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Pergolizzi J, LeQuang JAK, Wagner M, Varrassi G. Challenges in Palliative Care in Latin America: A Narrative Review. Cureus 2024; 16:e60698. [PMID: 38899235 PMCID: PMC11186623 DOI: 10.7759/cureus.60698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
In "graying" populations with extended lifespans and survivable forms of cancer, palliative services become increasingly important but may be difficult to introduce into public discourse, public policy, and healthcare systems. Latin America (LATAM) faces many challenges as it introduces and, in some cases, develops its palliative care programs; though the challenges faced here are in many ways universal ones, LATAM approaches may be unique and based on the region's specific culture, politics, and economics. This narrative review based on a literature search identified 10 main themes that can be interpreted as challenges and opportunities for palliative care in LATAM. These challenges are integrating palliation into healthcare systems; public policy and funding; therapeutic obstinacy; changing demographics; access to services; analgesia; the role of religion, spirituality, and folk medicine; social determinants of palliative care; low health literacy; and limited clinician training. Some of the LATAM nations have palliative programs and palliative care training in place while others are developing these systems. Integrating this care into existing healthcare and reimbursement systems has been a challenge. A notable challenge in LATAM is also access to care since palliative programs tend to cluster in metropolitan areas and create hardships for rural citizens to access them. The better-defined role of familial caregivers and telehealth may be important factors in the expansion of palliative care in LATAM and beyond.
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Affiliation(s)
- Joseph Pergolizzi
- Anesthesiology - Pain Medicine and Critical Care Medicine, NEMA Research, Inc., Naples, USA
| | | | - Morgan Wagner
- Entrepreneur Program, NEMA Research, Inc., Naples, USA
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2
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Durán D, Anyosa RC, Nicolau B, Kaufman JS. Uncovering the impact of COVID-19 on the place of death of cancer patients in South America. CAD SAUDE PUBLICA 2023; 39:e00057423. [PMID: 38055544 DOI: 10.1590/0102-311xen057423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/29/2023] [Indexed: 12/08/2023] Open
Abstract
The COVID-19 pandemic has significantly impacted healthcare systems worldwide, especially on the management of chronic diseases such as cancer. This study explores the effects of COVID-19 on cancer mortality trends in Brazil, Chile, and Peru. The monthly age-standardized mortality rates in different places of death (hospital/clinic or home) were estimated using vital statistics and death certificate databases. An interrupted time series analysis was performed for each country, using the date of lockdown implementation as the intervention point. Overall cancer mortality rates reduced after the implementation of pandemic restrictions, with a significant decrease in Brazil. In total, 75.3%, 55.4%, and 45.7% of deaths in Brazil, Peru, and Chile, respectively, occurred in hospitals. After lockdowns were implemented, at-home deaths increased in all countries, and in-hospital deaths correspondingly decreased only in Chile. Our results suggest that COVID-19 has significantly affected rates of cancer mortality and place of death in Latin America.
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Affiliation(s)
- Doris Durán
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | | | - Jay S Kaufman
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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3
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Díez-Concha JF, Gómez-García DM, Agudelo JA, Lizarazo Herrera EA. Assessing the impact of palliative care admission of end-of-life cancer adults. Palliat Care Soc Pract 2023; 17:26323524231198545. [PMID: 37706168 PMCID: PMC10496487 DOI: 10.1177/26323524231198545] [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: 04/01/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Background There is evidence that early admission to the palliative care (PC) program in adult cancer patients improves symptoms management, reduces unplanned hospital admissions, minimizes aggressive cancer treatments, and enables patients to make decisions about their end-of-life (EOL) care. Objectives This retrospective cohort study aimed to determine whether late admission to a PC program is associated with aggressive treatment at the EOL in adult patients with oncological diseases from their admission until death. Design/Methods The study evaluated the aggressiveness in EOL management in patients with advanced stage oncological diseases who died between 2017 and 2019. The study population was divided into two groups based on the time of admission to the PC program. Aggressiveness at the EOL was measured using five criteria: treatment, hospital admission and duration, emergency department care, and/or intensive care unit utilization. Results The study found a significant difference in the rate of aggressive EOL treatments between late admission to PC care and early admission [adjusted EOL 79.6% versus 70.4%; relative risk (RR): 1.98, 90% CI: 1.08-3.59, p: 0.061]; In the analysis of secondary variables, a significant association was observed between early admission to PC and the suspension of active treatments at the EOL, leading to a decrease in aggressiveness (77% versus 55.8%; RR: 1.38, 95% CI: 1.14-1.67, p: 0.004). Conclusion Our findings suggest that early referral to PC services is associated with less aggressive treatment at the EOL, including suspension of active treatments.
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Affiliation(s)
- Jose F. Díez-Concha
- Faculty of Health, Department of Family Medicine, Universidad del Valle, Cra 119a #60b-75, Cali, Valle del Cauca 760035, Colombia
| | - Diego Mauricio Gómez-García
- Faculty of Health, Department of Family Medicine, Universidad del Valle, Calle 15a #69-85, Cali, Valle del Cauca 760033, Colombia
| | - Julián Alberto Agudelo
- Pain Medicine and Palliative Care, Clínica de Occidente S.A., Cali, Valle del Cauca, Colombia
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Pérez-Cruz PE, Undurraga E, Arreola-Ornelas H, Corsi O, Jiang Kwete XX, Krakauer EL, Rosa WE, Knaul FM. Bridging gaps to universal palliative care access in Chile: serious health-related suffering and the cost of expanding the package of care services. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100425. [PMID: 36950031 PMCID: PMC10025417 DOI: 10.1016/j.lana.2022.100425] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/24/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
Background The Lancet Commission on Palliative Care (PC) and Pain Relief quantified the burden of serious health-related suffering (SHS), proposing an Essential Package of PC (EPPC) to narrow the global PC divide. We applied the EPPC framework to analyze PC access in Chile, identify gaps in coverage, and provide recommendations to improve PC access. Methods Total SHS and population in need of PC was estimated using official 2019 government data. We differentiated between cancer and non-cancer related SHS given guaranteed Chilean PC coverage for cancer. We calculated differences between the Chilean PC package and the Lancet Commission EPPC to estimate the cost of expanding to achieve national coverage of palliative care. Findings In 2019, nearly 105,000 decedent and non-decedent Chileans experienced SHS with a lower-bound estimate of 12.1 million days and an upper-bound estimate of 42.4 million days of SHS. Each individual experienced between 116 and 520 days of SHS per year. People living with a cancer diagnosis had PC access with financial protection, accounting for almost 42% of patients in need. People with non-cancer diagnoses-about 61 thousand patients-lacked PC coverage. Expanding coverage of the EPPC for all patients in need would cost just above $123 million USD, equivalent to 0.47% of Chilean National Health Expenditure. Interpretation Achieving universal PC access is urgent and feasible for Chile, classified as a high-income country. Expanding PC services and coverage to the EPPC standard are affordable and critical health system responses to ensuring financial protection for patients with SHS. In Chile, this requires closing large gaps in PC coverage pertaining to patients with non-cancer conditions and treatment of symptoms that go beyond pain. Our research provides an empirical approach for applying the Lancet Commission SHS framework to estimate the cost of achieving national universal PC access anchored in a package of health care services. Funding This research was partially funded by the Chilean Government through the Fondo Nacional de Ciencia y Tecnología (Fondecyt Regular) grant number 1201721, the U.S. Cancer Pain Relief Committee grant AWD-003806 awarded to the University of Miami and by the University of Miami Institute for Advanced Study of the Americas. We acknowledge NIH/NCI award P30CA008748.
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Affiliation(s)
- Pedro E. Pérez-Cruz
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- Sección Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- Corresponding author. Programa Medicina Paliativa y Cuidados Continuos, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Oficina 523, Santiago, 8330077, Chile.
| | - Eduardo Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON, Canada
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Chile
| | - Hector Arreola-Ornelas
- Institute for Obesity Research, Tecnológico de Monterrey, México
- Escuela de Gobierno y Transformación Pública, Tecnológico de Monterrey, México
- Tómatelo a Pecho, AC, México
- Fundación Mexicana para la Salud, México
| | - Oscar Corsi
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
| | | | - Eric L. Krakauer
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - William E. Rosa
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Felicia M. Knaul
- Tómatelo a Pecho, AC, México
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA
- Miller School of Medicine, University of Miami, Miami, FL, USA
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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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Van Christ Manirakiza A, Pfaendler KS. Breast, Ovarian, Uterine, Vaginal, and Vulvar Cancer Care in Low- and Middle-Income Countries. Obstet Gynecol Clin North Am 2022; 49:783-793. [DOI: 10.1016/j.ogc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Whitelaw S, Bell A, Clark D. The expression of 'policy' in palliative care: A critical review. Health Policy 2022; 126:889-898. [PMID: 35840439 DOI: 10.1016/j.healthpol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
The importance of 'policy' within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a 'policy turn' in palliative care. Applying Bacchi's "What's the Problem Represented to Be?" (WPR) framework to data from a systematic search, we address the research question, "in what ways has 'policy' been articulated in palliative care literature?". The paper describes the construction of 'the problem' context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of 'Global North' approaches; (3) the use of a policy narrative based on 'catastrophe' in justifying the need for palliative care; (4) the use of idealistic and aspirational 'calls to action'; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on 'Global South' perspectives, 'assets-based' approaches and attention to pragmatic implementation.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom.
| | - Anthony Bell
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
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8
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Abstract
Systems for end of life care around the world vary in availability, structure, and funding. When available, most end of life care is in the hospice model with an interdisciplinary team approach to care of people who are expected to die within months and whose primary goal is to maximize quality of life. Symptom management near the end of life is guided by prognosis and individual priorities. People dying with neurologic disease are likely to have impaired communication or mobility that adds to the complexity of prognostication and symptom management. Neurologic specialists have important roles to play in end of life care due to their unique understanding of disease prognosis as well as end of life symptom burden and management. Neurologic specialists need to become strong advocates for the importance of end of life care by being actively involved in the hospice movement and by addressing current disparities in access to care.
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Affiliation(s)
- Farrah N Daly
- EvenBeam Neuropalliative Care, Leesburg, VA, United States.
| | - Usha Ramanathan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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9
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de Vries E, Leal Arenas FA, van der Heide A, Gempeler Rueda FE, Murillo R, Morales O, Diaz-Amado E, Rodríguez N, Gonzalez BJ, Castilblanco Delgado DS, Calvache JA. Medical decisions concerning the end of life for cancer patients in three Colombian hospitals - a survey study. BMC Palliat Care 2021; 20:161. [PMID: 34657613 PMCID: PMC8520825 DOI: 10.1186/s12904-021-00853-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Cancer patients’ end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods Cancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient’s death. Results Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Specific end-of-life procedures, patients’ wishes, and availability of palliative care should be further investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00853-9.
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Affiliation(s)
- Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Piso 2, Bogota, Colombia.
| | - Fabián Alexander Leal Arenas
- Instituto Nacional de Cancerología, Cl. 1 No 9-85, Bogota, Colombia.,Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Fritz E Gempeler Rueda
- Anesthesiology Department, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Bogota, Colombia.,Clinical Ethics Service, Hospital Universitario San Ignacio, Cra. 7 No 40-62, Bogota, Colombia
| | - Raul Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia.,Department of Internal Medicine, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Bogotá, Colombia
| | - Olga Morales
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Eduardo Diaz-Amado
- Instituto de Bioética, Pontificia Universidad Javeriana, Tv. 4 #42, Bogota, Colombia
| | - Nelcy Rodríguez
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Piso 2, Bogota, Colombia
| | - Beatriz Juliana Gonzalez
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Danny Steven Castilblanco Delgado
- Instituto Nacional de Cancerología, Cl. 1 No 9-85, Bogota, Colombia.,Universidad Militar Nueva Granada, Carrera 11 n.° 101-80, Bogota, Colombia
| | - Jose A Calvache
- Department of Anesthesiology, Universidad del Cauca, Cl 5 #4-70, Popayán, Cauca, Colombia.,Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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10
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Haugen DF, Hufthammer KO, Gerlach C, Sigurdardottir K, Hansen MIT, Ting G, Tripodoro VA, Goldraij G, Yanneo EG, Leppert W, Wolszczak K, Zambon L, Passarini JN, Saad IAB, Weber M, Ellershaw J, Mayland CR. Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relatives' Survey within Seven Countries. Oncologist 2021; 26:e1273-e1284. [PMID: 34060705 PMCID: PMC8265351 DOI: 10.1002/onco.13837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/13/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recognized disparities in quality of end-of-life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries. MATERIALS AND METHODS A postbereavement survey was conducted by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i-CODE) questionnaire 6-8 weeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patient's last days of life. RESULTS Of 1,683 potential participants, 914 i-CODE questionnaires were completed (response rate, 54%). Approximately 94% reported the doctors treated their family member with dignity and respect "always" or "most of the time"; similar responses were given about nursing staff (94%). Additionally, 89% of participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3-17.8). Although 87% of participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase. CONCLUSION This is the first study assessing quality of care for dying cancer patients from the bereaved relatives' perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. (ClinicalTrials.gov Identifier: NCT03566732). IMPLICATIONS FOR PRACTICE Previous studies have shown that bereaved relatives' views represent a valid way to assess care for dying patients in the last days of their life. The Care Of the Dying Evaluation questionnaire is a suitable tool for quality improvement work to help determine areas where care is perceived well and areas where care is perceived as lacking. Health care professionals need to sustain high quality communication into the last phase of the cancer trajectory. In particular, discussions about what to expect when someone is dying and the provision of hydration in the last days of life represent key areas for improvement.
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Affiliation(s)
- Dagny Faksvåg Haugen
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | | | - Christina Gerlach
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Katrin Sigurdardottir
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Marit Irene Tuen Hansen
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Grace Ting
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool
| | - Vilma Adriana Tripodoro
- Pallium Latinoamérica, Buenos Aires, Argentina.,Instituto de Investigaciones Médicas Alfredo Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Goldraij
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba, Argentina
| | | | - Wojciech Leppert
- Department of Palliative Medicine, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland.,Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Lair Zambon
- Department of Internal Medicine, Campinas State University, Campinas, Brazil
| | | | | | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - John Ellershaw
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool.,Palliative Care Unit, University of Liverpool, Liverpool
| | - Catriona Rachel Mayland
- Academic Palliative and End-of-Life Care Department, Royal Liverpool University Hospital, Liverpool.,Palliative Care Unit, University of Liverpool, Liverpool.,Department of Oncology and Metabolism, University of Sheffield, Sheffield
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de Lima C, Paiva BSR, dos Santos Neto MF, Hui D, Perez-Cruz PE, Zimmermann C, Bruera E, Paiva CE. The Impact of International Research Collaborations on the Citation Metrics and the Scientific Potential of South American Palliative Care Research: Bibliometric Analysis. Ann Glob Health 2021; 87:32. [PMID: 33828950 PMCID: PMC8015710 DOI: 10.5334/aogh.3158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Progress in palliative care (PC) requires scientific advances which could potentially be catalyzed by international research collaboration (IRC). It is currently not known how often IRC occurs with PC investigators in South America. Objectives To evaluate the percentage of South America journal articles on PC involving IRCs and the impact of these collaborations on the scientific potential the studies and on their citations. Methods This was a bibliometric analysis of studies published between January 1, 1998, and December 31, 2017. A search of Pubmed, Embase, Lilacs, and Web of Science (WOS) was performed using the terms "palliative care," "hospice care," "hospices" and "terminal care," combined with the name of South America countries. The scientific potential was assessed by analyzing study design, characteristics of the journal and funding. IRCs were further subdivided in internal (within South America countries) and external (with countries outside South America). Findings Of the 641 articles, 117 (18.2%) involved IRCs (internal: 18, 2.8%; external: 110, 17.2%). Articles with IRCs had higher median two-year citations in WOS (2 vs. 1, p < 0.001), Scopus (3 vs. 1, p < 0.001) and Google Scholar (4.5 vs. 2, p < 0.001) compared to articles without IRC. Moreover, they were more often funded (40.7% vs. 9.7%, p < 0.001), published in Pubmed-indexed (76.1% vs. 41.6%; p < 0.001) and in WOS-indexed (70.1% vs. 29.6%; p < 0.001) journals, and with study designs most often classified as clinical trial (5.1% vs. 1.0%; p = 0.002) and cohort (10.3% vs. 2.9%; p < 0.001) compared to articles without IRC. Conclusions Studies with international research collaborations, both internal and external to South America, are more frequently cited and have characteristics with greater scientific potential than do studies without international collaborations.
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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
| | - Bianca Sakamoto Ribeiro Paiva
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Oncology Graduate Program, 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
- Oncology Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro Emilio Perez-Cruz
- Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos Eduardo Paiva
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Oncology Graduate Program, 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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Childhood cancer in Latin America: from detection to palliative care and survivorship. Cancer Epidemiol 2020; 71:101837. [PMID: 33121936 DOI: 10.1016/j.canep.2020.101837] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment options for childhood cancer have improved substantially, although in many low- and middle-income countries survival is lagging behind. Integral childhood cancer care involves the whole spectrum from detection and diagnosis to palliative and survivorship care. METHODS Based on a literature review and expert opinions, we summarized current practice and recommendations on the following aspects of childhood cancer in Latin America: diagnostic processes and time to diagnosis, stage at diagnosis, treatments and complications, survivorship programs and palliative care and end-of-life services. RESULTS Latin America is a huge and heterogeneous continent. Identified barriers show similar problems between countries, both logistically (time and distance to centers, treatment interruptions) and financially (cost of care, cost of absence from work). Governmental actions in several countries improved the survival of children with cancer, but difficulties persist in timely diagnosis and providing adequate treatment to all childhood cancer patients in institutions with complete infrastructure. Treatment abandonment is still common, although the situation is improving. Cancer care in the region has mostly focused on acute treatment of the disease and has not adequately considered palliative and end-of-life care and monitoring of survivors. CONCLUSIONS Decentralizing diagnostic activities and centralizing specialized treatment will remain necessary; measures to facilitate logistics and costs of transportation of the child and caretakers should be implemented. Twinning actions with specialized centers in high income countries for help in diagnosis, treatment and education of professionals and family members have been shown to work. Palliative and end-of-life care as well as childhood cancer survivorship plans are needed.
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Ioshimoto T, Shitara DI, do Prado GF, Pizzoni R, Sassi RH, de Gois AFT. Education is an important factor in end-of-life care: results from a survey of Brazilian physicians' attitudes and knowledge in end-of-life medicine. BMC MEDICAL EDUCATION 2020; 20:339. [PMID: 33008366 PMCID: PMC7531127 DOI: 10.1186/s12909-020-02253-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/23/2020] [Indexed: 06/08/2023]
Abstract
BACKGROUND According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial. METHODS A cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term. RESULTS Of the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p < 0,001). CONCLUSIONS Our study showed that Brazilian physicians lack not only the knowledge, but also training in end-of-life medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.
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Affiliation(s)
- Thais Ioshimoto
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Danielle Ioshimoto Shitara
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Gilmar Fernades do Prado
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Raymon Pizzoni
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil.
| | - Rafael Hennemann Sassi
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Aécio Flávio Teixeira de Gois
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
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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.
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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
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Knowledge, Attitudes and Expectations of Physicians with Respect to Palliative Care in Ecuador: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113906. [PMID: 32486456 PMCID: PMC7312868 DOI: 10.3390/ijerph17113906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/11/2022]
Abstract
Background: The worldwide need for palliative care is high, especially in mid- income countries like Ecuador, where the percentage of patients receiving such care is very small due to the scarcity of infrastructure and specialized personnel and to the unequal distribution in the country. The objective of this study is to explore the knowledge, attitudes and expectations related to palliative care of the physicians in Ecuador. Methods: A qualitative study based on 28 semi-structured interviews, from March 2014 to November 2016, with physicians working in four cities in Ecuador recruited through the snowball technique. Thematic analysis was developed supported by the ATLAS.ti software. Results: Five core themes were identified: (1) training, (2) health policy, (3) professionals’ activities, (4) health services and (5) development of palliative care in Ecuador. Conclusions: Strategies are needed which intensify the training of medical professional in palliative care, as well as avail the human resources and materials for providing it.
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16
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Cuervo-Suarez MI, Claros-Hulbert A, Manzano-Nunez R, Muñoz M, García X. Pediatric Palliative Care During End of Life: A Privilege of a Few in a Tertiary Referral Hospital From Colombia. Am J Hosp Palliat Care 2020; 37:636-640. [PMID: 32323561 DOI: 10.1177/1049909120920542] [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: 01/26/2023] Open
Abstract
BACKGROUND We aim to describe the access to palliative care (PC) in hospitalized children during end-of-life care and compare the circumstances surrounding the deaths of hospitalized children as a basis for implementing a pediatric PC program at our institution. METHODS We performed a retrospective chart review of deceased pediatric patients at a tertiary referral hospital in Colombia. The study group was selected by randomly drawing a sample of 100 observations from the 737 deceased children from 2013 to 2016. A 1:1 propensity score (PS) matching was performed to compare the characteristics and outcomes between PC and non-PC treated patients. RESULTS We included 87 patients. After PS matching, we found that patients under the care of non-PC physicians were more likely to die in the pediatric intensive care unit (non-PC: 6/10 vs PC: 1/10; P = .02), to be on vasopressor agents and mechanical ventilation (non-PC: 7/10 vs PC: 1/10; P = .02), and to receive cardiopulmonary resuscitation at the end of life (non-PC: 5/10 vs PC: 0/10; P = .03). In contrast, a significantly higher proportion of patients under the care of the pediatric PC team died with comfort measures (non-PC: 2/10 vs 8/10; P = .02) and nonescalation of care in physician orders (non-PC: 5/10 vs PC: 10/10; 0.03). CONCLUSION In this study, only 10 of 87 patients were treated by the pediatric PC team at the end of life. The latter finding is concerning and is a call to action to improve access to pediatric PC at our institution.
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Affiliation(s)
- Maria Isabel Cuervo-Suarez
- Fundación Valle de Lili, Pediatric Palliative Care Program, Cali, Colombia.,Universidad Icesi, Facultad de Medicina, Cali, Colombia
| | - Angélica Claros-Hulbert
- Fundación Valle de Lili, Pediatric Palliative Care Program, Cali, Colombia.,Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Ximena García
- Fundación Valle de Lili, Pediatric Palliative Care Program, Cali, Colombia.,Universidad Icesi, Facultad de Medicina, Cali, Colombia
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Cox-Seignoret K, Maharaj RG. Unmet needs of patients with cancer in their last year of life as described by caregivers in a developing world setting: a qualitative study. BMC Palliat Care 2020; 19:13. [PMID: 31980019 PMCID: PMC6982385 DOI: 10.1186/s12904-020-0516-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care is in its infancy in most of the developing world. We set out to explore the lived experiences of families and caregivers of recently deceased cancer patients in Trinidad and Tobago and to determine the unmet needs of the patients and what recommendations could be derived to improve the current services. METHODS A phenomenological approach with purposeful sampling was used. Participants were referred by key health professionals. Face-to-face interviews were conducted. Interviews were transcribed verbatim, with analysis and data collection occurring concurrently. Thematic content analysis was used to determine common domains, themes and sub-themes. RESULTS Interviews were completed with 15 caregivers. All were spouses or children of the deceased. Ages of the deceased ranged from 43 to 93, the average being 65.5 years. The deceased experienced a variety of cancers including lung, colorectal and oesophageal. Unmet needs were identified under 4 domains of institutions, community, the family unit and the wider society. Institutional unmet needs were delayed diagnosis and treatment and poor inter-institution coordination. Medical and nursing care failed in the areas of health care providers' attitudes, pain management and communication. The family unit lacked physical and psychosocial support for the caregiver and financial aid for the family unit. Societal needs were for public education to address myths and cultural beliefs around cancer. CONCLUSION There is need for systemic interventions to improve the care of those dying from cancer in Trinidad and Tobago. Stakeholders need to commit to palliative care as a public health priority, implementing education, planning services and mobilizing community resources.
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Affiliation(s)
| | - Rohan G. Maharaj
- The Unit of Public Health and Primary Care, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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18
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Vishnevetsky A, Zapata del Mar C, Luis Cam J, Cornejo-Olivas M, Creutzfeldt CJ. Palliative Care: Perceptions, Experiences, and Attitudes in a Peruvian Neurologic Hospital. J Palliat Med 2019; 22:250-257. [PMID: 30526275 PMCID: PMC6391604 DOI: 10.1089/jpm.2018.0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The development of palliative care in Peru remains limited, particularly for nononcological services, such as neurology. The goal of this study was to explore attitudes toward and knowledge about palliative and end-of-life care among patients, families, nurses, and doctors in a specialized neurological institute in Lima, Peru. MATERIALS AND METHODS We used a mixed methods approach consisting of 78 surveys and 21 qualitative, semistructured interviews that were recorded, transcribed, and analyzed using thematic analysis. RESULTS Surveys identified a substantial need for palliative care in the neurological institute (63% of doctors and 77% of nurses reported palliative care needs in >30% of their patients), and for training (82% of doctors and 69% of nurses reported inadequate palliative care education). The key themes emerging from qualitative interviews concerned transparency of communication about prognosis and end-of-life choices in neurological disease. Familiarity with advance directives was limited among both clinicians and families, and participants were divided about whether or not patients should be informed of serious diagnoses and prognoses, and who should inform them. Barriers to transparency in patient-physician communication included (1) expectation of cure; (2) physician's lack of training in communication and end-of-life care; (3) a paternalistic culture; and (4) the nature of neurological diseases. CONCLUSIONS Our study highlights opportunities to enhance palliative care and communication education for neurology providers and the public in Peru, a country that currently has no palliative care training program and no legal basis for advance directives.
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Affiliation(s)
- Anastasia Vishnevetsky
- Northern Pacific Global Health Consortium Fogarty Fellow, Lima, Peru
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | - Juan Luis Cam
- Unidad de Cuidados Intensivos, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
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Goodman-Meza D, Medina-Mora ME, Magis-Rodríguez C, Landovitz RJ, Shoptaw S, Werb D. Where Is the Opioid Use Epidemic in Mexico? A Cautionary Tale for Policymakers South of the US-Mexico Border. Am J Public Health 2019; 109:73-82. [PMID: 30495992 PMCID: PMC6301408 DOI: 10.2105/ajph.2018.304767] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2018] [Indexed: 12/31/2022]
Abstract
In North America, opioid use and its harms have increased in the United States and Canada over the past 2 decades. However, Mexico has yet to document patterns suggesting a higher level of opioid use or attendant harms.Historically, Mexico has been a country with low-level use of opioids, although heroin use has been documented. Low-level opioid use is likely attributable to structural, cultural, and individual factors. However, a range of dynamic factors may be converging to increase the use of opioids: legislative changes to opioid prescribing, national health insurance coverage of opioids, pressure from the pharmaceutical industry, changing demographics and disease burden, forced migration and its trauma, and an increase in the production and trafficking of heroin. In addition, harm-reduction services are scarce.Mexico may transition from a country of low opioid use to high opioid use but has the opportunity to respond effectively through a combination of targeted public health surveillance of high-risk groups, preparation of appropriate infrastructure to support evidence-based treatment, and interventions and policies to avoid a widespread opioid use epidemic.
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Affiliation(s)
- David Goodman-Meza
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Maria Elena Medina-Mora
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Carlos Magis-Rodríguez
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Raphael J Landovitz
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Steve Shoptaw
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Dan Werb
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
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Chidiac C. The evidence of early specialist palliative care on patient and caregiver outcomes. Int J Palliat Nurs 2018; 24:230-237. [DOI: 10.12968/ijpn.2018.24.5.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Claude Chidiac
- Lecturer in Palliative Care, Saint Francis Hospice, Romford, UK and Course Director MSc Palliative and End of Life Care, School of Health and Social Care, London South Bank University, UK
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De Lima L, Radbruch L. The International Association for Hospice and Palliative Care: Advancing Hospice and Palliative Care Worldwide. J Pain Symptom Manage 2018; 55:S96-S103. [PMID: 28797849 DOI: 10.1016/j.jpainsymman.2017.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 12/01/2022]
Abstract
The International Association for Hospice and Palliative Care (IAHPC) is a membership-based organization dedicated to the development and improvement of hospice and palliative care worldwide. The mission of IAHPC is to improve the quality of life of adults and children with life-threatening conditions and their families. The vision of IAHPC is universal access to high-quality palliative care, integrated into all levels of health care systems in a continuum of care with disease prevention, early diagnosis, and treatment, to assure that any patient's or family caregiver's suffering is relieved to the greatest extent possible. IAHPC focuses on the advancement of four areas of palliative care: education, access to medicines, health policies, and service implementation. IAHPC works on three levels: at the grass roots, developing resources, and educational strategies that enable health workers to provide cost-effective palliative care; at the national level, working with government representatives to improve national policies to ensure adequate care and access to medicines; and at the international level, advocating with the UN organizations to ensure that access to palliative care and to essential medicines for palliative care and pain treatment is stipulated and incorporated as an obligation of member states.
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Affiliation(s)
- Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, Texas.
| | - Lukas Radbruch
- International Association for Hospice and Palliative Care, Houston, Texas; Department of Palliative Medicine, University Hospital Bonn, Germany; The Malteser Hospital, Bonn, Germany
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Soto-Perez-de-Celis E, Chavarri-Guerra Y, Pastrana T, Ruiz-Mendoza R, Bukowski A, Goss PE. End-of-Life Care in Latin America. J Glob Oncol 2017; 3:261-270. [PMID: 28717769 PMCID: PMC5493222 DOI: 10.1200/jgo.2016.005579] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cancer has become a global pandemic with disproportionately higher mortality rates in low- and middle- income countries, where a large fraction of patients present in advanced stages and in need of end-of-life care. Globally, the number of adults needing end-of-life care is greater than 19 million, and up to 78% of these patients are living in low- and middle- income countries. In the Americas alone, more than one million people are in need of end-of-life care, placing an enormous burden on local health systems, which are often unprepared to meet the challenge presented by this complex patient population. In Latin America, cancer care is characterized by the presence of vast inequalities between and within countries, and the provision of end-of-life care is no exception. Disparities in access to advanced care planning, with a lack of provision of adequate palliative care and pain medication, are common in the region. These shortcomings are related in large part to inadequate or inappropriate legislation, lack of comprehensive national palliative care plans, insufficient infrastructure, lack of opportunities for clinical training, unreliable reporting of data, and cultural barriers. This report reviews the current status of end-of-life care in Latin America, focusing on identifying existing deficiencies and providing a framework for improvement.
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Affiliation(s)
- Enrique Soto-Perez-de-Celis
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Yanin Chavarri-Guerra
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Tania Pastrana
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Rossana Ruiz-Mendoza
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Alexandra Bukowski
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Paul E. Goss
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
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Mertnoff R, Vindrola-Padros C, Jacobs M, Gómez-Batiste X. The Development of Palliative Care in Argentina: A Mapping Study Using Latin American Association for Palliative Care Indicators. J Palliat Med 2017; 20:829-837. [PMID: 28498026 DOI: 10.1089/jpm.2016.0312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Latin American Association for Palliative Care (ALCP) developed 10 indicators to monitor the development of palliative care. The indicators have been applied across Latin American countries but have not been used internally. OBJECTIVE The aims of this study were to document the development of palliative care in Argentina at the national and provincial levels by using a selection of the indicators developed by the ALCP and identify the difficulties and needs of healthcare professionals working in palliative care. This is the first study to apply the indicators intranationally. METHODS This was a cross-sectional pilot study based on two questionnaires with representatives from each province, one workshop, and telephone conversations to corroborate the collected data. These data were used to calculate a preselection of eight ALCP indicators covering four main areas of development: education, policy, service delivery, and medication. A total of 30 participants took part in the study. RESULTS The application of the ALCP indicators at the province level led to the identification of inequalities in the development and distribution of services across the country. The provinces in the north-west were identified as the region with the greatest need for development. The main difficulties for healthcare professionals were lack of national service registries, certified palliative care specialties, and opportunities for continuous training. DISCUSSION The ALCP indicators are useful tools for mapping palliative care development within countries. Further work needs to be carried out to increase their specificity and integrate them in policy design and service delivery.
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Affiliation(s)
- Rosa Mertnoff
- 1 British Hospital Buenos Aires , Argentina-Paliativa Asociación Civil, Buenos Aires, Argentina .,2 Red Federal de Cronicided Avanzada y Atencion Paliativa, Buenos Aires, Argentina
| | - Cecilia Vindrola-Padros
- 3 Department of Applied Health Research, University College London (UCL) , London, United Kingdom
| | - Mariana Jacobs
- 2 Red Federal de Cronicided Avanzada y Atencion Paliativa, Buenos Aires, Argentina .,4 Department of Psychooncology, Hospital Aleman , Buenos Aires, Argentina
| | - Xavier Gómez-Batiste
- 5 WHO Collaborating Center for Palliative Care Public Health Programs, Catalan Institute of Oncology , Hospitalet, Spain .,6 Chair of Palliative Care, University of Vic , Barcelona, Spain
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Sánchez D, Chala A, Alvarez A, Payan C, Mendoza T, Cleeland C, Sanabria A. Psychometric Validation of the M. D. Anderson Symptom Inventory-Head and Neck Module in the Spanish Language. J Pain Symptom Manage 2016; 51:1055-61. [PMID: 26899822 DOI: 10.1016/j.jpainsymman.2015.12.320] [Citation(s) in RCA: 8] [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: 10/26/2015] [Revised: 12/04/2015] [Accepted: 12/23/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT The assessment of cancer-related symptoms requires culturally adapted and psychometrically validated symptom assessment tools. The M. D. Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) is a useful instrument for measuring symptom burden that was specifically developed for head and neck cancer patients. OBJECTIVES To validate the Spanish version of the MDASI-HN. METHODS We evaluated the psychometric features of the MDASI-HN in patients with head and neck cancer. We evaluated the item-scale correlations and the internal consistency. We conducted principal axis factoring to identify the underlying dimensions as a measure of construct validity. The convergence/concurrent validity was assessed with the University of Washington Quality of Life Questionnaire for Head and Neck Patients, and known-group validity and test-retest reliability also were assessed. RESULTS One hundred thirty patients were included. The mean ± SD age was 60.5 ± 13.6 years; 68% of patients were male, 42% had laryngeal tumors, and 45.9% had Stage III tumors. Forty-seven percent of the patients underwent surgery, 55% underwent radiotherapy, and 36% underwent chemotherapy. The global Cronbach alpha for the HN module was 0.81. The factor analysis identified two factors (Factor 1: speech, mucus, coughing, and constipation; Factor 2: teeth, taste, sores, swallowing, and skin). The correlation with the global score of the University of Washington Quality of Life was -0.68. The difference in the MDASI-HN scores according to Eastern Cooperative Oncology Group performance status was statistically significant (2.72 vs. 4.01, P = 0.006). The intraclass test-retest correlation was 0.62. CONCLUSION The Spanish version of the MDASI-HN is reliable and valid for evaluating cancer-related symptoms in head and neck cancer patients.
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Affiliation(s)
- Daniel Sánchez
- Department of Surgery, Universidad de Antioquia, Medellin, Colombia
| | - Andrés Chala
- Department of Surgery, Universidad de Caldas, Manizales, Colombia
| | - Andrés Alvarez
- Department of Surgery, Universidad del Rosario, Bogota, Colombia
| | - Catalina Payan
- Oncology Unit, Hospital Pablo Tobón Uribe, Medellin, Colombia
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Charles Cleeland
- Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Medellin, Colombia; Oncology Unit, Hospital Pablo Tobón Uribe, Medellin, Colombia.
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Abstract
Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, illness understanding, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available.
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Affiliation(s)
- David Hui
- Department of Palliative Care &Rehabilitation Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
| | - Eduardo Bruera
- Department of Palliative Care &Rehabilitation Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
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Hui D, dos Santos R, Reddy S, Nascimento MSDA, Zhukovsky DS, Paiva CE, Dalal S, Costa ED, Walker P, Scapulatempo HH, Dev R, Crovador CS, De La Cruz M, Bruera E. Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study. Palliat Med 2015; 29:826-33. [PMID: 25881622 DOI: 10.1177/0269216315583031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Limited information is available on the symptomatic complications that occur in the last days of life. AIM We documented the frequency, clinical course, and survival for 25 symptomatic complications among patients admitted to acute palliative care units. DESIGN Prospective longitudinal observational study. MEASUREMENTS Their attending physician completed a daily structured assessment of symptomatic complications from admission to discharge or death. SETTING/PARTICIPANTS We enrolled consecutive advanced cancer patients admitted to acute palliative care units at MD Anderson Cancer Center, USA, and Barretos Cancer Hospital, Brazil. RESULTS A total of 352 patients were enrolled (MD Anderson Cancer Center = 151, Barretos Cancer Hospital = 201). Delirium, pneumonia, and bowel obstruction were the most common complications, occurring in 43%, 20%, and 16% of patients on admission, and 70%, 46%, and 35% during the entire acute palliative care unit stay, respectively. Symptomatic improvement for delirium (36/246, 15%), pneumonia (52/161, 32%), and bowel obstruction (41/124, 33%) was low. Survival analysis revealed that delirium (p < 0.001), pneumonia (p = 0.003), peritonitis (p = 0.03), metabolic acidosis (p < 0.001), and upper gastrointestinal bleed (p = 0.03) were associated with worse survival. Greater number of symptomatic complications on admission was also associated with poorer survival (p < 0.001). CONCLUSION Symptomatic complications were common in cancer patients admitted to acute palliative care units, often do not resolve completely, and were associated with a poor prognosis despite active medical management.
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Affiliation(s)
- David Hui
- Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata dos Santos
- Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil
| | - Suresh Reddy
- Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Donna S Zhukovsky
- Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Shalini Dalal
- Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Paul Walker
- Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Rony Dev
- Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Maxine De La Cruz
- Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Pastrana T, Centeno C, De Lima L. Palliative Care in Latin America from the Professional Perspective: A SWOT Analysis. J Palliat Med 2015; 18:429-37. [PMID: 25658701 DOI: 10.1089/jpm.2014.0120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The development of palliative care (PC) in Latin America (LA) has been slow compared to other regions. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis may contribute to the identification of barriers and successful strategies. OBJECTIVE The study's objective was to conduct a SWOT analysis of the development of PC in LA from the PC professional perspective. METHODS Experts from 19 countries of the region were selected in collaboration with national associations. Specific questions were included in the Latin American Association for Palliative Care (ALCP) Atlas of Palliative Care cross-survey 2012. Content analysis was conducted categorizing responses in a SWOT framework. Descriptive and correlation analyses were performed. RESULTS A total of 577 statements were provided. Among the Strengths were integration into health systems and increasing number of professionals with PC training. Among weaknesses were lack of national PC programs, limited connection between policymakers and professionals, and barriers in the availability of opioids. Opportunities were increased awareness of policymakers and higher interest of students and professionals. Threats were competing funding for other services and medications, limited interest of the pharmaceutical industry in producing affordable opioid medications, and emphasis by the media on opioid diversion and abuse. Comments were categorized under (1) health policy, (2) education and research, (3) service provision, (4) opioid availability, and (5) advocacy. A moderately positive correlation was found (R=0.4 in both) between the ALCP development index and the number of positive/negative factors mentioned by country. CONCLUSIONS A SWOT framework is applicable in a situational analysis and helps to identify common aspects among the countries and key elements in the development of PC in Latin America.
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Affiliation(s)
- Tania Pastrana
- 1 Department of Palliative Medicine, RWTH Aachen University , Aachen, Germany
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Mutto EM, Bunge S, Vignaroli E, Bertolino M, Villar MJ, Wenk R. Medical Students' Palliative Care Education in a Latin American University: A Three-Year Experience at Austral University in Buenos Aires, Argentina. J Palliat Med 2014; 17:1137-42. [DOI: 10.1089/jpm.2013.0673] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eduardo Mario Mutto
- Department of Palliative Medicine, Universidad Austral, Buenos Aires, Argentina
| | - Sofía Bunge
- Fundación FEMEBA (PAMP), Buenos Aires, Argentina
| | | | | | | | - Roberto Wenk
- Fundación FEMEBA (PAMP), Buenos Aires, Argentina
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Rodríguez Prada A, Calderon Gómez J, Krikorian Daveloza A, Zuleta Benjumea A. Comunidades compasivas en cuidados paliativos: revisión de experiencias internacionales y descripción de una iniciativa en Medellín, Colombia. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.57089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: Describir experiencias internacionales de comunidades compasivas y dar a conocer los avances de la iniciativa desarrollada en Colombia llamada “Medellín compasiva, todos contigo”. Metodología: Se realizó una revisión narrativa de la literatura haciendo una búsqueda en Medline, Ovid, Sciencedirect, Embase, Mediclatina, Health source y Google, así como exploración manual. Se emplearon los términos: “comunidades compasivas” o “comunidades” o “redes de apoyo” y “cuidados paliativos” o “cuidados al final de la vida” y sus respectivos en idioma inglés. Resultados: El origen de las comunidades compasivas proviene de la propuesta de ciudades saludables adoptada por la Organización Mundial de la Salud, que ha permeado la salud pública y los cuidados paliativos; esta busca complementar la atención sanitaria promoviendo la responsabilidad ciudadana por el cuidado de sus enfermos y la generación de redes de apoyo. El artículo describe el desarrollo de las comunidades compasivas en cuidados paliativos, una serie de experiencias internacionales y la iniciativa llevada a cabo en Medellín, Colombia. Conclusiones: El principal objetivo de las comunidades compasivas en el mundo es mejorar la calidad de vida de las personas con enfermedades avanzadas, mediante el empoderamiento de su grupo social, ayuda en las tareas y satisfacción de las necesidades de cuidado. Las comunidades han surgido en diversas localizaciones y logran estos objetivos desde diferentes miradas y acciones. Esta estrategia es útil para empoderar a las comunidades del cuidado de sus enfermos y servir como un complemento eficaz en cuidados paliativos, particularmente en contextos donde estos están en fase de desarrollo.
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