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Coghlan R, Zadeh-Cummings N, Petrova PhD M, Spiegel P. The "New-Old" Dimensions of Caring in Humanitarian Response: The Opportunity for Public Health Palliative Care to Advance the Humanitarian-Development Nexus, Decoloniality, and Localization Thought. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241277443. [PMID: 39257381 PMCID: PMC11402077 DOI: 10.1177/00469580241277443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
How can palliative care framings advance humanitarian discourse? The imperative for palliative care in humanitarian settings is increasingly urgent. Recent efforts by health and humanitarian organizations demonstrate increasing attention to the issue. Yet palliative care is still not adequately formally considered or enacted by humanitarian agencies in rhetoric, policy, research, or practice. Even where it is considered in humanitarian action, palliative care is often assumed to be a novel intervention, rather than a caring practice that has existed from time immemorial, including in humanitarian situations. The generation of ideas in this paper has followed a dynamic, iterative, and reflexive process through engagement with key literature, critical thinking, conversations with colleagues across both sectors, primary data, and debate amongst the authors. The paper argues that the current dominant frame of a new, specialized, professionalized, and medicalized palliative care in the humanitarian sector would perpetuate existing challenges. It contends that viewing both fields through a "new-old" lens, where historical and traditional caring practices intertwine with progressive discourse for a more just and appropriate public health response, can further humanitarianism. It posits that the humanitarian-development nexus, decoloniality, and localization thought can benefit from palliative care practice through critical interaction with a broad range of literature.
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Affiliation(s)
- Rachel Coghlan
- Centre for Humanitarian Leadership, Deakin University, Burwood, VIC, Australia
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Paul Spiegel
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Plagg B, Ballmann J, Ewers M. Hospice and Palliative Care during Disasters: A Systematic Review. Healthcare (Basel) 2023; 11:2382. [PMID: 37685416 PMCID: PMC10486474 DOI: 10.3390/healthcare11172382] [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: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Providing and maintaining hospice and palliative care during disasters poses significant challenges. To understand the impact of disasters on the provision of hospice and palliative care and the disaster preparedness initiatives in the field, a systematic review was undertaken. Eligibility criteria for the selection of studies were: peer-reviewed original research papers addressing HPC during disasters published between January 2001 and February 2023 in English. The databases CINAHL, MEDLINE, APA PsycInfo, APA PsycArticles, and SocINDEX were searched with textword and MeSh-terms between October 2022 and February 2023. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the studies. Content analysis was performed. The results are presented in the form of a narrative synthesis. Of 2581 studies identified, 57 met the inclusion criteria. Most studies were published recently on the impact of the COVID-19 pandemic. Four main themes were identified in the literature: disruption of the system, setting-specific differences, emotional challenges, and system adaptation. Overall, strategies to tackle hospice and palliative care needs have been poorly integrated in disaster preparedness planning. Our findings highlight the need to strengthen the resilience of hospice and palliative care providers to all types of disasters to maintain care standards.
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Affiliation(s)
- Barbara Plagg
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
- Institute of General Practice and Public Health, College of Health Care Professions–Claudiana, Lorenz-Böhler-Straße 13, 39100 Bolzano, Italy
| | - Julia Ballmann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
| | - Michael Ewers
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
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Yantzi R, Hadiuzzaman M, Sen Gupta PK, Lamrous A, Richardson K, Pringle J, Schwartz L, Hossain P, Kizito D, Burza S. Doing our best and doing no harm: A focused ethnography of staff moral experiences of providing palliative care at a Médecins Sans Frontières pediatric hospital in Cox's Bazar, Bangladesh. PLoS One 2023; 18:e0288938. [PMID: 37471393 PMCID: PMC10358957 DOI: 10.1371/journal.pone.0288938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION The Médecins Sans Frontières (MSF) Goyalmara Hospital in Cox's Bazar, Bangladesh is a referral centre offering the highest level of care available in the Rohingya camps for pediatrics and neonatology. Efforts are underway to integrate pediatric palliative care due to high mortality and medical complexity of patients, yet little is known about the experiences of staff delivering palliative and end-of-life care. The purpose of this study was to understand the moral experiences of MSF staff to inform program planning and implementation. METHODS This focused ethnography was conducted between March-August 2021 at Goyalmara Hospital. Data collection involved participant-observation, individual interviews (22), focus group discussions (5), and analysis of documents including MSF clinical guidelines, admission and referral criteria, reports, and training materials. Data analysis followed a modified version of the Qualitative Analysis Guide of Leuven and data were coded using NVivo software. RESULTS The prevailing understanding of pediatric palliative care among national and international staff was care that prioritized comfort for infants and children who were not expected to survive. Staff's views were informed by their sense of obligation to do no harm, to do their best on behalf of their patients, and religious beliefs about God's role in determining the child's outcome. The authority of doctors, international staff, as well as protocols and guidelines shaped palliative care decision-making. Staff saw clinical guidelines as valuable resources that supported a consistent approach to care over time, while others were concerned that palliative care guidelines were rigidly applied. CONCLUSION When integrating palliative care into humanitarian programs, it is important to emphasize the active role of palliative care in reducing suffering. Advocacy for access to the highest level of care possible should continue alongside palliative care integration. While palliative care guidelines are valuable, it is essential to encourage open discussion of staff concerns and adapt care plans based on the family's needs and preferences.
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Affiliation(s)
- Rachel Yantzi
- Médecins Sans Frontières, Cox’s Bazar, Bangladesh
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | | | | | | | | | | | - Lisa Schwartz
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Puspita Hossain
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - David Kizito
- Médecins Sans Frontières, Cox’s Bazar, Bangladesh
| | - Sakib Burza
- Médecins Sans Frontières, Barcelona, Spain
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Coghlan R, Shamieh O, Bloomer MJ. Inequities of palliative care availability and access to opioids in low- and middle-income countries. Palliat Med 2022; 36:NP1-NP2. [PMID: 34310882 DOI: 10.1177/02692163211034083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Porter B, Zile A, Peryer G, Farquhar M, Sanderson K. The impact of providing end-of-life care during a pandemic on the mental health and wellbeing of health and social care staff: Systematic review and meta-synthesis. Soc Sci Med 2021; 287:114397. [PMID: 34537656 PMCID: PMC8445829 DOI: 10.1016/j.socscimed.2021.114397] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/24/2021] [Accepted: 09/12/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Disease outbreaks and disasters can result in excess deaths and severe disruption of usual end-of-life care processes. We aimed to: i) synthesise evidence describing the experiences of health and social care staff providing end-of-life care during a disease outbreak or humanitarian disaster, ii) understand the impact on their mental health and wellbeing and, iii) identify means of support. METHODS A systematic review with meta-synthesis was conducted including studies of health and social care staff providing end-of-life care during disease outbreaks (Ebola, COVID-19, SARs, MERs) or humanitarian disasters (2001-2020). MEDLINE (Ovid), Embase, PsycInfo, Web of Science, and grey literature databases were searched systematically, with forward and backward citation searching of included studies. Any research study designs, in any care settings, were included. Study quality was assessed using an appraisal tool relevant to each study design. Qualitative meta-synthesis was used to analyse the findings, which were then reported narratively. PROSPERO registration: CRD42020181444. RESULTS Nineteen studies were included, including 10 Ebola studies and two COVID-19 studies. The analysis generated two superordinate themes: individual experience and organisational responsibilities. Individual experience comprised four themes: dignity in death, positive experiences, negative experience and support for staff. Organisational responsibilities comprised four themes: preparation, adaption, resources, and Personal Protective Equipment (PPE). DISCUSSION No studies quantitively measured the impact of providing end-of-life care on staff mental health and wellbeing, however qualitative studies described experiences in varied settings. Serious disease outbreaks and disasters can expose care staff to abnormally high levels of mortality and suffering. Health and social care systems need to proactively prepare for future events and enable peer support mechanisms that may help mitigate experiences of psychological distress in humanitarian crises.
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Affiliation(s)
- Bryony Porter
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
| | - Amy Zile
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
| | - Guy Peryer
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
| | - Kristy Sanderson
- School of Health Sciences, University of East Anglia, Norwich Research Park, NR4 7TJ, United Kingdom.
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Abbott J, Ferraro K, Johnson D, Statland B, Massone J, Fowler C, Budai P, Cantrill SV. Colorado Palliative Care and Hospice Crisis Standards: Moving Beyond Critical Care Planning. J Pain Symptom Manage 2021; 61:1287-1296. [PMID: 33348027 DOI: 10.1016/j.jpainsymman.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
Palliative care (PC) and hospice services have experienced shortages before 2020, and during the initial phases of the current pandemic, more critical gaps are expected with future surges, much as scarcity in intensive care unit services may recur during the COVID-19 pandemic. Although ethical allocation of ventilators and intensive care unit care is the subject of important discussions during this pandemic, caring for those at the end of life and those not desiring or qualifying for critical interventions must not be neglected, as critical care and comfort-focused care are intertwined. We review state and regional gaps already recognized in planning for scarcity in PC and hospice services during this pandemic and describe the planning initiatives Colorado has developed to address potential scarcities for this vulnerable and diverse group of people. We hope to encourage other state and regional groups to anticipate needs in the coming surges of this pandemic or in public health crises to come. Such planning is key to avoid the degradation of care that may result if it is necessary to invoke crisis standards of care and ration these essential services to our communities.
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Affiliation(s)
- Jean Abbott
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Kelly Ferraro
- Palliative Medicine Physician, Denver Health & Hospital Authority, Denver, Colorado, USA
| | - Daniel Johnson
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Barbara Statland
- Hospitalist and Co Chair Ethics Committee, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - John Massone
- Medical Director, Palliative Care and Hospice, TRU Community Care, Lafayette, Colorado, USA
| | - Carol Fowler
- SCL Health-St. Mary's Hospital Palliative Medicine & Medical Director, HopeWest, Grand Junction, Colorado, USA
| | - Peggy Budai
- Poudre Valley Hospital and Medical Center of the Rockies, Older Adult and Palliative Care Programs, Fort Collins, Colorado, USA
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Hunt M, Nouvet E, Chénier A, Krishnaraj G, Bernard C, Bezanson K, de Laat S, Schwartz L. Addressing obstacles to the inclusion of palliative care in humanitarian health projects: a qualitative study of humanitarian health professionals' and policy makers' perceptions. Confl Health 2020; 14:70. [PMID: 33133234 PMCID: PMC7592183 DOI: 10.1186/s13031-020-00314-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background Humanitarian non-governmental organizations provide assistance to communities affected by war, disaster and epidemic. A primary focus of healthcare provision by these organizations is saving lives; however, curative care will not be sufficient, appropriate, or available for some patients. In these instances, palliative care approaches to ease suffering and promote dignity are needed. Though several recent initiatives have increased the probability of palliative care being included in humanitarian healthcare response, palliative care remains minimally integrated in humanitarian health projects. Methods We conducted a qualitative study using interpretive description methodology to investigate humanitarian policy-makers’ and health care professionals’ experiences and perceptions of palliative care during humanitarian crises. In this article, we report on the analysis of in-depth interviews with 24 participants related to their perceptions of obstacles to providing palliative care in humanitarian crises, and opportunities for overcoming these obstacles. Among the participants, 23 had experience as humanitarian health professionals, and 12 had experience with policy development and organizational decision-making. Results Participants discussed various obstacles to the provision of palliative care in humanitarian crises. More prominent obstacles were linked to the life-saving ethos of humanitarian organizations, priority setting of scarce resources, institutional and donor funding, availability of guidance and expertise in palliative care, access to medication, and cultural specificity around death and dying. Less prominent obstacles related to continuity of care after project closure, equity, security concerns, and terminology. Conclusion Opportunities exist for overcoming the obstacles to providing palliative care in humanitarian crises. Doing so is necessary to ensure that humanitarian healthcare can fulfill its objectives not only of saving lives, but also of alleviating suffering and promoting dignity of individuals who are ill or injured during a humanitarian crises, including persons who are dying or likely to die.
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Affiliation(s)
- Matthew Hunt
- School of Physical and Occupational Therapy, McGill University; Researcher, Centre for Interdisciplinary Research on Rehabilitation, 3654 Prom Sir William Osler, Montreal, QC H3G 1Y5 Canada
| | - Elysée Nouvet
- School of Health Studies, Western University, HSB 339 1151 Richmond St, London, ON N6A 5B9 Canada
| | - Ani Chénier
- Humanitarian Health Ethics Research Group, Western University, School of Health Studies, Western University, School of Health Studies, HSB 339, 1151 Richmond St, London, ON N6A 5B9 Canada
| | - Gautham Krishnaraj
- Humanitarian Health Ethics Research Group, McMaster University, CRL Building, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Carrie Bernard
- Department of Community and Family Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7 Canada.,Department of Family Medicine, McMaster University 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Kevin Bezanson
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay Regional Health Sciences Centre, 980 Oliver Rd, Thunder Bay, Ontario P7B 6V4 Canada
| | - Sonya de Laat
- Global Health, McMaster University, 1280 Main Street West, MDCL 3500, Hamilton, ON L8S 4K1 Canada
| | - Lisa Schwartz
- Department of Health Research Methods & Impact, McMaster University, CRL Building, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
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