is possible even in markedly impoverished settings. Improved national health system support, specialized training and opioid access are key targets for research and advocacy. Application of a checklist methodology can promote awareness of gaps to guide program evaluation, reporting, and strengthening.
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Affiliation(s)
- Amy E Caruso Brown
- 1 Center for Bioethics and Humanities, and Department of Pediatrics, SUNY Upstate Medical University , Syracuse, New York
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Weaver MS, Yao AJJ, Renner LA, Harif M, Lam CG. The prioritisation of paediatrics and palliative care in cancer control plans in Africa. Br J Cancer 2015; 112:1845-56. [PMID: 26042935 PMCID: PMC4580392 DOI: 10.1038/bjc.2015.158] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/15/2015] [Accepted: 04/06/2015] [Indexed: 01/03/2023] Open
Abstract
Background: Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans. Methods: We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance. Results: Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0–14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0–14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion. Conclusions: Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings.
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Affiliation(s)
- M S Weaver
- Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 721, Memphis, TN 38105, USA
| | - A J J Yao
- Pediatric Oncology Service, Hôpital de Treichville, Abidjan, Côte d'Ivoire
| | - L A Renner
- Department of Child Health, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - M Harif
- Cheikh Khalifa Hospital, Casablanca, Morocco
| | - C G Lam
- 1] Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 721, Memphis, TN 38105, USA [2] International Outreach Program, St Jude Children's Research Hospital, Memphis, TN, USA
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Kruger M, Hendricks M, Davidson A, Stefan CD, van Eyssen AL, Uys R, van Zyl A, Hesseling P. Childhood cancer in Africa. Pediatr Blood Cancer 2014; 61:587-92. [PMID: 24214130 DOI: 10.1002/pbc.24845] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/09/2013] [Indexed: 12/11/2022]
Abstract
The majority of children with cancer live in low- and middle-income countries (LMICs) with little or no access to cancer treatment. The purpose of the paper is to describe the current status of childhood cancer treatment in Africa, as documented in publications, dedicated websites and information collected through surveys. Successful twinning programmes, like those in Malawi and Cameroon, as well as the collaborative clinical trial approach of the Franco-African Childhood Cancer Group (GFAOP), provide good models for childhood cancer treatment. The overview will hopefully influence health-care policies to facilitate access to cancer care for all children in Africa.
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Affiliation(s)
- Mariana Kruger
- Department of Paediatrics and Child Health, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
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Harding R, Albertyn R, Sherr L, Gwyther L. Pediatric palliative care in sub-saharan Africa: a systematic review of the evidence for care models, interventions, and outcomes. J Pain Symptom Manage 2014; 47:642-51. [PMID: 23972573 DOI: 10.1016/j.jpainsymman.2013.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/21/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT The progressive disease burden among children in sub-Saharan Africa means the provision of palliative care is essential and should be provided alongside treatment where it is available. OBJECTIVES To systematically review the evidence for pediatric palliative care models, interventions, and outcomes to appraise the state of the science and inform best practice. METHODS A systematic review search strategy was implemented in eight electronic databases, the search results reported using a PRISMA statement, and findings tabulated. RESULTS In terms of evidence of palliative care provision and outcomes, only five articles were identified. These represent a small range of acute, community, and hospice care and offer some limited guidance on the development and delivery of services. CONCLUSION Pediatric palliative care is a pressing clinical and public health challenge in sub-Saharan Africa. Explicit evidence-based models of service development, patient assessment, and evidence for control of prevalent problems (physical, psychological, social, spiritual, and developmental) are urgently needed. Greater research activity is urgently required to ensure an evidence-based response to the enormous need for pediatric palliative care in sub-Saharan Africa.
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Affiliation(s)
- Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, United Kingdom.
| | - Rene Albertyn
- Department of Paediatric Surgery, Red Cross Children's Hospital, Cape Town, South Africa
| | - Lorraine Sherr
- Infection & Population Health, Institute of Epidemiology & Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Liz Gwyther
- Hospice Palliative Care Association of South Africa, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Philips PL, Lazenby M. The emotional and spiritual well-being of hospice patients in Botswana and sources of distress for their caregivers. J Palliat Med 2013; 16:1438-45. [PMID: 24083653 DOI: 10.1089/jpm.2013.0114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little regional data exists on the distress of people nearing the end of their lives and their caregivers. OBJECTIVE The purpose of this study was to describe the quality of life and the emotional and spiritual well-being of people at the end of life and the sources of distress for their primary caregivers in Gaborone, Botswana, in order to inform further development of hospice services. DESIGN This study employed a mixed-methods design. SETTING/SUBJECTS Twenty-eight primary caregivers who cared for an adult who passed away fewer than 14 months prior to the interview date and in the care of a nongovernmental hospice in Botswana were interviewed between June and August 2012. MEASUREMENTS Semistructured interviews and the Quality of Death and Dying questionnaire (QODD) were used. Quantitative descriptive analysis and qualitative content analysis were performed. RESULTS Quality of life of decedents was poor. Emotional and spiritual distress persist at high rates even for those receiving support from a nongovernmental hospice (NGH). Caregiver distress arises from practical needs, including lack of food, clothing, and shelter, the need for assistance physically caring for their loved one, and from emotional and spiritual concerns. CONCLUSIONS The practical, physical, emotional, and spiritual needs of people at the end of life in Botswana and their caregivers are not being fully met, with poor overall quality of life among the dying. More research is needed to explore how hospice and home health services and the services of spiritual leaders can be expanded to meet their needs.
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Wilkins ML, Dallas RH, Fanone KE, Lyon ME. Pediatric palliative care for youth with HIV/AIDS: systematic review of the literature. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2013; 5:165-79. [PMID: 23930080 PMCID: PMC3733874 DOI: 10.2147/hiv.s44275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Improvement in treatment has led to decreased death in youth with human immunodeficiency virus (HIV) in developed countries. Despite this, youth with HIV are still at risk for increased mortality and morbidity compared with their uninfected counterparts. In developing countries, high numbers of youth die from acquired immune deficiency syndrome (AIDS)-related illnesses due to lack of access to consistent antiretroviral treatment. As a result, pediatric palliative care is a relevant topic for those providing care to youth with HIV. A systematic review was conducted to gather information regarding the status of the literature related to pediatric palliative care and medical decision-making for youth with HIV. The relevant literature published between January 2002 and June 2012 was identified through searches conducted using PubMed, CINAHL, Scopus, and PSYCInfo databases and a series of key words. Articles were reviewed by thematic analysis using the pillars of palliative care set out by the National Consensus Project. Twenty-one articles were retained after review and are summarized by theme. In general, few empirically based studies evaluating palliative care and medical decision-making in youth with HIV were identified. Articles identified focused primarily on physical aspects of care, with less attention paid to psychological, social, ethical, and cultural aspects of care. We recommend that future research focuses on broadening the evaluation of pediatric palliative care among youth with HIV by directly evaluating the psychological, social, ethical, and cultural aspects of care and investigating the needs of all involved stakeholders.
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Affiliation(s)
- Megan L Wilkins
- St Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, USA
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Abstract
Background: Palliative care is not a priority in developing countries. Hospice Africa Uganda (HAU), where nurses complete a course in clinical palliative care, is considered a model for other African countries. Aim: To explore the role of the palliative care nurse specialist (PCNS) in Uganda. Methods: This ethnographic field study uses observations, interviews, and group interviews. Participants: In total, 20 participants are included in this study. Result: The role of the palliative care nurse specialist is multifaceted. Beyond prescribing drugs, their role is to deliver holistic care. They encounter numerous challenges in their work, but they also have the possibility to improve the quality of the patient’s life.
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Affiliation(s)
| | | | - Ingrid Bolmsjö
- Department of Health and Society, Malmö University, Malmö, Sweden
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