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Salako O, Enyi A, Miesfeldt S, Kabukye JK, Ngoma M, Namisango E, LeBaron V, Sisimayi C, Ebenso B, Lorenz KA, Wang Y, Ryan Wolf J, van den Hurk C, Allsop M. Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7190. [PMID: 38131741 PMCID: PMC10743024 DOI: 10.3390/ijerph20247190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.
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Affiliation(s)
- Omolola Salako
- Radiation Biology, Radiotherapy and Radiodiagnosis (RBRR) Digital Health Hub, College of Medicine, Lagos University Teaching Hospital, Lagos 102215, Nigeria;
| | | | - Susan Miesfeldt
- Medical Oncology, Maine Medical Center, MaineHealth Cancer Care Center, Scarborough, ME 04106, USA;
| | - Johnblack K. Kabukye
- Uganda Cancer Institute, Upper Mulago Hill Road, Kampala P.O. Box 3935, Uganda;
- Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Sciences (DSV), Stockholm University, 164 55 Stockholm, Sweden
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
| | - Eve Namisango
- African Palliative Care Association, Kampala P.O. Box 72518, Uganda;
| | - Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA;
| | - Chenjerai Sisimayi
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg 2006, South Africa;
| | - Bassey Ebenso
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
| | - Karl A. Lorenz
- Ci2i, United States Department of Veterans Affairs, Menlo Park, CA 94025, USA;
- Primary Care and Population Health, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Yan Wang
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Corina van den Hurk
- R&D Department, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands;
| | - Matthew Allsop
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
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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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Akeju D, Ziegler F, Dandadzi A, Nabirye E, Namisango E, Namukwaya E, Adejoh SO, Okunade K, Fu Y, Ebenso B, Nkhoma K, Allsop M. The use of and need for data and information by health professionals supporting the delivery of palliative cancer care services in sub-Saharan Africa: A qualitative study. Health Informatics J 2022; 28:14604582221139054. [PMID: 36515494 DOI: 10.1177/14604582221139054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The ability to develop and evaluate approaches to the management of advanced cancer in sub-Saharan Africa is limited by the lack of local, reliable and valid data to ensure that practice is evidence-based, replicable and reflects the needs of the population served. METHODS A secondary qualitative analysis of in-depth interviews with 59 health professionals delivering palliative cancer care in Nigeria, Uganda and Zimbabwe were conducted to determine the use and needs for data and information for patient care and service delivery. Framework analysis was used, informed by a conceptual model for data use in low and middle-income countries. RESULTS Three meta-themes include: (1) Current practice in data gathering and use; (2) Gaps for capturing, storing information and supporting communication, and; (3) Needs and opportunities for data use. Deficits in current data access and use were identified, alongside targets for improving the quality, accessibility and utility of data to inform the development of palliative cancer care. CONCLUSIONS The availability and use of relevant and reliable data relating to the current provision of palliative cancer care are requisite for the contextually appropriate and effective development of health services. The requirements and constraints articulated by participants can guide future development and optimisation of digital health approaches for palliative cancer care in the participating countries, with relevance to the wider sub-Saharan Africa region.
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Affiliation(s)
- David Akeju
- Department of Sociology, 70670University of Lagos, Nigeria
| | | | - Adlight Dandadzi
- Clinical Trials Research Centre, 108329University of Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Nabirye
- Department of Internal Medicine, 58588Makerere University, Kampala, Uganda
| | - Eve Namisango
- 108118African Palliative Care Association, Kampala, Uganda
| | | | - Samuel O Adejoh
- Department of Social Work, 70670University of Lagos, Nigeria
| | | | - Yu Fu
- Population Health Sciences Institute, 5994Newcastle University, UK
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, 4468University of Leeds, UK
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, 4616King's College London, London, UK
| | - Matthew Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, 4468University of Leeds, UK
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Dandadzi A, Chapman E, Chirenje ZM, Namukwaya E, Pini S, Nkhoma K, Allsop MJ. Patient experiences of living with cancer before interaction with palliative care services in Zimbabwe: A qualitative secondary data analysis. Eur J Cancer Care (Engl) 2022; 31:e13632. [PMID: 35712980 PMCID: PMC9542205 DOI: 10.1111/ecc.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cancer patients in Zimbabwe typically access health services with advanced disease, limiting treatment choices and lessening the likelihood of positive treatment outcomes. We outline experiences of patients with advanced cancer prior to interaction with palliative care services to identify targets for future intervention development to enhance care delivery in Zimbabwe. METHODS Participants were purposively sampled adult patients with advanced cancer. We adopted a thematic approach to guide a qualitative secondary data analysis exploring factors influencing support sought by participants, external factors influencing decision making across the disease trajectory and the process for seeking and accessing palliative care. RESULTS Participants reported fragmented and uncoordinated care, from initial symptom experience and throughout disease progression. A recurring notion of disjuncture was present through participants' experiences of gaps, breaks and discontinuity across the disease trajectory. Each step had a beginning and end without clear routes for transition with movement between steps as a result of happenstance or informal encounters. CONCLUSION Targets for intervention development at the patient and family level exist that may reduce the disjuncture currently experienced between need and care provision. A holistic response that incorporates engagement with policy actors is critical to addressing prominent financial constraints for patients.
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Affiliation(s)
- Adlight Dandadzi
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Z Mike Chirenje
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | | | - Simon Pini
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Karera MGD, Omar MA, Nabirye E, Namukwaya E, Allsop MJ. Mobile Technologies for Palliative Cancer Care in Uganda: Qualitative Secondary Analysis of Health Professional Perspectives. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mwase C, Nkhoma K, Allsop MJ. The role of digital health in palliative care for people living with HIV in sub-Saharan Africa: A systematic review. Digit Health 2022; 8:20552076221133707. [DOI: 10.1177/20552076221133707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background In 2018, 26.6 million people were living with HIV in sub-Saharan Africa. Palliative care services are recommended for people living with HIV at all stages from diagnosis through to end-of-life. However, the provision of palliative care in sub-Saharan Africa is limited, leading to little or no access for the majority of patients. Digital technologies in sub-Saharan Africa present an opportunity to improve access to palliative care for people living with HIV in the region. This review synthesised literature on digital health interventions for palliative care for people living with HIV in sub-Saharan Africa and assessed their effects on patient outcomes. Methods Literature searches were conducted in MEDLINE, Embase, PsycINFO and Global Health. Inclusion and exclusion criteria were applied. Two independent reviewers conducted study screening, data extraction and quality appraisal. A narrative synthesis was performed to draw together and report findings across heterogeneous studies. Reporting of this review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist. Results Out of 4117 records, 25 studies were included, covering 3592 people living with HIV, across 21 countries. Studies included three randomised controlled trials, three qualitative, three pre- and post-test, two observational, two case series, six cross-sectional and six mixed methods studies. Telemedicine was the most reported digital health intervention, with 12 studies demonstrating the effectiveness of digital health interventions. Conclusion Emerging evidence suggests digital health interventions can be effective in facilitating patient-provider communication and health professional decision-making as a part of palliative care for people living with HIV. There is a need for further development and evaluation of digital health interventions alongside determining optimal approaches to their implementation as a part of palliative care provision in sub-Saharan Africa.
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Affiliation(s)
- Christopher Mwase
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
| | | | - Mathew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
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Expanding telemedicine to reduce the burden on the healthcare systems and poverty in Africa for a post-coronavirus disease 2019 (COVID-19) pandemic reformation. GLOBAL HEALTH JOURNAL 2021; 5:128-134. [PMID: 36338822 PMCID: PMC9625850 DOI: 10.1016/j.glohj.2021.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) global public health emergency, has exposed the fragility of health systems. Access to healthcare became a scarce commodity as healthcare providers and resource-poor populations became victims of the novel corona virus. Therefore, this study focuses on Africa's readiness to integrate telemedicine into the weak health systems and its adoption may help alleviate poor healthcare and poverty after COVID-19. We conducted a narrative review through different search strategies in Scopus on January 20, 2021, to identify available literature reporting implementation of various telemedicine modes in Africa from January 1, 2011 to December 31, 2020. We summarized 54 studies according to geographies, field, and implementation methods. The results show a willingness to adopt telemedicine in the resource-poor settings and hard-to-reach populations, which will bring relief to the inadequate healthcare systems and alleviate poverty of those who feel the burden of healthcare cost the most. With adequate government financing, telemedicine promises to enhance the treating of communicable and non-communicable diseases as well as support health infrastructure. It can also alleviate poverty among vulnerable groups and hard-to-reach communities in Africa with adequate government financing. However, given the lack of funding in Africa, the challenges in implementing telemedicine require global and national strategies before it can yield promising results. This is especially true in regards to alleviating the multidimensionality of poverty in post-COVID-19 Africa.
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Harding R, Carrasco JM, Serrano-Pons J, Lemaire J, Namisango E, Luyirika E, Immanuel T, Paleri AK, Mathews L, Chifamba D, Mupaza L, Martínez CL, Zirimenya L, Bouësseau MC, Krakauer EL. Design and Evaluation of a Novel Mobile Phone Application to Improve Palliative Home-Care in Resource-Limited Settings. J Pain Symptom Manage 2021; 62:1-9. [PMID: 33246073 DOI: 10.1016/j.jpainsymman.2020.09.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Mobile health (mHealth) provides an opportunity to use internet coverage in low- and middle-income countries to improve palliative care access and quality. OBJECTIVES This study aimed to design a mobile phone application (app) to enable or improve communication between family caregivers, community caregivers, and palliative care teams; to evaluate its acceptability, processes, and mechanisms of action; and to propose refinements. METHODS A codesign process entailed collaboration between a Project Advisory Group and collaborators in India, Uganda, and Zimbabwe. We then trained community and family caregivers to use an app to communicate patient-reported outcomes to their palliative care providers each week on a data dashboard. App activity was monitored, and qualitative in-depth interviews explored experience with the app and its mechanisms and impact. RESULTS N = 149 caregivers participated and uploaded n = 837 assessments of patient-reported outcomes. These data were displayed to the palliative care team on an outcomes dashboard on n = 355 occasions. Qualitative data identified: 1) high acceptability and data usage; 2) improved understanding by team members of patient symptoms and concerns; 3) a need for better feedback to caregivers, for better prioritisation of patients according to need, for enhanced training and support to use the app, and for user-led recommendations for ongoing improvement. CONCLUSION An outcomes-focused app and data dashboard are acceptable to caregivers and health-care professionals. They are beneficial in identifying, monitoring, and communicating patient outcomes and in allocating staff resource to those most in need.
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Affiliation(s)
- Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College Liondon, Cicely Saunders Institute, London, UK.
| | - José Miguel Carrasco
- Cooperativa APLICA, Madrid, Spain; ATLANTES Research Programme, Instituto Cultura y Sociedad; University of Navarra, Navarra, Spain
| | | | | | - Eve Namisango
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College Liondon, Cicely Saunders Institute, London, UK; African Palliative Care Association, Kampala, Uganda
| | | | | | - Anil Kumar Paleri
- WHOCC for Long-term Care and Palliative Care, Institute of Palliative Medicine, Kozhikode, India
| | - Lulu Mathews
- Institute of Palliative Medicine, Kozhikode, Kerala, India
| | | | | | | | | | | | - Eric L Krakauer
- Department of Palliative Care, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam; Department of Global Health and Social Medicine, Harvard Medical School, USA; Division of Palliative Care & Geriatrics, Massachusetts General Hospital, Boston, USA
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Namisango E, Ramsey L, Dandadzi A, Okunade K, Ebenso B, Allsop MJ. Data and information needs of policymakers for palliative cancer care: a multi-country qualitative study. BMC Med Inform Decis Mak 2021; 21:189. [PMID: 34130668 PMCID: PMC8204555 DOI: 10.1186/s12911-021-01555-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/01/2021] [Indexed: 11/05/2022] Open
Abstract
Background Despite regional efforts to address concerns regarding the burden of advanced cancer in Africa, urgent attention is still required. Widespread issues include late symptom presentation, inaccessibility of palliative care services, limited resources, poor data quality, disparity in data availability, and lack of stakeholder engagement. One way of helping to address these issues is by understanding and meeting the data and information needs of policymakers in palliative cancer care. Aims To explore the views of policymakers regarding data availability, data gaps and preferred data formats to support policy and decision making for palliative cancer care in Nigeria, Uganda and Zimbabwe. Methods A secondary analysis of interview data collected as part of a cross-sectional qualitative study that aimed to explore the data and information needs of patients, policymakers and caregivers in Nigeria, Uganda and Zimbabwe. Framework analysis, guided by the MEASURE evaluation framework, was used to qualitatively analyse the data. Results Twenty-six policymakers were recruited. The policymakers data and information concerns are aligned to the MEASURE evaluation framework of data and information use and include; assessing and improving data use (e.g. low prioritisation of cancer); identifying and engaging the data user (e.g. data processes); improving data quality (e.g. manual data collection processes); improving data availability (e.g. the accessibility of data); identifying information needs (e.g. what is ‘need to know’?); capacity building in core competencies (e.g. skills gaps); strengthening organisational data demand and use (e.g. policy frameworks); monitoring, evaluating and communicating of data demand and use (e.g. trustworthiness of data). Conclusions We present evidence of data sources, challenges to their access and use, guidance on data needs for policymakers, and opportunities for better engagement between data producers, brokers and users. This framework of evidence should inform the development of strategies to improve data access and use for policy and decision making to improve palliative cancer services in participating countries with relevance to the wider region.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Lauren Ramsey
- Bradford Institute for Health Research, Bradford, UK
| | - Adlight Dandadzi
- University of Zimbabwe-Clinical Trials Research Centre ZW, Harare, Zimbabwe
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
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Adejoh SO, Boele F, Akeju D, Dandadzi A, Nabirye E, Namisango E, Namukwaya E, Ebenso B, Nkhoma K, Allsop MJ. The role, impact, and support of informal caregivers in the delivery of palliative care for patients with advanced cancer: A multi-country qualitative study. Palliat Med 2021; 35:552-562. [PMID: 33353484 PMCID: PMC7975852 DOI: 10.1177/0269216320974925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cancer is increasing in its prevalence in sub-Saharan Africa. Informal caregivers are key to supporting engagement and interaction with palliative care services, but limited literature on their role impedes development of supportive interventions. AIM We aimed to understand the role, impact, and support of informal caregivers of patients with advanced cancer when interacting with palliative care services in Nigeria, Uganda, and Zimbabwe. DESIGN Secondary analysis of qualitative interview transcripts. The dataset was assessed for fit and relevance and framework approach was used. SETTING/PARTICIPANTS Interview transcripts of informal caregivers included participants aged over 18 years of age recruited from palliative care services across participating countries. RESULTS A total of 48 transcripts were analyzed. Mean age was 37 (range 19-75) with equal numbers of men and women. Five themes emerged from the data: (1) caregivers are coordinators of emotional, practical, and health service matters; (2) caregiving comes at a personal social and financial cost; (3) practical and emotional support received and required; (4) experience of interacting and liaising with palliative care services; and (5) barriers and recommendations relating to the involvement of palliative care. CONCLUSIONS The role of informal caregivers is multi-faceted, with participants reporting taking care of the majority of medical, physical, financial, and emotional needs of the care recipient, often in the face of sacrifices relating to employment, finances, and their own health and social life. Efforts to develop comprehensive cancer control plans in sub-Saharan Africa must take account of the increasing evidence of informal caregiver needs.
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Affiliation(s)
| | - Florien Boele
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,Patient-Centred Outcomes Group, Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, UK
| | - David Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Adlight Dandadzi
- Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Nabirye
- Department of Internal Medicine, Makerere University, Kampala, Uganda
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Stakeholder perspectives and requirements to guide the development of digital technology for palliative cancer services: a multi-country, cross-sectional, qualitative study in Nigeria, Uganda and Zimbabwe. BMC Palliat Care 2021; 20:4. [PMID: 33397321 PMCID: PMC7784352 DOI: 10.1186/s12904-020-00694-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Coverage of palliative care in low and middle-income countries is very limited, and global projections suggest large increases in need. Novel approaches are needed to achieve the palliative care goals of Universal Health Coverage. This study aimed to identify stakeholders’ data and information needs and the role of digital technologies to improve access to and delivery of palliative care for people with advanced cancer in Nigeria, Uganda and Zimbabwe. Methods We conducted a multi-country cross-sectional qualitative study in sub-Saharan Africa. In-depth qualitative stakeholder interviews were conducted with N = 195 participants across Nigeria, Uganda and Zimbabwe (advanced cancer patients n = 62, informal caregivers n = 48, health care professionals n = 59, policymakers n = 26). Verbatim transcripts were subjected to deductive and inductive framework analysis to identify stakeholders needs and their preferences for digital technology in supporting the capture, transfer and use of patient-level data to improve delivery of palliative care. Results Our coding framework identified four main themes: i) acceptability of digital technology; ii) current context of technology use; iii) current vision for digital technology to support health and palliative care, and; iv) digital technologies for the generation, reporting and receipt of data. Digital heath is an acceptable approach, stakeholders support the use of secure data systems, and patients welcome improved communication with providers. There are varying preferences for how and when digital technologies should be utilised as part of palliative cancer care provision, including for increasing timely patient access to trained palliative care providers and the triaging of contact from patients. Conclusion We identified design and practical challenges to optimise potential for success in developing digital health approaches to improve access to and enhance the delivery of palliative cancer care in Nigeria, Uganda and Zimbabwe. Synthesis of findings identified 15 requirements to guide the development of digital health approaches that can support the attainment of global health palliative care policy goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-020-00694-y.
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Boufkhed S, Namisango E, Luyirika E, Sleeman KE, Costantini M, Peruselli C, Normand C, Higginson IJ, Harding R. Preparedness of African Palliative Care Services to Respond to the COVID-19 Pandemic: A Rapid Assessment. J Pain Symptom Manage 2020; 60:e10-e26. [PMID: 32949761 PMCID: PMC7493734 DOI: 10.1016/j.jpainsymman.2020.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT Palliative care is an essential component of the coronavirus disease 2019 (COVID-19) pandemic response but is overlooked in national and international preparedness plans. The preparedness and capacity of African palliative care services to respond to COVID-19 is unknown. OBJECTIVES To evaluate the preparedness and capacity of African palliative care services to respond to the COVID-19 pandemic. METHODS We developed, piloted, and conducted a cross-sectional online survey guided by the 2005 International Health Regulations. It was electronically mailed to the 166 African Palliative Care Association's members and partners. Descriptive analyses were conducted. RESULTS About 83 participants from 21 countries completed the survey. Most services had at least one procedure for the case management of COVID-19 or another infectious disease (63%). Respondents reported concerns over accessing running water, soap, and disinfectant products (43%, 42%, and 59%, respectively) and security concerns for themselves or their staff (52%). Two in five services (41%) did not have any or make available additional personal protective equipment. Most services (80%) reported having the capacity to use technology instead of face-to-face appointment, and half (52%) reported having palliative care protocols for symptom management and psychological support that could be shared with nonspecialist staff in other health care settings. CONCLUSION Our survey suggests that African palliative care services could support the wider health system's response to the COVID-19 pandemic with greater resources such as basic infection control materials. It identified specific and systemic weaknesses impeding their preparedness to respond to outbreaks. The findings call for urgent measures to ensure staff and patient safety.
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Affiliation(s)
- Sabah Boufkhed
- Cicely Saunders Institute for Palliative Care and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, United Kingdom.
| | - Eve Namisango
- Cicely Saunders Institute for Palliative Care and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, United Kingdom; African Palliative Care Association, Kampala, Uganda
| | | | - Katherine E Sleeman
- Cicely Saunders Institute for Palliative Care and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, United Kingdom
| | | | | | - Charles Normand
- Cicely Saunders Institute for Palliative Care and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute for Palliative Care and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Richard Harding
- Cicely Saunders Institute for Palliative Care and Rehabilitation, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, United Kingdom
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13
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Gopal S, Sivaram S, Rajaraman P, Trimble EL. Thinking globally about cancer research on World Cancer Day. Indian J Med Res 2020; 151:269-272. [PMID: 32461388 PMCID: PMC7371059 DOI: 10.4103/ijmr.ijmr_198_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Satish Gopal
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sudha Sivaram
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Preetha Rajaraman
- Office of Global Affairs, US Department of Health & Human Services, Washington, DC, USA
| | - Edward L. Trimble
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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