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Paiva CE, Bonilla-Sierra P, Tripodoro VA, Rodríguez-Nunez A, De Simone G, Rodriguez LH, de Oliveira Vidal EI, Ríos MR, Crispim DH, Pérez-Cruz P, de Angelis Nascimento MS, Ospina PMR, de Lima L, Pastrana T, Zimmerman C, Hui D, Bruera E, Paiva BSR. How to Advance Palliative Care Research in South America? Findings From a Delphi Study. J Pain Symptom Manage 2023; 65:193-202. [PMID: 36455800 DOI: 10.1016/j.jpainsymman.2022.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
CONTEXT Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved. OBJECTIVES To develop a set of recommendations to advance PC research in SA. METHODS Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of ≥75%. RESULTS 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public policies, education and prognosis were defined as the most relevant. CONCLUSION Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resources and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region.
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Affiliation(s)
- Carlos Eduardo Paiva
- Palliative and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, Brazil.
| | - Patricia Bonilla-Sierra
- Department of Health Sciences (P.B.S.), Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador
| | | | - Alfredo Rodríguez-Nunez
- Palliative Care Program, Faculty of Medicine (A.R.N.), Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gustavo De Simone
- Instituto Pallium Latinoamérica (V.A.T., G.S.), Buenos Aires, Argentina
| | | | | | - Miriam Riveros Ríos
- Departamento de Cuidados Paliativos, Hospital de Clinicas (M.R.R.), Universidad Nacional de Asunción, Paraguay
| | - Douglas Henrique Crispim
- Hospital das Clínicas, Faculdade de Medicina FMUSP (D.H.C.), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Pérez-Cruz
- Sección Medicina Paliativa, Facultad de Medicina (P.P.C.), Pontificia Universidad Católica de Chile
| | | | | | - Liliana de Lima
- International Association for Hospice and Palliative Care (IAHPC) (L.L.), Houston, Texas, USA
| | - Tania Pastrana
- Department of Palliative Medicine (T.P.), RWTH Aachen University, Aachen, Germany
| | - Camilla Zimmerman
- Department of Supportive Care (C.Z.), Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine (D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine (D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bianca Sakamoto Ribeiro Paiva
- Palliative and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, Brazil
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Alsirafy SA, Mousa SMA. Palliative care journal publications by country as a metric for palliative care development level. BMJ Support Palliat Care 2022:spcare-2022-003820. [PMID: 36130815 DOI: 10.1136/spcare-2022-003820] [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: 06/16/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is a growing interest in developing a scientific research metric to assess the level of palliative care (PC) development in countries. This study assesses a metric based on publishing in specialised PC journals as an indicator for the level of PC development. METHODS A 3-year average articles per million population per year (3y-AAMY) metric was calculated using documents published in 19 specialised PC journals indexed in Scopus database. Countries were categorised into six levels starting with level '0' with no publications then levels Q1 to Q5 according to the 3y-AAMY quintiles (Q5=best performance). The relationship between the 3y-AAMY and the level of PC development in countries and opioid consumption figures was tested. RESULTS During 2016-2018, 6610 eligible documents were published in the selected 19 journals. The median (IQR) 3y-AAMY of 191 countries was 0.0123 (0-0.237). The 3y-AAMY differed significantly among the levels of PC development, being 0 (IQR:0-0) for category 1 (no known activity) countries and 1.129 (IQR:0.286-4.625) for category 4B (advanced integration) countries (Kruskal-Wallis test p<0.000001 and Jonckheere-Terpstra trend test p<0.00001). The correlation between the 3y-AAMY and average opioid consumption was a highly significant positive one (Spearman's ρ=0.681, p<0.0001). Furthermore, opioid consumption differed significantly between the 3y-AAMY categories being highest for Q5 countries (Kruskal-Wallis test p<0.000001 and Jonckheere-Terpstra trend test p<0.00001). CONCLUSION A metric based on publishing in specialised PC journals correlates significantly with the levels of PC development and opioid consumption in countries and may be used alongside other indicators for the assessment of PC development.
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Affiliation(s)
- Samy A Alsirafy
- Palliative Medicine Unit, Department of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Somaia M A Mousa
- Department of Clinical Pathology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Alsirafy SA, Hassan AD, Sroor MY, Samy I, Mousa SMA. Contribution of Eastern Mediterranean Region countries to palliative care journals from 1991 to 2020 and its relationship to the development of palliative care. BMC Palliat Care 2022; 21:123. [PMID: 35821039 PMCID: PMC9277915 DOI: 10.1186/s12904-022-01016-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Palliative care (PC) is in an early stage of development in the Eastern Mediterranean Region (EMR) of the World Health Organization. A metric based on publishing in specialized PC journals may be useful in assessing PC development. This study was conducted to describe the contribution of EMR countries to PC research and to study the relationship between this contribution and the levels of PC development. Methods The Scopus database was used to search 21 PC journals (1991–2020) for articles with at least one EMR-affiliated author independently of his/her position in the article. As an indicator, the 3-year average articles per million population per year (AAMY) was calculated. Changes over time were calculated through a regression analysis. The relationship between the AAMY and the level of PC development and opioid consumption were assessed through Mann-Witney test using the worldmap PC development categories as a proxy, and Spearman analysis, respectively. Results The number of articles published during the 30-year period was 31,108 of which 402 (1.3%) were EMR-affiliated. There was a steady rise in the AAMY of the EMR (R2 = 0.894). The number of EMR-affiliated articles increased from 3 in the period 1991–1995 to 191 in 2016–2020. The 2018–2020 AAMY was significantly higher in countries with greater PC development than in those without (median [IQR] = 0.0975 [0.0254–0.1802] and 0.0098 [0–0.0256], p = 0.042). Also, it was significantly higher in countries that progressed to a higher level of PC development between 2006 and 2017 (p = 0.0159). There was a significant positive correlation between the average opioid consumption for the years 2017–2019 and the AAMY for the same period (p = 0.0043). Conclusions There is a slow steady progress in the contribution of EMR countries to PC journals, which corresponds to the level of PC development and its progress in the region. A metric based on the contribution to specialized PC journals may be a useful indicator of PC development.
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Affiliation(s)
- Samy A Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Amneh D Hassan
- Palliative Care Unit, Hemato-Oncology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mahmoud Y Sroor
- Palliative Care Medicine, Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ismail Samy
- Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Somaia M A Mousa
- Clinical Pathology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Jin S, Liu S, Li J, Ning X, Liu X. Stumbling and Growing: A Bibliometric Study of Academic Publications of Palliative Care in Mainland China for 2010-2020. J Palliat Care 2021; 37:226-232. [PMID: 34747263 DOI: 10.1177/08258597211039056] [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: 11/15/2022]
Abstract
Background: Mainland China is facing increasing demand for palliative care and has launched related policies after 2010. Research and publications are important for sustainable development of palliative care, and should be encouraged by policy. Objectives: This study aimed to describe the development of palliative care-related publications in Mainland China in various aspects. Design: We searched Web of Science, Scopus, PubMed, Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, and China National Knowledge Infrastructure for publications from Mainland China for 2010-2020, with the topic words "hospice," "palliative care," "end-of-life care," or "terminal care." The publishing year, region, impacts, journals, publication types, and topics were analyzed. Results: A total of 3682 publications were identified, 754 of them (20.5%) published in Chinese core journals or international journals. The annual publication number and impact factor rose rapidly after 2016 and dropped again in 2020. There is no specialized palliative care journal in Mainland China. The publication numbers differed significantly between East and Western China and were closely linked to the economy (R2 = 0.8120, P < .0001). The megacities Beijing and Shanghai comprised 2.6% of the total population of Mainland China but produced 22.6% of the publications. Palliative care in cancer patients was the most common topic (37.7% of the publications). Practical keywords such as "pain management" and "living will" gained popularity recently. Conclusions: Palliative care-related research and publication in Mainland China are growing in recent years. However, the early stage growth is unstable, with a conspicuous regional disparity. Policies should be designed, in an equitable manner, to encourage original research and publication of palliative care.
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Affiliation(s)
- Shuang Jin
- 34732Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Shuo Liu
- 34732Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Jiaojiao Li
- 34732Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Xiaohong Ning
- 34732Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Xiaohong Liu
- 34732Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
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de Lima C, Dos Santos Neto MF, Costa RFA, Franco JO, Calfi GS, Paiva BSR, Paiva CE. Characteristics of Palliative Care Publications by South American Authors in the Last 20 Years: Systematic Literature Review With Bibliometric Analysis. J Pain Symptom Manage 2021; 62:e177-e185. [PMID: 33819513 DOI: 10.1016/j.jpainsymman.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Research on palliative care (PC) can be used as a direct measure to assess the level of PC development in a country or region. OBJECTIVES To investigate the scientific production in the field of PC in South American countries over the last two decades. METHODS The search was performed using the terms "palliative care," "hospice care," "hospices," and "terminal care" combined with the names of South American countries in several databases. The trend in publications over time was analyzed by linear equations (R2) and by calculating the annual percentage change (APC). The article citations were extracted from Web of Science (WOS), Scopus and Google Scholar, and the countries' impact factors (IFc) were calculated. RESULTS Of the 4259 identified articles, 641 were included in the analysis. There was a clear increase in the number of publications over the analyzed period (R2 = 0.8794, APC = 14.42%). Brazil was the country with the highest number of publications (n = 389); however, after adjustments by population, GDP and number of researchers, Chile was the country with the greatest prominence, including the highest IF in WOS (4.409). Only 8.3% of publications were systematic review, clinical trial or cohort studies; only 15.4% were funded. CONCLUSION This bibliometric review identified an annual increase of 14% in the number of scientific publications by researchers from South America over the last 20 years. Although Brazil produced the most articles, Chile, had the most efficient scientific production. In general, the articles had low potential for scientific impact.
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Affiliation(s)
- Crislaine de Lima
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Martins Fideles Dos Santos Neto
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Julia Onishi Franco
- Barretos School of Health Sciences Dr. Paulo Prata, FACISB, Barretos, São Paulo, Brazil
| | - Giovanna Simões Calfi
- Barretos School of Health Sciences Dr. Paulo Prata, FACISB, Barretos, São Paulo, Brazil
| | | | - Carlos Eduardo Paiva
- Oncology Graduate Program, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Clinical Oncology, Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
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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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Walshe C, Ahmed F, Preston N. Do journals contribute to the international publication of research in their field? A bibliometric analysis of palliative care journal data. Palliat Med 2020; 34:541-546. [PMID: 31973638 DOI: 10.1177/0269216319897536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research is important internationally, impacting on health service provision and patient benefit. Journals play an important dissemination role, but there may be geographical bias, potentially affecting access to evidence. AIM To understand if there is a relationship between the continent of journals and that of contributing authors. DESIGN Bibliometric analysis of journal citation report data (June 2018). Odds ratio of association of an author being from region, region of journal publication, publication model and the number of papers. SETTING Journals specialising in palliative care research, with an impact factor above the median impact factor for their most common indexing category. RESULTS Five journals: three published in Europe (Palliative Medicine, BMJ Supportive and Palliative Care, and BMC Palliative Care) and two in North America (Journal of Pain and Symptom Management and Journal of Palliative Medicine). Authors were from 30+ countries, but mostly North America (54.18%) or Europe (27.94%). Preliminary sensitivity tests show that the odds of an author being from a North American institution increase 16.4 times (p < 0.01; 95% confidence interval: 12.9, 20.8) if the region of journal publication is North America. The odds of an author being from a European institution is 14.0 times (p < 0.01; 95% confidence interval: 10.9, 17.9) higher if the region of journal publication is Europe. CONCLUSION Publishers, editors and authors are concentrated in North America or Europe. North American authors are more present in North American journals and European authors in European journals. This polarised approach, if replicated across readerships, may lead to research waste, duplication, and be sub-optimal for healthcare development.
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Affiliation(s)
- Catherine Walshe
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Faraz Ahmed
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
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Pöyhiä RTI, Mwalumuli EO, Mtega AC, Vegula JJ. Sustainability of Palliative Care in a Rural Hospital in Tanzania: A Longitudinal and Prospective 4-Year Study. J Palliat Care 2020; 35:192-198. [PMID: 31973645 DOI: 10.1177/0825859719892083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Palliative care has been developed in recent years in many sub-Saharan countries in Africa due to activities of African Association for Palliative Care. Palliative care units have been established also in most hospitals in Tanzania. Yet very little is known about their functions. Long-term studies about the sustainability of palliative care have not been carried out. METHODS The attitudes of 101 members of hospital staff and persons in charge of palliative care services of Ilembula District Designated Hospital (IDDH), Tanzania, were assessed using a modified and prevalidated questionnaire annually in 2014 to 2017. The inquiries were executed on randomly allocated days. Also, the patient and economy registries were analyzed. Additional qualitative data were obtained in personal interviews and during observational visits twice a year at the IDDH. RESULTS Ilembula District Designated Hospital has a true multiprofessional palliative care team, which provides services in the hospital, in the villages, and at homes. The activities are based on careful 5-year planning and budgeting. Up to 17 villages have been included in the services. Ninety-five percent of the patients were HIV infected. Short-acting morphine oral solution was the only available strong opioid. The hospital staff evaluated palliative care as good or excellent; 50% of the staff would need more support in the end-of-life care. CONCLUSIONS A sustainable palliative care service can be built in a Tanzanian rural hospital if an advanced planning and budgeting are made. In Tanzania, the biggest group of palliative care patients are still HIV-infected individuals. There is a lack of opioids in the country.
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Affiliation(s)
- Reino Torsti Ilmari Pöyhiä
- Department of Oncology, Division of Palliative Care, University of Turku, Turku, Finland.,Kauniala Hospital, Kauniainen, Finland
| | - Emmanuel Owden Mwalumuli
- Departments of Palliative Care and Aministration, Ilembula District Designated Hospital, Ilembula, Tanzania
| | - Aida Charles Mtega
- Departments of Palliative Care and Aministration, Ilembula District Designated Hospital, Ilembula, Tanzania
| | - Jackson John Vegula
- Departments of Palliative Care and Aministration, Ilembula District Designated Hospital, Ilembula, Tanzania
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Arias N, Garralda E, De Lima L, Rhee JY, Centeno C. Global Palliative Care and Cross-National Comparison: How Is Palliative Care Development Assessed? J Palliat Med 2019; 22:580-590. [DOI: 10.1089/jpm.2018.0510] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Natalia Arias
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Eduardo Garralda
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, Texas
| | - John Y. Rhee
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
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