1
|
Chung HH, Wang CL, Wu JJ, Chien SP, Lee LC, Juang YH, Chu WM. Trend analysis of quality indicators in palliative home care among terminally ill cancer and non-cancer patients in Taiwan: a 6-year observational study. Support Care Cancer 2024; 32:75. [PMID: 38170324 DOI: 10.1007/s00520-023-08277-2] [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: 05/28/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Palliative home care services (PHCS) have been emerging for years. However, limited data exist regarding quality indicators for pain control, unplanned hospital readmissions, and household deaths among terminal cancer and non-cancer patients receiving PHCS. METHODS We conducted a retrospective collection and recording of data from 1242 terminally ill cancer and non-cancer patients receiving PHCS. The data were obtained from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH) for the period from 2016 to 2021. T test and chi-square test were applied for characteristics and the quality indicators among cancer and non-cancer groups. Chi-square test was used for trend analysis of the number of patients receiving PHCS and the quality indicators among cancer and non-cancer groups throughout the study period. RESULTS A total of 1242 terminally ill cancer and non-cancer patients who had received PHCS were documented by TCVGH from the years 2016 to 2021, including 221 non-cancer patients and 1021 cancer patients having an average age of 70. The number of terminally ill cancer and non-cancer patients receiving PHCS has increased annually since 2016. Another finding was that age was a statistically significant factor impacting quality indicators. On the other hand, compared to non-cancer patients, cancer patients had a higher likelihood of receiving treatment with analgesics when needed. Their odds of needing analgesics more than three times within 4 days after PHCS enrollment were significantly elevated [OR 4.188, 95% CI (1.002, 17.51)]. CONCLUSION The results of this 6-year observational study indicate a substantial increase in the number of terminal cancer and non-cancer patients receiving PHCS over the past decade. Furthermore, aging plays an important role in life quality of terminal cancer and non-cancer patients.
Collapse
Affiliation(s)
- Hao-Hsun Chung
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Jia-Jyun Wu
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Szu-Pei Chien
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705
| | - Ya-Huei Juang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Department of Epidemiology On Aging, National Center for Geriatrics and Gerontology, Aichi, Japan.
| |
Collapse
|
2
|
Vâlcu EG, Firescu D, Nechita A, Ciubară A, Constantin GB, Rahnea-Nita G, Rebegea LF. Considerations Regarding Online Group Psychotherapy Sessions for Breast Cancer Patients in Active Phase of Oncological Treatment. Healthcare (Basel) 2023; 11:2311. [PMID: 37628508 PMCID: PMC10454484 DOI: 10.3390/healthcare11162311] [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: 06/16/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION The aim of this study is to evaluate the results of online group meetings for breast cancer patients in the active phase of treatment. The group therapy sessions took place weekly, synchronously, online, on Zoom, with a total of 12 meetings lasting about 2.5 h per session, between December 2021 and February 2022. We analyzed the topics of discussion chosen by the participants, the structure of the group, the results obtained at the main scales of evaluation/monitoring of quality of life and the motivation of patients to participate in the therapeutic group. All patients were in the active phase of treatment (chemotherapy, radiotherapy, hormone therapy, etc.). The main goal of the group therapy was to reduce the stress related to the disease. MATERIAL AND METHODS Systematic observations included ABS psychological tests, EQ-5D-5L, HADS-Hospital Anxiety and Depression Scale, and the Recurrence Fear Questionnaire; the questionnaires were administered at the beginning and at the end of the therapeutic intervention; the participation in the therapy and in the research of the patients began after signing the informed consent document; the intervention was evaluated at the end using a feedback questionnaire. The group was closed, and the participants signed an informed consent document and agreed to have the sessions recorded. RESULTS Comparing the initial with the final results of the psychological tests administered, there was an improvement in the quality of life of the participants in all areas, with a clinically significant decrease in the areas of pain and depression, along with an increase in perception of well-being, a decrease in FoP scores and an increase in the level of rationality about the disease. CONCLUSIONS Group therapy for cancer patients was useful in improving the quality of life; the closed group, even online, provided a safe environment in which they could share feelings. A close correlation was noted between the scores obtained on the FoP-Q and HADS scales. It is evident that there is a strong relationship between FoP and depression. Results on these scales correlated well with results on the EQ-5D-5L quality of life questionnaire.
Collapse
Affiliation(s)
- Elena Gabriela Vâlcu
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
| | - Dorel Firescu
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
| | - Aurel Nechita
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
- Department of Pediatrics, “Sf. Ioan” Clinical Hospital for Children, 800487 Galati, Romania
| | - Anamaria Ciubară
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
| | | | - Gabriela Rahnea-Nita
- Clinical Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Sf. Luca” Chronic Diseases Hospital, 041915 Bucharest, Romania
| | - Laura-Florentina Rebegea
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
- Department of Oncology, “Sf. Andrei” County Emergency Clinical Hospital, 800179 Galati, Romania
| |
Collapse
|
3
|
Korwisi B, Garrido Suárez BB, Goswami S, Gunapati NR, Hay G, Hernández Arteaga MA, Hill C, Jones D, Joshi M, Kleinstäuber M, López Mantecón AM, Nandi G, Papagari CSR, Rabí Martínez MDC, Sarkar B, Swain N, Templer P, Tulp M, White N, Treede RD, Rief W, Barke A. Reliability and clinical utility of the chronic pain classification in the 11th Revision of the International Classification of Diseases from a global perspective: results from India, Cuba, and New Zealand. Pain 2022; 163:e453-e462. [PMID: 34393200 DOI: 10.1097/j.pain.0000000000002379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic pain affects 1 in 5 persons and contributes substantially to the global burden of disease. The 11th Revision of the International Classification of Diseases (ICD-11) includes a comprehensive classification of chronic pain. The aim of this ecological implementation field study was to evaluate the classification's interrater reliability and clinical utility in countries with different income levels. The study was conducted in 4 pain clinics in Cuba, India, and New Zealand. Twenty-one clinicians used the ICD-11 to diagnose and code n = 353 patients with chronic pain. Of these, 111 were assessed by 2 clinicians, and Fleiss' kappa was calculated to establish interrater reliability for any diagnosis assigned to ≥15 patients. The clinicians rated the clinical utility of all diagnoses. The interrater reliability could be calculated for 11 diagnoses. It was substantial for 10 diagnoses and moderate for 1 (kappa: 0.596-0.783). The mean clinical utility of the ICD-11 chronic pain diagnoses was rated as 8.45 ± 1.69/10. Clinical utility was rated higher for ICD-11 than for the commonly used classification systems (P < 0.001, η2 = 0.25) and differed between all centers (P < 0.001, η2 = 0.60). The utility of the ICD-11 diagnoses was rated higher than the commonly used diagnoses in Dunedin and Havana, and no difference was found in Kolkata and Hyderabad. The study showed the high interrater reliability of the new chronic pain diagnoses. The perceived clinical utility of the diagnoses indicates their superiority or equality compared with the classification systems currently used in pain clinics. These results suggest the global applicability of the classification in specialized pain treatment settings.
Collapse
Affiliation(s)
- Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Bárbara Beatriz Garrido Suárez
- Department of Pharmacology, Institute of Marine Science (ICIMAR), Havana, Cuba
- Pain Clinic, Hospital 10 de Octubre, Havana, Cuba
| | - Subrata Goswami
- ESI Institute of Pain Management, ESI Hospital Sealdah, Kolkata, India
| | | | - Ginea Hay
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | | | - Charlotte Hill
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - David Jones
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | | | - Maria Kleinstäuber
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
- Department of Psychological Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Ana Marta López Mantecón
- Pain Clinic, Hospital 10 de Octubre, Havana, Cuba
- Rheumatological Disease Reference Centre, Hospital 10 de Octubre, Havana, Cuba
| | - Gargi Nandi
- ESI Institute of Pain Management, ESI Hospital Sealdah, Kolkata, India
| | | | | | - Biplab Sarkar
- ESI Institute of Pain Management, ESI Hospital Sealdah, Kolkata, India
| | - Nicola Swain
- Department of Psychological Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Paul Templer
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Maartje Tulp
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Naomi White
- Persistent Pain Service, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Division of Clinical and Biological Psychology, Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Ingolstadt, Germany
| |
Collapse
|
4
|
Edwards RL, Patrician PA, Bakitas M, Markaki A. Palliative care integration: a critical review of nurse migration effect in Jamaica. BMC Palliat Care 2021; 20:155. [PMID: 34641826 PMCID: PMC8510844 DOI: 10.1186/s12904-021-00863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. METHODS A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth's methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. RESULTS Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. 'Push-factors' such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. CONCLUSION Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.
Collapse
Affiliation(s)
- Rebecca L Edwards
- Department of Acute, Chronic, and Continuing Care, School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA.
| | - Patricia A Patrician
- Family, Community and Health Systems Department, School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Marie Bakitas
- Center for Palliative and Supportive Care, School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue, South, Birmingham, AL, 35294-1210, USA
| | - Adelais Markaki
- PAHO/WHOCC for International Nursing, Family, Community and Health Systems Department, School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| |
Collapse
|
5
|
Earl-Royal E, Feltes M, Gisondi MA, Matheson L, Htoo MOT, Walker R. Physicians in Myanmar Provide Palliative Care Despite Limited Training and Low Confidence in Their Abilities. Palliat Med Rep 2020; 1:314-320. [PMID: 34223491 PMCID: PMC8241381 DOI: 10.1089/pmr.2020.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Patients in low-income and middle-income countries (LMICs) have limited access to palliative care providers. In Myanmar, little is known about physician knowledge of or perceptions about palliative care. An assessment of physician practice and capacity to provide palliative care is needed. Objective: Our objective was to identify physician practice patterns, knowledge gaps, and confidence in providing palliative and end-of-life care in Myanmar. Design: This was a cross-sectional survey study. Setting/Subjects: Participants were physicians practicing in Myanmar who attended the Myanmar Emergency Medicine Updates Symposium on November 10 to 11, 2018 in Yangon, Myanmar (n = 89). Measurements: The survey used modified Likert scales to explore four aspects of palliative care practice and training: frequency of patient encounters, confidence in skills, previous training, and perceived importance of formal training. Results: Study participants were young (median age 27 years old); 89% cared for terminally ill patients monthly, yet 94% reported less than two weeks of training in common palliative care domains. Lack of training significantly correlated with lack of confidence in providing care. Priorities for improving palliative care services in Myanmar include better provider training and medication access. Conclusions: Despite limited training and low confidence in providing palliative care, physicians in Myanmar are treating patients with palliative needs on a monthly basis. Future palliative care education and advocacy in Myanmar and other LMICs could focus on physician training to improve end-of-life care, increase physician confidence, and reduce barriers to medication access.
Collapse
Affiliation(s)
- Emily Earl-Royal
- Department of Emergency Medicine, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michelle Feltes
- Department of Emergency Medicine, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael A Gisondi
- The Precision Education and Assessment Research Lab, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Loretta Matheson
- Department of Emergency Medicine, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Rebecca Walker
- Department of Emergency Medicine, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
6
|
Judkins J, Alhalel J, Hauser J, Pastrana T. Countrywide Situational Analysis of Palliative Care in Bolivia. J Palliat Med 2020; 24:673-679. [PMID: 32955990 DOI: 10.1089/jpm.2020.0169] [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: 11/13/2022] Open
Abstract
Background: There are substantial disparities in distribution of palliative care (PC) services within Latin America, with Bolivia historically lagging behind neighboring countries in PC metrics. Comprehensive data on PC in Bolivia were last collected in 2012 through the Latin American Association for Palliative Care (ALCP) Atlas of PC. Objective: To update the 2012 data and describe the current state of PC in Bolivia to aid in their ongoing efforts to expand PC services. In addition, to develop an instrument for assessment of national PC capacity that can be adapted for use in other countries. Design: A cross-sectional study was conducted using personal and online structured interviews of PC team directors from all 19 PC teams around the country. Measurements: A new survey was developed for this study based on the ALCP Atlas of PC and international PC guidelines. Results: PC teams in Bolivia have slowly increased in number since 2008. There are currently 19 PC teams in Bolivia, highly concentrated in urban centers. Multidisciplinary teams typically include physicians, nurses, psychologists, and social workers. The majority of teams offer treatments for all 16 essential PC symptoms included in our study. Teams report significant barriers for their patients to obtain opioid pain medications. Conclusions: Bolivian PC teams utilize multidisciplinary teams and have the capability to treat many of the essential PC symptoms with guideline-recommended treatments. However, it is unclear whether availability of services translates to accessibility for most patients, especially given their geographic distribution and cost of services.
Collapse
Affiliation(s)
- Jonathon Judkins
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan Alhalel
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joshua Hauser
- Department of Palliative Medicine and Supportive Care, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
7
|
Uribe C, Amado A, Rueda AM, Mantilla L. Barriers to access to palliative care services perceived by gastric cancer patients, their caregivers and physicians in Santander, Colombia. CIENCIA & SAUDE COLETIVA 2019; 24:1597-1607. [PMID: 31166495 DOI: 10.1590/1413-81232018245.04432019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 02/19/2019] [Indexed: 11/22/2022] Open
Abstract
Gastric cancer (GC) is a public health issue with high incidence and mortality in Colombia due to tardy diagnosis and barriers to access to curative treatment; this leaves palliative care (PC) as the only option. Our aim is to describe the access barriers to PC perceived by adults with GC, caregivers and physician in Santander, Colombia. A qualitative study was carried out with the analysis of the grounded theory (Strauss and Corbin), through semi-structured interviews, after sampling for convenience we found that the access barriers were: administrative, economic, cultural, knowledge, communication, institutional and geographical; strategies to overcome barriers: screening programs, governmental surveillance, and investment in health. In conclusion, access to PC requires remove barriers to timely and integral access and strengthen health and education policies to facilitate procedures and services that ensure the attention required by the adult with GC.
Collapse
Affiliation(s)
- Claudia Uribe
- Centro de Investigación en Ciencias de la Salud y Psicosociales CICSP, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga. Calle 157/19-55, Cañaveral Parque. 68001 Bucaramanga Santander
| | - Angélica Amado
- Universidad Santo Tomas de Bucaramanga. Santander, Colômbia
| | - Ana María Rueda
- Universidad Autónoma de Bucaramanga. Bucaramanga Santander Colômbia
| | - Leydi Mantilla
- Universidad Autónoma de Bucaramanga. Bucaramanga Santander Colômbia
| |
Collapse
|
8
|
Vu M, Yu J, Awolude OA, Chuang L. Cervical cancer worldwide. Curr Probl Cancer 2018; 42:457-465. [DOI: 10.1016/j.currproblcancer.2018.06.003] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
|
9
|
Namisango E, Allsop MJ, Powell RA, Friedrichsdorf SJ, Luyirika EBK, Kiyange F, Mukooza E, Ntege C, Garanganga E, Ginindza-Mdluli MN, Mwangi-Powell F, Mondlane LJ, Harding R. Investigation of the Practices, Legislation, Supply Chain, and Regulation of Opioids for Clinical Pain Management in Southern Africa: A Multi-sectoral, Cross-National, Mixed Methods Study. J Pain Symptom Manage 2018; 55:851-863. [PMID: 29155288 DOI: 10.1016/j.jpainsymman.2017.11.010] [Citation(s) in RCA: 6] [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: 08/23/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 11/23/2022]
Abstract
CONTEXT Sub-Saharan Africa faces an increasing incidence and prevalence of life-limiting and life-threatening conditions. These conditions are associated with a significant burden of pain linked to high morbidity and disability that is poorly assessed and undertreated. Barriers to effective pain management partly relate to lack of access to opioid analgesia and challenges in their administration. OBJECTIVES To identify country-specific and broader regional barriers to access, as well as the administration of opioids, and generate recommendations for advancing pain management in Southern Africa. METHODS A parallel mixed methods design was used across three countries: Mozambique, Swaziland, and Zimbabwe. Three activities were undertaken: 1) a review of regulatory and policy documentation, 2) group interviews, and 3) a self-administered key informant survey. RESULTS Barriers to accessing opioid analgesics for medical use include overly restrictive controlled medicines' laws; use of stigmatizing language in key documents; inaccurate actual opioid consumption estimation practices; knowledge gaps in the distribution, storage, and prescription of opioids; critical shortage of prescribers; and high out-of-pocket financial expenditures for patients against a backdrop of high levels of poverty. CONCLUSION Policies and relevant laws should be updated to ensure that the legislative environment supports opioid access for pain management. Action plans for improving pain treatment for patients suffering from HIV or non-communicable diseases should address barriers at the different levels of the supply chain that involve policymakers, administrators, and service providers.
Collapse
Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda; Uganda and King's College London, Cicely Saunders Institute, London, UK.
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Stefan J Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emmanuel B K Luyirika
- African Palliative Care Association, Kampala, Uganda; Uganda and King's College London, Cicely Saunders Institute, London, UK
| | - Fatia Kiyange
- African Palliative Care Association, Kampala, Uganda; Uganda and King's College London, Cicely Saunders Institute, London, UK
| | | | | | | | | | | | | | - Richard Harding
- King's College London, Cicely Saunders Institute, London, UK
| |
Collapse
|
10
|
Grunauer M, Mikesell C. A Review of the Integrated Model of Care: An Opportunity to Respond to Extensive Palliative Care Needs in Pediatric Intensive Care Units in Under-Resourced Settings. Front Pediatr 2018; 6:3. [PMID: 29410951 PMCID: PMC5787068 DOI: 10.3389/fped.2018.00003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/08/2018] [Indexed: 01/27/2023] Open
Abstract
It is estimated that 6.3 million children who die annually need pediatric palliative care (PPC) and that only about 10% of them receive the attention they need because about 98% of them live in under-resourced settings where PPC is not accessible. The consultative model and the integrated model of care (IMOC) are the most common strategies used to make PPC available to critically ill children. In the consultative model, the pediatric intensive care unit (PICU) team, the patient, or their family must request a palliative care (PC) consultation with the external PC team for a PICU patient to be evaluated for special care needs. While the consultation model has historically been more popular, issues related to specialist availability, referral timing, staff's personal biases, misconceptions about PC, and other factors may impede excellent candidates from receiving the attention they need in a timely manner. Contrastingly, in the IMOC, family-centered care, PC tasks, and/or PC are a standard part of the treatment automatically available to all patients. In the IMOC, the PICU team is trained to complete critical and PC tasks as a part of normal daily operations. This review investigates the claim that the IMOC is the best model to meet extensive PPC needs in PICUs, especially in low-resource settings; based on an extensive review of the literature, we have identified five reasons why this model may be superior. The IMOC appears to: (1) improve the delivery of PPC and pediatric critical care, (2) allow clinicians to better respond to the care needs of patients and the epidemiological realities of their settings in ways that are consistent with evidence-based recommendations, (3) facilitate the universal delivery of care to all patients with special care needs, (4) maximize available resources, and (5) build local capacity; each of these areas should be further researched to develop a model of care that enables clinicians to provide pediatric patients with the highest attainable standard of health care. The IMOC lays out a pathway to provide the world's sickest, most vulnerable children with access to PPC, a human right to which they are entitled by international legal conventions.
Collapse
Affiliation(s)
- Michelle Grunauer
- Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
- Pediatric Intensive Care Unit, Hospital de los Valles, Quito, Ecuador
| | - Caley Mikesell
- Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| |
Collapse
|
11
|
Charman LA, Esterhuizen P. A nurse’s phenomenological enquiry into doctors’ end-of-life decision making. J Res Nurs 2016. [DOI: 10.1177/1744987116628327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper is based on an exploratory study conducted in a UK NHS oncology unit, informed by the interpretation of hermeneutic phenomenology by Van Manen and Dahlberg et al. Four senior oncology doctors (trainees) were recruited using homogenous purposive sampling. In-depth interviews were conducted to understand participants’ lived experience of decision making for oncology patients near the end of life. Analysis followed a line-by-line approach, with consideration of the lifeworld existentials identified by ( Van Manen, 1990 ). Common themes were uncovered of empathy, the unacknowledged influence; dichotomy and conflict; and subverted emotion (uncovered through reflection). Findings are discussed in relation to current clinical decision-making theory, particularly cognitive continuum theory, current UK end of life care policy and practice, role socialisation and inter-professional team working.
Collapse
Affiliation(s)
- Lesley Ann Charman
- Clinical Nurse Specialist (Palliative Care),
Hospital Palliative Care Team, St James Hospital, UK
| | - Philip Esterhuizen
- Associate Director of Student Education, Curriculum
and Assessment School of Healthcare, University of Leeds, UK
| |
Collapse
|