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Ibrahim AM, Elnaghy SF, Abo Elmatty GM, Mohamed Ghida NI, Mohamed MA. Effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy in Port Said City: A pre-post quasi-experimental study. Palliat Support Care 2024; 22:546-562. [PMID: 38287515 DOI: 10.1017/s1478951523002067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment. OBJECTIVES To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy. METHODS The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program. RESULTS Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program. SIGNIFICANCE OF THE RESULTS The palliative care education program significantly improved caregivers' knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.
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Affiliation(s)
- Ateya Megahed Ibrahim
- College of Nursing, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
- Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt
| | - Sara Fawzy Elnaghy
- Family and Community Health Nursing Department, Health Technical Institute in Port Said, Port Said, Egypt
| | - Gehad Mohamed Abo Elmatty
- Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt
| | | | - Magda Ali Mohamed
- Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt
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Elias H, Kisembe E, Nyariki S, Kiplimo I, Amisi J, Boit J, Tarus A, Mohamed N, Cornetta K. Impact of training on knowledge, confidence and attitude amongst community health volunteers in the provision of community-based palliative care in rural Kenya. BMC Palliat Care 2024; 23:97. [PMID: 38605309 PMCID: PMC11007868 DOI: 10.1186/s12904-024-01415-5] [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: 04/21/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES Existing literature suggests multiple potential roles for community health volunteers (CHVs) in the provision of palliative care (PC) in low- and middle-income countries. In Kenya the role of CHV in the provision of PC has not been reported. The objective of this study was to assess knowledge, confidence, attitude, and clinical practice of community health volunteers after attending a novel palliative care (PC) training program. METHODS A total of 105 CHVs participated in a 3-day in person training followed by a 1-month in person and telephone observation period of the palliative care activities in the community. Structured questionnaires were used pre- and post-training to assess knowledge acquisition, impact on practice, and content delivery. A mixed method study design was conducted 12-month post training to assess impact on clinical practice. RESULTS Immediately after training, CHV provided positive ratings on relevance and content delivery. In the month following training, CHVs evaluated 1,443 patients, referred 154, and conducted 110 and 129 tele consults with the patients and PC providers respectively. The follow up survey at 12 months revealed improved knowledge and confidence in various domains of palliative care including symptom and spiritual assessment and provision of basic nursing and bereavement care. Focus group discussions revealed the CHVs ability to interpret symptoms, make referrals, improved communication/ interpersonal relationships, spiritual intervention, patient comfort measures and health care practices as newly learned and practiced skills. CONCLUSIONS We noted improved knowledge, new skills and change in practice after CHVs participation in a novel training curriculum. CHVs can make important contributions to the PC work force and be first line PC providers in the community as part of larger hub and spoke care model.
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Affiliation(s)
- Hussein Elias
- Department of Family Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - Evelyne Kisembe
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sarah Nyariki
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ivan Kiplimo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - James Amisi
- Department of Family Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Juli Boit
- Living Room International Hospital, Eldoret, Kenya
| | | | | | - Kenneth Cornetta
- Department of Family Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, IN, USA
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Rowe JT, Parrillo E, Stanford O, Wenzel J, Johnston FM. Individual and Systemic Barriers Blocking Community Health Workers from Helping the Seriously Ill. J Palliat Med 2024; 27:358-366. [PMID: 38010809 PMCID: PMC10903179 DOI: 10.1089/jpm.2022.0516] [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] [Accepted: 09/15/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Palliative care is a valuable component of health care that improves a patient's quality of life, yet its availability to patients with serious chronic illness remains relatively low. Due to their knowledge of community preferences and ability to improve patient education and access to care, community health workers (CHWs) can increase palliative care usage by patients. Notably, barriers to CHWs helping patients with serious chronic illness remain poorly understood. Objective: Explore the perception of barriers CHWs feel they face when attempting to support the health care of patients with serious chronic illness. Design: Qualitative semistructured individual interviews of CHWs and qualitative descriptive analysis. Setting/Subjects: Twelve CHWs who have worked with patients with serious chronic illness were recruited from the Johns Hopkins Healthcare LLC and the Baltimore Alliance for Careers in Healthcare organizations to virtually participate. Results: CHWs perceived both active and passive barriers that obstructed their efforts to work with seriously ill patients. CHWs shared that these barriers were dependent on themselves, their peers, and their work environments. Prevalent themes included interprofessional conflict, poor health care worker understanding of the CHW's role, and lack of access to quality resource organizations. CHWs noted job-specific training, better means to identify needed resources for patients, and inclusive health care teams as solutions to support their professional goals, while helping patients with serious illness. Conclusions: There are multiple perceived barriers to CHWs helping seriously ill patients. CHWs aiding patients with serious illness can be supported through better job training, better resource management tools, and improved communication between health care team members.
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Affiliation(s)
- Julian T. Rowe
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elaina Parrillo
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olivia Stanford
- Community Outreach and Engagement Department, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fabian M. Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Segarmurthy MV, Lim RBL, Yeat CL, Ong YX, Othman S, Taher SW, Spence D, Ahmad F, Sullivan R, Rosa WE, Bhoo-Pathy N. Mapping Palliative Care Availability and Accessibility: A First Step to Eradicating Access Deserts in the Low- and Middle-Income Settings. J Palliat Care 2023:8258597231214485. [PMID: 37981855 PMCID: PMC11102529 DOI: 10.1177/08258597231214485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Palliative care is unavailable and/or inaccessible for the majority of people in low- and middle-income countries (LMIC). This study aims to determine the availability and accessibility of palliative care services in Malaysia, a middle-income country that has made good progress toward universal health coverage (UHC). METHOD Publicly available data, and databases of registered palliative care services were obtained from governmental and nongovernmental sources. Google Maps and Rome2Rio web-based applications were used to assess geographical disparities by estimating the median distance, travel time, and travel costs from every Malaysian district to the closest palliative care service. RESULTS Substantial variations in availability, components, and accessibility (distance, time, and cost to access care) of palliative care services were observed. In the highly developed Central Region of Peninsular Malaysia, specialty care was available within 4 km whereas in the less-developed East Coast of Peninsular Malaysia, patients had to travel approximately 46 km. In the predominantly rural East Malaysia, basic palliative care services were 82 km away and, in some instances, where land connectivity was scarce, it took 2.5 h to access care via boat. The corresponding median travel costs were USD2 (RM9) and USD23 (RM114) in Peninsular Malaysia and East Malaysia. CONCLUSION The stark urban-rural divide in the availability and accessibility of palliative care services even in a setting that has made good progress toward UHC highlights the urgent need for decentralization of palliative care in the LMICs. This may be achieved by capacity building and task shifting in primary care and community settings.
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Affiliation(s)
- Malar Velli Segarmurthy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Training Division, Ministry of Health Malaysia, Putrajaya Wilayah, Persekutuan, Malaysia
| | - Richard Boon-Leong Lim
- Department of Palliative Care, Hospital Selayang, Ministry of Health Malaysia, Putrajaya Wilayah, Persekutuan, Malaysia
| | - Choi Ling Yeat
- Department of Palliative Care, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health Malaysia, Putrajaya Wilayah, Persekutuan, Malaysia
| | - Yu-Xiang Ong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Salimah Othman
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya Wilayah, Persekutuan, Malaysia
| | | | - Dingle Spence
- Oncology and Palliative Care Unit, Hope Institute Hospital, Jamaica
| | - Fazlina Ahmad
- Palliative Care Unit, Department of Medicine, Hospital Sultanah Bahiyah Kedah, Malaysia
| | - Richard Sullivan
- Palliative Care Unit, Department of Medicine, Institute of Cancer Policy, School of Cancer Sciences, King’s College London, London, UK
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Mapoko BSE, Frambo A, Saidu Y, Mbassi EDB, Atenguena E, Azemafac K, Kobayashi E, Tabola L, Nkeng G, Sango A, Maison AM, Noa SA, Ntama A, Mapenya RRM, Tayou R, Kouya F, Mbah G, Douanla P, Fonkwa C, Biwole ME, Sando Z, Sone AM, Ndom P. Assessment of barriers to optimal cancer control in adult cancer treatment centres in Cameroon. Ecancermedicalscience 2023; 17:1601. [PMID: 37799946 PMCID: PMC10550327 DOI: 10.3332/ecancer.2023.1601] [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: 11/26/2022] [Indexed: 10/07/2023] Open
Abstract
Approximately 20,745 new cases of cancer were registered annually with 13,199 (64%) deaths in 2020 in Cameroon. Despite the increasing cancer burden, there is a paucity of reliable data that can enhance decision-making for cancer control in Cameroon. This assessment was, therefore, designed to generate data that may enable stakeholders, policymakers and funders to make data-driven decisions on cancer control. We conducted a cross-sectional survey in July 2020, which enabled us to collect data on key cancer variables from six adult cancer treatment centres in Cameroon. The key components of the assessment included case detection, service availability, human resource capacity, cost of chemotherapy and radiotherapy, the safety of chemotherapy sessions, data systems, patient education, palliative care, funding for chemotherapy and chemotherapy stock. Data were compiled and analysed using Microsoft Excel 2016. Data from four of the 6 sites show that 1,636 new cases were recorded representing an annual case detection rate of 11.8%. All the six assessed facilities offered chemotherapy services, 5/6 (83.3%) offered surgery for cancers, while just 1 (16.7%) offered radiotherapy services. In addition, none offered nuclear medicine services for cancer care and treatment. Similarly, none of the facilities had the WHO-recommended number of human resources for optimal cancer care. Overall, there were only 6 medical oncologists, 2 surgical oncologists, 3 radiation oncologists and 14 oncology nurses providing services across the 6 cancer treatment centres. Treatment services are expensive for an average national, with a complete course of chemotherapy followed by radiotherapy costing ~XAF 1,240,000 (~$2,480). None of the survey facilities had a recommended safe biosafety cabinet and clean room for the preparation of chemotherapies, rendering the preparation of chemotherapies suboptimal and hazardous. Data collection tools were manual, relatively available and very different across all the surveyed sites and the interval for data collection and transmission was collectively undefined. Optimal cancer care in adult cancer treatment centres is limited by several health systems and socio-economic factors. The identification of these barriers has enabled the formulation of action-oriented interventions, leveraging on the recently adopted national strategy for the prevention and control of cancers in the country.
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Affiliation(s)
| | - Andreas Frambo
- Clinton Health Access Initiative, Yaoundé 99322, Cameroon
| | - Yauba Saidu
- Clinton Health Access Initiative, Yaoundé 99322, Cameroon
- Institute for Global Health, University of Siena, Siena 53100, Italy
| | - Esther Dina Bell Mbassi
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala 99322, Cameroon
| | - Etienne Atenguena
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Kareen Azemafac
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé 99322, Cameroon
| | | | - Lionel Tabola
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Glenda Nkeng
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Anne Sango
- Faculty of Health Sciences, University of Buea, Buea 99322, Cameroon
| | - Anne Marthe Maison
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala 99322, Cameroon
| | - Sidonie Ananga Noa
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala 99322, Cameroon
| | - Ambroise Ntama
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala 99322, Cameroon
| | | | - Rachel Tayou
- Faculty of Health Sciences, University of Dschang, Dschang 99322, Cameroon
| | | | - Glenn Mbah
- Mbingo Baptist Hospital, Bamenda 99322, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bamenda 99322, Cameroon
| | - Pelagie Douanla
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé 99322, Cameroon
| | | | - Martin Essomba Biwole
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala 99322, Cameroon
| | - Zacharie Sando
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Albert Mouelle Sone
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala 99322, Cameroon
| | - Paul Ndom
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé 99322, Cameroon
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Cartmell KB, Doherty EA, Gikaara N, Ali Z, Qanungo S, Melikam ES, Powell RA. Kenyan palliative care providers' and leaders' perceptions of palliative care research needs and support to facilitate rigorous research. BMC Palliat Care 2023; 22:135. [PMID: 37697339 PMCID: PMC10496291 DOI: 10.1186/s12904-023-01199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/20/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Palliative care (PC) can reduce symptom distress and improve quality of life for patients and their families experiencing life-threatening illness. While the need for PC in Kenya is high, PC service delivery and research is limited. Qualitative research is needed to explore potential areas for PC research and support needed to enable that research. This insight is critical for informing a national PC research agenda and mobilizing limited resources for conducting rigorous PC research in Kenya. OBJECTIVES To explore perceptions of priority areas for PC research and support needed to facilitate rigorous research from the perspective of Kenyan PC providers and leaders. METHODS Focus groups (FGs) were conducted in November and December of 2018 using a semi-structured interview guide. FGs were audio-recorded, transcribed, and analyzed using a thematic content analysis approach. RESULTS Three FGs were conducted (n = 22 participants). Ten themes related to PC research emerged, including research on: 1) beliefs about death, disease, and treatment to inform PC; 2) awareness about PC, 3) integration of PC within the health system; 4) understanding caregiver experiences and needs; 5) community health volunteers (CHVs) and volunteer programs; 6) evaluation of costs and benefits of PC; 7) treatment approaches, including complementary and alternative medicine (CAM) and advanced diagnostics at end of life; 8) other suggestions for research, 9) populations in need of PC research; and 10) resources for enabling research. CONCLUSIONS Kenyan PC providers and leaders identified key areas requiring increased scientific inquiry and critical resources needed to enable this research. These findings can help to focus future PC research in Kenya and encourage funding agencies to prioritize the issues identified.
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Affiliation(s)
- K B Cartmell
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA.
| | - E A Doherty
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA
| | - N Gikaara
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Z Ali
- Kenyan Hospice and Palliative Care Association, Nairobi, Kenya
| | - S Qanungo
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - E S Melikam
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA
| | - R A Powell
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London, England
- Ethnicity and Health Unit, NIHR Applied Research Collaboration Northwest London, London, England
- MWAPO Health Development Group, Nairobi, Kenya
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Salikhanov I, Katapodi MC, Kunirova G, Crape BL. Improving palliative care outcomes in remote and rural areas of LMICs through family caregivers: lessons from Kazakhstan. Front Public Health 2023; 11:1186107. [PMID: 37601198 PMCID: PMC10434554 DOI: 10.3389/fpubh.2023.1186107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Approximately 60 million people require palliative care worldwide, and nearly 80% of them live in low- and middle-income countries (LMICs). Providing palliative care in remote and rural areas of LMICs requires special consideration to ensure equitable access to healthcare. This perspective aims to deliver pragmatic, context-oriented policy recommendations designed to improve palliative care outcomes in Kazakhstan by capitalizing on existing resources and considering its unique geopolitical and sociocultural context. With approximately half of the population in Kazakhstan residing in remote and rural regions, the provision of healthcare services - specifically palliative care - mandates particular attention to ensure equal access to high-quality care. To understand challenges of implementing palliative care in remote and rural regions of Kazakhstan and to propose tailored solutions, 29 key stakeholders, including family caregivers, health professionals, and palliative care administrators, were identified in five regions of Kazakhstan. The main challenges encountered by family caregivers include lack of palliative care skills, the need for home-based care from mobile services, and high out-of-pocket expenditures. The challenges highlighted by healthcare providers and administrators were the lack of formal education in palliative care, shortage of opioids, and limited societal awareness and state support. Based on challenges elaborated from stakeholders and existing literature in palliative care and family caregiving, this perspective advocates against replicating the strategies implemented in high-income countries. Family caregivers play a critical role in implementing affordable and efficient palliative care in resource-limited settings. Enhancing their competencies through digital training and increasing access to palliative care services through mobile teams are tailored and localized solutions that address specific challenges in Kazakhstan. It is postulated that these recommendations may find utility in other LMICs, potentially benefiting nearly 48 million individuals who require these services.
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Affiliation(s)
- Islam Salikhanov
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gulnara Kunirova
- President of the Kazakhstan Association of Palliative Care, Almaty, Kazakhstan
| | - Byron L. Crape
- Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
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Cornetta K, Nyariki S, Manji I, Kiplimo I, Korir M, Muinga E, Busakhala N, Elias H. Telehospice for Cancer Patients Discharged from a Tertiary Care Hospital in Western Kenya. J Pain Symptom Manage 2023; 65:378-387. [PMID: 36773732 PMCID: PMC10106447 DOI: 10.1016/j.jpainsymman.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
CONTEXT Worldwide, most patients lack access to hospice services. OBJECTIVES Assess the feasibility of telephone monitoring (Telehospice) in providing symptom management for patients discharged from a tertiary care hospital in Western Kenya. METHODS Inclusion criteria included adults with cancer no longer eligible for chemo-radiation and receiving opioid therapy. Thirty patients were enrolled in a weekly monitoring program assessing physical symptoms and patient and caregiver distress. The participants also had access to a 24-hour hotline. Symptom assessment included 18 questions with 8 from the African Palliative Outcome Scale. Participants were followed for eight weeks or until death or admission to an inpatient hospital or hospice. RESULTS The primary objective was participation in weekly calls, and we obtained 100% participation. A secondary objective was the use of "comfort kits" which contained 30 doses of six medications. Most patients utilized one or more of the provided medications, with high usage of bisacodyl, paracetamol, and omeprazole. While 12% of weekly calls and 24% of hotline calls led to medication changes, participants continued to express worry and there was only a modest decrease in pain scores despite having morphine available throughout the follow-up period. Family confidence in providing care and access to information remained high. At the end of the eight-weeks of observation, eight participants were alive, 10 died at home, and 12 were admitted to an in-patient facility. CONCLUSION Patient and family participation in Telehospice is feasible and may provide an interim solution to managing end-of-life patients who lack access to home hospice.
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Affiliation(s)
- Kenneth Cornetta
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya; Moi University School of Medicine (K.C., M.K., N.B., H.E.), Eldoret, Kenya; Indiana University School of Medicine (K.C.), Indianapolis, Indiana.
| | - Sarah Nyariki
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya
| | - Imran Manji
- Moi Teaching and Referral Hospital (I.M.), Eldoret, Kenya
| | - Ivan Kiplimo
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya
| | - Millicent Korir
- Moi University School of Medicine (K.C., M.K., N.B., H.E.), Eldoret, Kenya
| | - Esther Muinga
- Kenya Hospices and Palliative Care Association (E.M.), Nairobi, Kenya
| | - Naftali Busakhala
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya; Moi University School of Medicine (K.C., M.K., N.B., H.E.), Eldoret, Kenya
| | - Hussein Elias
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya; Moi University School of Medicine (K.C., M.K., N.B., H.E.), Eldoret, Kenya
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Chowdhury MK, Bezzahou M, Khanom M, Doherty M. Developing Community-Based Palliative Care for Children: A Community
Case Study from an Urban Informal Settlement in Bangladesh. Health Serv Insights 2023; 16:11786329231162996. [PMID: 36968659 PMCID: PMC10034310 DOI: 10.1177/11786329231162996] [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: 07/26/2022] [Accepted: 02/23/2023] [Indexed: 03/24/2023] Open
Abstract
Background: Globally, more than 97% of children needing palliative care reside in low-
and middle-income countries, where there is very limited access to
palliative care. Several community-based palliative care programs focused on
adults, have been described in resource limited settings, suggesting a
simple and low-cost approach to providing palliative care. The
implementation of community-based palliative care for children has not
previously been described. Context: This community case study describes the implementation of an innovative model
of community-based palliative care program in and urban informal settlement,
(Korail Slum, Bangladesh). The program is led by a local government
hospital, with experience in community-based palliative care, in partnership
with the local community. Problem: Children with serious conditions in an urban unformal settlement do not have
access to health services which address their medical, psychosocial and
spiritual needs. This gap leads to a significant burden of preventable
suffering for them and their families. Solution: A community-based palliative care program was implemented, which includes
home care by trained community health workers, with support and supervision
from palliative care nurses and physicians. The program’s objective is to
provide effective symptom management, clear communication about the child’s
condition with parents, and psychosocial support including support for basic
needs. The program was free for families including medications, medical
equipment, physiotherapy, and speech therapy. The program was monitored
through regular assessments of quality of life using standardized tools
(PedsQL Family Impact Module), as well as interviews and focus group
discussions. Conclusion and lessons learned: A model of community-based palliative care for children can be implemented in
an urban informal settlement. Program effectiveness is enhanced by community
health workers who share language, culture, and life-experiences with the
individuals they serve. Partnerships with local health care facilities and
community groups strengthen the program’s sustainability. Ensuring financial
sustainability remains a challenge.
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Affiliation(s)
- Mostofa Kamal Chowdhury
- Department of Palliative Medicine,
Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Maryam Bezzahou
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
| | - Marufa Khanom
- Department of Palliative Medicine,
Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Megan Doherty
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario,
Ottawa, ON, Canada
- Megan Doherty, Children’s Hospital of
Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1, Canada.
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Namukwaya E, Nabirye E, Dandadzi A, Akeju D, Adejoh S, Namisango E, Nkhoma K, Ebenso B, Allsop MJ. "From the Time You Start With them Until the Lord Calls You": A Qualitative Study on the Experiences and Expectations of People Living with Advanced Cancer Interacting With Palliative Care Services in Uganda, Nigeria and Zimbabwe. J Pain Symptom Manage 2022; 64:588-601. [PMID: 36089175 DOI: 10.1016/j.jpainsymman.2022.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT A challenge facing the provision of palliative care in sub-Saharan Africa is a means of increasing coverage of services whilst maintaining quality. Developing an evidence base that reflects patients' experiences and expectations of palliative care services, the context within which services are provided, and the approaches adopted by services in caring for patients, could facilitate and inform the planning and development of patient-centered and responsive services. OBJECTIVES To explore the experiences and expectations of palliative care for people living with advanced cancer in Nigeria, Uganda, and Zimbabwe. METHODS A secondary qualitative analysis of in-depth interviews with 62 people with advanced cancer in Nigeria, Uganda, and Zimbabwe. Framework approach to thematic analysis of transcripts was adopted, focusing on patients' experiences and expectations when interacting with palliative care services, aligning reporting with the COnsolidated criteria for REporting Qualitative research (COREQ). RESULTS Four main themes were generated from the analysis: 1) Condition and community as drivers of a multidimensional burden when living with advanced cancer; 2) The expectations and endeavors of palliative care to ameliorate the impact of cancer on physical, psychological and basic needs; 3) Processes and preferences for interacting and communicating with palliative care services, and; 4) Restoration of hope in the context of limited resources. CONCLUSION Wide-ranging physical, psychological, social and financial impacts on participants were outlined. These concerns were largely met with compassionate and responsive care in the context of constrained resources. Study findings can inform evolving notions of patient-centred care for serious illnesses in the participating countries.
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Affiliation(s)
| | - Elizabeth Nabirye
- Department of Internal Medicine, Makerere University, Kampala, Uganda
| | - Adlight Dandadzi
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - David Akeju
- Department of Social Work, University of Lagos, Lagos, Nigeria
| | - Samuel Adejoh
- Department of Social Work, University of Lagos, Lagos, Nigeria
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK.
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11
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Smith SE, Chowdhury MK, Doherty M, Morgan DD. Serious health-related suffering experienced by children with disability and their families living in Bangladesh: A scoping review. Palliat Med 2022; 37:602-626. [PMID: 36428280 DOI: 10.1177/02692163221136896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2020, the International Association for Hospice and Palliative Care redefined palliative care to incorporate the concept of serious health-related suffering. An estimated 21 million children globally live with conditions which would benefit from a palliative approach to relieve suffering. Bangladesh is a lower-middle income country with isolated provision of palliative care. AIM To synthesise existing evidence describing serious health-related suffering of children with disability and their families living in Bangladesh and the intersection between this suffering, palliative care and rehabilitation. DESIGN Scoping review methodology. DATA SOURCES A search strategy related to serious health-related suffering and childhood disability was applied to online databases and grey literature. English language studies (1990-2021) were included. Papers pertaining to serious health-related suffering of typically developing children and those over eighteen years were excluded. Data which addressed the three domains of serious health-related suffering (physical, social and emotional/spiritual) were extracted. Palliative care interventions were assessed with a pre-existing checklist. RESULTS Forty-six studies were included, representing ten different methodologies. Sample sizes ranged from 11 to 2582 participants, with 87% of studies including children with cerebral palsy. Serious health-related suffering was described in 100% of the studies, only 14 of the studies described specific interventions to mitigate suffering. Convergence between palliative care and rehabilitation approaches was evident. CONCLUSION Findings document the extensive nature and burden of serious childhood health-related suffering that may be remediated by a palliative approach. They highlight the urgent need to prioritise service development and research in this area.
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Affiliation(s)
- Suzanne E Smith
- Master of Palliative Care student, Flinders University, Australia; Victorian Paediatric Rehabilitation Service, Australia
| | | | - Megan Doherty
- University of Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), College of Nursing and Health Sciences, Flinders University, SA, Australia
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12
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Cartmell KB, Kenneson SAE, Roy R, Bhattacharjee G, Panda N, Kumar G, Qanungo S. Feasibility of a Palliative Care Intervention Utilizing Community Health Workers to Facilitate Delivery of Home-based Palliative Care in India. Indian J Palliat Care 2022; 28:21-27. [PMID: 35673377 PMCID: PMC9165458 DOI: 10.25259/ijpc_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives:
The purpose of this study was to evaluate the feasibility of a home-based palliative care program delivered by community health workers (CHW) in rural areas outside of Kolkata, India. The specific aims were to assess CHWs’ ability to implement the intervention protocol and maintain records of care, to characterize patient problems and CHW activities to assist patients, and to assess change in patient pain scores over the course of the intervention.
Materials and Methods:
Four CHWs were hired to facilitate delivery of home-based palliative care services. CHWs were trained using the Worldwide Hospice and Palliative Care Alliance’s Palliative Care Toolkit. CHWs provided care for patients for 3-months, making regular home visits to monitor health, making and implementing care plans, and referring patients back to the cancer center team for serious problems.
Results:
Eleven patients enrolled in the intervention, with ten of these patients participating in the intervention and one patient passing away before starting the intervention. All ten participants reported physical pain, for which CHWs commonly recommended additional or higher dose medication and/or instructed patients how to take medication properly. For two patients, pain levels decreased between baseline and end of study, while pain scores did not decrease for the remaining patients. Other symptoms for which CHWs provided care included gastro-intestinal, bleeding, and respiratory problems.
Conclusion:
The study findings suggest that utilization of CHWs to provide palliative care in low-resource settings may be a feasible approach for expanding access to palliative care. CHWs were able to carry out the study visit protocol and assess and document patient problems and their activities to assist. They were also able to alleviate many common problems patients experienced with simple suggestions or referrals. However, most patients did not see a decrease in pain levels and more emphasis was needed on the emotional aspects of palliative care, and so CHWs may require additional training on provision of pain management and emotional support services.
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Affiliation(s)
- Kathleen B. Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States,
| | - Sarah Ann E. Kenneson
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States,
| | - Rakesh Roy
- Department of Palliative and Supportive Care, Saroj Gupta Cancer Center and Research Institute, Kolkata, West Bengal, India,
| | - Gautam Bhattacharjee
- Department of Palliative and Supportive Care, Saroj Gupta Cancer Center and Research Institute, Kolkata, West Bengal, India,
| | - Nibedita Panda
- Department of Palliative and Supportive Care, Saroj Gupta Cancer Center and Research Institute, Kolkata, West Bengal, India,
| | - Gaurav Kumar
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India,
| | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, Clemson, South Carolina, United States,
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13
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Doherty M, Lynch-Godrei A, Azad T, Ladha F, Ferdous L, Ara R, Richardson K, Groninger H. Using Virtual Learning to Develop Palliative Care Skills Among Humanitarian Health Workers in the Rohingya Refugee Response in Bangladesh. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221096099. [PMID: 36032810 PMCID: PMC9403457 DOI: 10.1177/23821205221096099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Palliative care is an essential component of health responses in humanitarian settings, yet it remains largely unavailable in these settings, due to limited availability of palliative care training for healthcare professionals. Online training programs which connect experts to clinicians in the field have been proposed as an innovative strategy to build palliative care capacity humanitarian settings. OBJECTIVE To describe the implementation and evaluate the impact of delivering palliative care education using an established virtual learning model (Project ECHO) for healthcare clinicians working in the Rohingya refugee response in Bangladesh. Program acceptability and the impacts on learners' self-reported knowledge, comfort, and practice changes were evaluated. METHODS Using the Project ECHO model, an education program consisting of 7 core sessions and monthly mentoring sessions was developed. Each session included a didactic lecture, case presentation and interactive discussion. Surveys of participants were conducted before and after the program to assess knowledge, confidence, and attitudes about palliative care as well as learning experiences from the program. RESULTS This virtual palliative care training program engaged 250 clinicians, including nurses (35%), medical assistants (28%) and physicians (20%). Most participants rated the program as a valuable learning experience (96%) that they would recommend to their colleagues (98%). Participants reported improvements in their knowledge and comfort related to palliative care after participation in the program, and had improved attitudes towards palliative care with demonstrated statistical significance (p < 0.05). CONCLUSIONS Virtual training is a feasible model to support healthcare providers in a humanitarian health response. Project ECHO can help to address the urgent need for palliative care in humanitarian responses by supporting healthcare workers to provide essential palliative care to the growing number of individuals with serious health-related suffering in humanitarian settings.
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Affiliation(s)
- Megan Doherty
- CHEO Research Institute, Ottawa, Ontario, Canada
- Roger Neilson House, Ottawa, Ontario, Canada
- CHEO, Ottawa, Ontario, Canada
- uOttawa, Ottawa, Ontario, Canada
| | - Anisha Lynch-Godrei
- CHEO Research Institute, Ottawa, Ontario, Canada
- Roger Neilson House, Ottawa, Ontario, Canada
| | - Tasnim Azad
- International Organization for Migration, Chittagong,
Bangladesh
| | | | | | - Rowsan Ara
- Shaheed Tajuddin Ahmad Nursing College, Gazipur, Bangladesh
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Ghoshal A, Damani A, Deodhar J, Muckaden MA. Organizational Strategies for Providing Cancer Palliative Care to Many. Curr Oncol Rep 2021; 23:62. [PMID: 33852078 DOI: 10.1007/s11912-021-01061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Hospitals and healthcare organizations are today operating in an extremely competitive environment, with increasing pressure to improve quality while reducing costs. In responding to this dynamic situation, transformation of any organization requires the will to organize delivery around the needs of patients. RECENT FINDINGS Providing palliative care to the many who require it needs the value agenda to be formulated based on mutually reinforcing components. Here we present an overview of the framework for a palliative care department in a comprehensive cancer center, which includes different levels that are embedded within a comprehensive system. Detailed information on each level is presented, followed by a discussion of quality of care, as an integrating theme for the framework. The chapter concludes by detailing the benefits that a comprehensive cancer palliative care center provides to a country's healthcare efforts through service, education, research, and advocacy.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Patel MI, Khateeb S, Coker T. Lay Health Workers' Perspectives on Delivery of Advance Care Planning and Symptom Screening Among Adults With Cancer: A Qualitative Study. Am J Hosp Palliat Care 2020; 38:1202-1211. [PMID: 33267632 DOI: 10.1177/1049909120977841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Advance care planning and symptom screening among patients with cancer require team-based approaches to ensure that these services are equitably and appropriately delivered. In several organizations across the United States, we trained and employed lay health workers (LHWs) to assist with delivering these services for patients with cancer. The aim of this study was to understand LHWs' views on delivering these services. METHODS We conducted semi-structured interviews with 22 LHWs in 6 US-based clinical cancer care settings in 4 large cities. We recorded, transcribed, and analyzed interviews using the constant comparative method of qualitative analysis. RESULTS Participants noted the importance of their role in assisting with the delivery of advance care planning (ACP) and symptom screening services. Participants noted the importance of developing relationships with patients to engage openly in ACP and symptom screening discussions. Participants reported that ongoing training provided skills and empowered them to discuss sensitive issues with patients and their caregivers. Participants described challenges in their roles including communication with oncology providers and their own emotional well-being. Participants identified solutions to these challenges including formal opportunities for introduction with oncology clinicians and staff and grievance sessions with LHWs and other team members. DISCUSSION LHWs from several organizations endorsed the importance of their roles in ensuring the delivery of ACP and proactive symptom screening. LHWs noted challenges and specific solutions to improve their effectiveness in delivering these important services to patients after their diagnosis of cancer.
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Affiliation(s)
- Manali I Patel
- Division of Oncology, 6429Stanford University School of Medicine, Stanford, CA, USA.,Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Primary Care and Outcomes Research/Health Research and Policy, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - Sana Khateeb
- Division of Oncology, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - Tumaini Coker
- Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
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Essential oncology nursing care along the cancer continuum. Lancet Oncol 2020; 21:e555-e563. [PMID: 33212045 DOI: 10.1016/s1470-2045(20)30612-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022]
Abstract
Oncology nurses are at the heart of tackling the increasing global burden of cancer. Their contribution is unique because of the scale and the diversity of care roles and responsibilities in cancer care. In this Series paper, to celebrate the International Year of the Nurse and Midwife, we highlight the contribution and impact of oncology nurses along the cancer care continuum. Delivering people-centred integrated care and optimal communication are essential components of oncology nursing care, which are often played down. More oncology nurses using, doing, and leading research will further show the key nursing impact on care as part of a team. The oncology nurse influence in saving lives through prevention and early detection of cancer is noteworthy. Supportive care, the central pillar of oncology nursing, enables and empowers people to self-manage where possible. Globally, oncology nurses make a great positive difference to cancer care worldwide; their crucial contribution throughout the continuum of care warrants the inclusion and promotion of nursing in every country's cancer strategy. 2020 is the year of the nurse: let us take this learning to the future.
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