1
|
Laabar TD, Saunders C, Auret K, Johnson CE. Socially, Culturally and Spiritually Sensitive Public Health Palliative Care Models in the Lower-income Countries: An Integrative Literature Review. Indian J Palliat Care 2023; 29:15-27. [PMID: 36846282 PMCID: PMC9944658 DOI: 10.25259/ijpc_92_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022] Open
Abstract
The demand for palliative care (PC) is ever-increasing globally. The emergence of COVID-19 pandemic has further accelerated the need for PC. In the lower-income countries (LICs), where PC need is highest, PC, the most humane, appropriate and realistic approach to care for patients and families affected by life-limiting illness, is minimal or non-existent. Recognising the disparity between high, middle and LICs, the World Health Organization (WHO) has recommended public health strategies for PC within the socioeconomic, cultural and spiritual contexts of individual countries. This review aimed to: (i) identify PC models in the LICs utilising public health strategies and (ii) characterise how social, cultural and spiritual components were integrated into these models. This is an integrative literature review. Thirty-seven articles were included from a search of four electronic databases - Medline, Embase, Global Health and CINAHL. Literature, both empirical and theoretical literature, published in English from January 2000 to May 2021 that mentioned PC models/services/programmes integrating public health strategies in the LICs were included in the study. A number of LICs utilised public health strategies to deliver PC. One-third of the selected articles highlighted the importance of integrating sociocultural and spiritual components into PC. Two main themes - WHO-recommended public health framework and sociocultural and spiritual support in PC and five subthemes - (i) suitable policies; (ii) availability and accessibility of essential drugs; (iii) PC education for health professionals, policymakers and the public; (iv) implementation of PC at all levels of healthcare and (v) sociocultural and spiritual components, were derived. Despite embracing the public health approach, many LICs encountered several challenges in integrating all four strategies successfully.
Collapse
Affiliation(s)
- Tara Devi Laabar
- Department of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Nursing and Midwifery, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Christobel Saunders
- Department of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Claire E. Johnson
- Department of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
2
|
Laabar TD, Auret K, Saunders C, Ngo H, Johnson CE. Support Needs for Bhutanese Family Members Taking Care of Loved Ones Diagnosed with Advanced Illness. J Palliat Care 2021; 37:401-409. [PMID: 34898330 DOI: 10.1177/08258597211066248] [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: 11/17/2022]
Abstract
Background: Palliative care aims to improve the quality of life of patients diagnosed with an advanced illness and their families. Family members, who often play a central role caring for their very ill loved ones, have significant support needs. In Bhutan, where palliative care is an emerging concept, the needs of family members have not been assessed thus far. Objective: This study explored the support needs of Bhutanese family members caring for their loved ones diagnosed with advanced illness. Design: This is a cross-sectional descriptive study. Setting/Subjects: Study sites included the national referral hospital, the two regional referral hospitals, four district hospitals and Basic Health Units (Grade I and II), spread across Bhutan. Participants were recruited through purposeful and snowball sampling strategies. Data were collected from May to August 2019. The Carer Support Needs Assessment Tools (CSNAT) was used. Results: Despite unforeseen challenges, 46 family members out of 60 identified (77%) participated in the survey. Twenty-three (50%) cared for relatives with advanced cancer and the remainder for loved ones with non-malignant conditions. This study found high support needs among both groups. The priority needs included understanding their relative's illness, managing symptoms, providing personal care, financial aspects, dealing with their own feelings and emotions and knowing what to expect in the future. Conclusion: This study will help inform the World Health Organization recommended public health approach to palliative care modified to the Bhutanese context for enabling a cost-effective intervention to improve the quality of lives of patients and families.
Collapse
Affiliation(s)
- Tara Devi Laabar
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Kirsten Auret
- The University of Western Australia, Albany, Western Australia, Australia
| | - Christobel Saunders
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Hanh Ngo
- The University of Western Australia (M706), Crawley, Western Australia, Australia
| | - Claire E Johnson
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.,Australian Health Services Research Institute (AHSRI), University of Wollongong, NSW, Australia
| |
Collapse
|
3
|
Gautam D, Adhikari S. Palliative care services for cancer patients in Nepal, a lower-middle-income country. Palliat Care Soc Pract 2021; 15:26323524211021105. [PMID: 34164623 PMCID: PMC8191070 DOI: 10.1177/26323524211021105] [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: 10/21/2020] [Accepted: 05/07/2021] [Indexed: 12/24/2022] Open
Abstract
With the rise in cancer burden, need for palliative care services has increased simultaneously and majority of people requiring services are from low- and middle-income countries where palliative care is in primitive stage. Nepal is also facing similar challenges of dealing with cancer care and end-of-life care. From its initiation in the early 1990s, there has been gradual progress in the development of palliative care with joint effort of government as well as non-governmental organizations. Morphine, a major milestone for pain management, is being manufactured in the country for nearly a decade, yet morphine equivalence mg per capita is far below the global average. Currently, Nepal has been placed under ‘Category 3a’ with isolated care provision and there are a lot of challenges to overcome to improve the existing services. Majority of hospice and palliative care centres are located in the capital city and only a few in the periphery. Scarcity of treatment centres and expertise, limited finances, lack of awareness among patients and health care workers, and difficult terrain are major barriers for optimal care. Proper implementation of national guidelines, human resource development and integration of palliative care to primary healthcare level would be crucial steps for further improvement.
Collapse
Affiliation(s)
- Deepa Gautam
- Department of Radiation Oncology, B.P. Koirala Memorial Cancer Hospital, Bharatpur 44207, Nepal
| | - Sudhir Adhikari
- Department of Paediatrics, Chitwan Medical College, Bharatpur, Nepal
| |
Collapse
|
4
|
Lijimol AS, Krishnan A, Rajagopal MR, Gopal BK, Booth CM. Improving Access and Quality of Palliative Care in Kerala: A Cross-sectional Study of Providers in Routine Practice. Indian J Palliat Care 2021; 26:500-505. [PMID: 33623312 PMCID: PMC7888431 DOI: 10.4103/ijpc.ijpc_17_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Expanding access and improving quality of palliative care in low-middle income countries is a pressing priority. Objective: The objective of the study was to describe structure and processes of care across government (GO) and non-GO (NGO) palliative care providers (PCPs) in Kerala, India. Design: This was a cross-sectional telephone survey. Setting/Subjects: This study consisted of 200 randomly selected PCPs across Kerala. The survey explored organizational structure, patient assessment, opioid availability, and explored elements considered essential to palliative care delivery in the Indian context. Results: One hundred GO and 100 NGO PCPs agreed to participate (100% response rate). The annual median number of new patients was 183 and 159 in GO and NGO PCPs, respectively. The median number of annual home visits in GO PCPs was 1398 and in NGO PCPs was 979. Median number of outpatient visits in GO PCPs was 600 and in NGO PCPs was 520. Only 24% (47/200) of the PCPs had full-time physicians with training in palliative care; 60% of GO PCPs had no full time physician with training in palliative care. Patient-reported pain was routinely documented by 21% (21/100) and 65% (65/100) of the GO and NGO sites, respectively (P < 0.001). None of the GO and only 36% (36/100) of NGO PCPs were able to prescribe oral morphine. Psychosocial and spiritual issues were documented routinely in only 4% (4/100) and 48% (47/99) of the GO and NGO PCPs, respectively (P < 0.001). Conclusions: Caution is needed against potential challenges to quality care in any new initiative. Kerala has achieved remarkable success in the coverage of palliative care through hundreds of locally active NGOs through GO machinery involving every primary health center. Yet, there are gaps such as absence of full-time physicians. This study highlights the need for periodic review to identify gaps in care.
Collapse
Affiliation(s)
- A S Lijimol
- Department of Projects, Trivandrum Institute of Palliative Sciences and Pallium India, Aisha Memorial Hospital Building, Paruthikuzhy, India
| | - Anjali Krishnan
- Department of Projects, Trivandrum Institute of Palliative Sciences and Pallium India, Aisha Memorial Hospital Building, Paruthikuzhy, India
| | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences and Pallium India, Aisha Memorial Hospital Building, Paruthikuzhy, India
| | - Bipin K Gopal
- Directorate of Health Services, Kerala and State Nodal Officer: NCD, NHM Kerala, Thiruvananthapuram, Kerala, India
| | - Christopher M Booth
- Department of Medical Oncology, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| |
Collapse
|
5
|
A Global Perspective: the Role of Palliative Care for the Trauma Patient in Low-Income Countries. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
6
|
Sriram V, Bennett S. Strengthening medical specialisation policy in low-income and middle-income countries. BMJ Glob Health 2020; 5:e002053. [PMID: 32133192 PMCID: PMC7042575 DOI: 10.1136/bmjgh-2019-002053] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/10/2019] [Accepted: 12/22/2019] [Indexed: 12/13/2022] Open
Abstract
The availability of medical specialists has accelerated in low-income and middle-income countries (LMICs), driven by factors including epidemiological and demographic shifts, doctors' preferences for postgraduate training, income growth and medical tourism. Yet, despite some policy efforts to increase access to specialists in rural health facilities and improve referral systems, many policy questions are still underaddressed or unaddressed in LMIC health sectors, including in the context of universal health coverage. Engaging with issues of specialisation may appear to be of secondary importance, compared with arguably more pressing concerns regarding primary care and the social determinants of health. However, we believe this to be a false choice. Policy at the intersection of essential health services and medical specialties is central to issues of access and equity, and failure to formulate policy in this regard may have adverse ramifications for the entire system. In this article, we describe three critical policy questions on medical specialties and health systems with the aim of provoking further analysis, discussion and policy formulation: (1) What types, and how many specialists to train? (2) How to link specialists' production and deployment to health systems strengthening and population health? (3) How to develop and strengthen institutions to steer specialisation policy? We posit that further analysis, discussion and policy formulation addressing these questions presents an important opportunity to explicitly determine and strengthen the linkages between specialists, health systems and health equity.
Collapse
Affiliation(s)
- Veena Sriram
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, USA
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Affiliation(s)
- CT Sudhir Kumar
- Alzheimer's and Related Disorders Society of India, Grace Hospital, Aymanam, Kottayam, Kerala, India
| | - Sanju George
- Centre for Behavioural Sciences and Research, Rajagiri College of Social Sciences, Kalamassery, Kochi, Kerala, India
| | | |
Collapse
|
8
|
Dawson GA. Low- to Middle-Income Nations: Resource Rich in People but Resource Poor in Reliable Utility (electrical grid) Infrastructure for Effective Delivery of High-Impact Supportive Care Modalities-Some Thoughts on the Radiotherapy Perspective. J Glob Oncol 2018; 4:1-2. [PMID: 30084701 PMCID: PMC6223497 DOI: 10.1200/jgo.18.00082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- George A Dawson
- George A. Dawson, James J. Peters VA Medical Center, Bronx, NY
| |
Collapse
|