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Rosa WE, Connor S, Downing J, Marston J, Radbruch L. Access to palliative medicine in armed conflict: a basic right and an urgent need. Lancet 2023; 402:2291-2292. [PMID: 38042169 DOI: 10.1016/s0140-6736(23)02638-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023]
Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10023, USA.
| | | | - Julia Downing
- International Children's Palliative Care Network, Bristol, UK
| | - Joan Marston
- Palliative Care in Humanitarian Aid Situations and Emergencies, Edinburgh, UK; Palliative Care for Children, Bloemfontein, South Africa
| | - Lukas Radbruch
- International Association for Hospice and Palliative Care, Houston, TX, USA; Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
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2
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Pettus K, Connor S, Downing J, Marston J. Pandemic treaty should include provisions for palliative care. Bull World Health Organ 2023; 101:363-363A. [PMID: 37265673 PMCID: PMC10225945 DOI: 10.2471/blt.23.289957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Katherine Pettus
- International Association for Hospice and Palliative Care, 5535 Memorial Drive, Suite F-509, Houston, Texas77007, United States of America
| | - Stephen Connor
- Worldwide Hospice and Palliative Care Alliance, London, England
| | - Julia Downing
- International Children’s Palliative Care Network, Bristol, England
| | - Joan Marston
- Palliative Care in Humanitarian Aid Situations and Emergencies (PallCHASE), Scotland
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Rosa WE, Rajagopal MR, Bhadelia A, Jones KF, Khanyola J, Knaul FM, Marston J, Spence D. Racism and casteism: global chasms of access to palliative care and pain relief. BMJ Support Palliat Care 2023; 13:57-60. [PMID: 36041818 PMCID: PMC9971343 DOI: 10.1136/spcare-2022-003717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022]
Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
| | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences, Thiruvananthapuram, Kerala, India
- Pallium India, Trivandrum, India
| | - Afsan Bhadelia
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Judy Khanyola
- Center for Nursing and Midwifery, University of Global Health Equity, Kigali, Rwanda
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Tómatelo a Pecho, Mexico City, Mexico
- Fundación Mexicana para la Salud, Mexico City, Mexico
| | - Joan Marston
- Palliative Care in Humanitarian Aid Situations and Emergencies, University of Edinburgh, Edinburgh, UK
- Palliative Care for Children Bloemfontein, Free State, South Africa
| | - Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica
- University of the West Indies, Kingston, Jamaica
- Cicely Saunders Institute, King's College, London, UK
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4
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Lohman D, Cleary J, Connor S, De Lima L, Downing J, Marston J, Morris C, Pardy S, Pettus K. Advancing Global Palliative Care Over Two Decades: Health System Integration, Access to Essential Medicines, and Pediatrics. J Pain Symptom Manage 2022; 64:58-69. [PMID: 35263621 DOI: 10.1016/j.jpainsymman.2022.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
CONTEXT Between 2000 and 2020 Open Society Foundations was one of very few funders that supported global palliative care development and advocacy. OBJECTIVES To describe progress made in three priority areas-the integration of palliative care into public health systems, access to controlled medicines, and pediatric palliative care-during those 20 years. METHODS Activities and developments between 2000 and 2020 on global integration of palliative care into health systems, access to and availability of controlled medicines, and pediatric palliative care are described and analyzed. RESULTS Major progress has been made in each area. Whereas in 2000, integration of palliative care into public healthcare systems was on the agenda in just a few pioneering countries, by 2020 a global consensus had emerged that palliative care should be integral to all health systems including in universal health coverage and countries were increasingly taking steps to integrate it into national health systems. While limited availability of these medicines was barely recognized as a public health or drug control issue in 2000, it had become an important priority in global drug policy debates by 2020 and numerous countries had taken steps to improve access to these medicines. Pediatric palliative care, available mostly in a small number of wealthy countries in the 1990s, has seen rapid growth, especially in low- and middle-income countries, and now has a solid foothold in all world regions. CONCLUSION Despite this progress, significant challenges remain as funding for palliative care advocacy is limited, the overdose crisis in the US has recently had a chilling effect on efforts to improve availability of opioid analgesics, and economic crises related to the COVID-19 pandemic create uncertainty over the future of universal health coverage.
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Affiliation(s)
- Diederik Lohman
- Open Society Foundations (D.L., S.P.), New York, New York, USA.
| | - James Cleary
- Walther Global Palliative Care and Supportive Oncology, IUSCC, Indianapolis (J.C.), Indiana, USA
| | - Stephen Connor
- Worldwide Hospice Palliative Care Alliance (S.C., C.M.), London, UK
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston (L.D., K.P.), Texas, USA
| | - Julia Downing
- International Children's Palliative Care Network, Makerere University (J.D.), London/ Kampala, UK/ Uganda
| | - Joan Marston
- PatchSA Palliative Treatment for Children South Africa (J.M.), Bloemfontein, South Africa
| | - Claire Morris
- Worldwide Hospice Palliative Care Alliance (S.C., C.M.), London, UK
| | - Sara Pardy
- Open Society Foundations (D.L., S.P.), New York, New York, USA
| | - Katherine Pettus
- International Association for Hospice and Palliative Care, Houston (L.D., K.P.), Texas, USA
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5
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Benini F, Papadatou D, Bernadá M, Craig F, De Zen L, Downing J, Drake R, Friedrichsdorf S, Garros D, Giacomelli L, Lacerda A, Lazzarin P, Marceglia S, Marston J, Muckaden MA, Papa S, Parravicini E, Pellegatta F, Wolfe J. International Standards for Pediatric Palliative Care: From IMPaCCT to GO-PPaCS. J Pain Symptom Manage 2022; 63:e529-e543. [PMID: 35031506 DOI: 10.1016/j.jpainsymman.2021.12.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Since the publication of the IMPaCCT project in 2007, much effort has been made to develop new approaches to pediatric palliative care (PPC). Fifteen years later, it is time to redefine the standards in PPC. OBJECTIVES An international group of experts in PPC has revised the standards in PPC through the GO-PPaCS project (Global Overview - PPC Standards). The goal was to update the PPC standards considering the specificity of different settings, resources, and emerging challenges. The present document is intended to reach all people directly or indirectly involved in PPC. METHODS A literature review in MEDLINE was conducted to expand on the fundamental points and current standards on PPC and to cover an international setting. The literature search (updated on the 15th of April 2021) was carried out using different combinations of keywords and focusing on papers published in English over the past 5 years (2016-2020), but older articles were considered when relevant. The consensus on the fundamental points, standards of care and paper contents was reached by open discussion. RESULTS Fundamental points were defined regarding the definition of PPC, eligibility criteria and the magnitude of the need for PPC, while standards were redefined for the following six areas: 1) clinical, developmental, psychological, social, ethical and spiritual needs; 2) end-of-life care; 3) care models and settings of care; 4) PPC in humanitarian emergencies; 5) care tools; and 6) education and training for healthcare providers. CONCLUSION The present document, developed with the contribution of an international group of experts from different countries, experiences and models of care, provides fundamental points and standards for a wider implementation of PPC worldwide.
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Affiliation(s)
- Franca Benini
- Paediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy.
| | - Danai Papadatou
- Professor of Clinical Psychology, Department of Mental Health and Behavioral Studies, Faculty of Nursing, National and Kapodistrian University of Athens, Greece
| | - Mercedes Bernadá
- Associated Professor of Pediatrics, School of Medicine, Universidad de la República, Pereira Rossell Hospital Center, Pediatric Palliative Care Team Director, Montevideo, Uruguay
| | - Finella Craig
- Consultant in Paediatric Palliative Medicine at the Louis Dundas Centre, Great Ormond Street Hospital for Children, London, UK
| | - Lucia De Zen
- Pediatric Palliative Care and Pain Service, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Julia Downing
- International Children's Palliative Care Network (ICPCN), Uganda/UK
| | - Ross Drake
- Pediatric Palliative Care and Pain Services, Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Stefan Friedrichsdorf
- Professor in Pediatrics, Medical Director, Center of Pediatric Pain, Palliative and Integrative Medicine at UCSF Benioff Children's Hospitals in Oakland and San Francisco, California, USA
| | - Daniel Garros
- Department of Pediatrics, Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital PICU, Edmonton, Alberta, Canada
| | | | - Ana Lacerda
- Department of Pediatrics, Portuguese Institute of Oncology, Lisbon Centre, Lisbon, Portugal
| | - Pierina Lazzarin
- Paediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Joan Marston
- Sunflower Children's Hospice, Bloemfontein, South Africa
| | | | | | | | | | - Joanne Wolfe
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute and Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
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6
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Rosa WE, Grant L, Knaul FM, Marston J, Arreola-Ornelas H, Riga O, Marabyan R, Penkov A, Sallnow L, Rajagopal MR. The value of alleviating suffering and dignifying death in war and humanitarian crises. Lancet 2022; 399:1447-1450. [PMID: 35325605 PMCID: PMC9245676 DOI: 10.1016/s0140-6736(22)00534-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022]
Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.
| | - Liz Grant
- Global Health Academy, University of Edinburgh, Edinburgh, UK
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico; Fundación Mexicana Para la Salud, Mexico City, Mexico
| | - Joan Marston
- Palliative Care in Humanitarian Aid Situations and Emergencies, University of Edinburgh, Edinburgh, UK; Palliative Care for Children Bloemfontein, Free State, South Africa
| | - Hector Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Tómatelo a Pecho, Mexico City, Mexico; Fundación Mexicana Para la Salud, Mexico City, Mexico
| | - Olena Riga
- National Medical University of Kharkiv, Kharkiv, Ukraine
| | - Roman Marabyan
- Regional Clinical Centre of Medical Rehabilitation and Palliative Care for Children, Kharkiv, Ukraine
| | - Andriy Penkov
- Eastern Ukrainian Academy of Pediatrics, Kharkiv, Ukraine
| | - Libby Sallnow
- St Christopher's Hospice, London, UK; End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - M R Rajagopal
- Trivandrum Institute of Palliative Services, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Trivandrum, India; Pallium India, Trivandrum, India
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Zuniga-Villanueva G, Ramos-Guerrero JA, Osio-Saldaña M, Casas JA, Marston J, Okhuysen-Cawley R. Quality Indicators in Pediatric Palliative Care: Considerations for Latin America. Children (Basel) 2021; 8:250. [PMID: 33806896 PMCID: PMC8004984 DOI: 10.3390/children8030250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Pediatric palliative care is a growing field in which the currently available resources are still insufficient to meet the palliative care needs of children worldwide. Specifically, in Latin America, pediatric palliative care services have emerged unevenly and are still considered underdeveloped when compared to other regions of the world. A crucial step in developing pediatric palliative care (PPC) programs is delineating quality indicators; however, no consensus has been reached on the outcomes or how to measure the impact of PPC. Additionally, Latin America has unique sociocultural characteristics that impact the perception, acceptance, enrollment and implementation of palliative care services. To date, no defined set of quality indicators has been proposed for the region. This article explores the limitations of current available quality indicators and describes the Latin American context and how it affects PPC development. This information can help guide the creation of standards of care and quality indicators that meet local PPC needs while considering the sociocultural landscape of Latin America and its population.
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Affiliation(s)
- Gregorio Zuniga-Villanueva
- Department of Pediatrics, Tecnologico de Monterrey, Monterrey 64849, Mexico
- Division of Pediatric Palliative Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | | | - Monica Osio-Saldaña
- Department of Global Studies, Universidad Nacional Autonoma de Mexico, Mexico City 04510, Mexico;
| | - Jessica A. Casas
- Department of Pediatric Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA; (J.A.C.); (R.O.-C.)
| | - Joan Marston
- Global Ambassador, International Children’s Palliative Care Network, Assagay 3624, South Africa;
| | - Regina Okhuysen-Cawley
- Department of Pediatric Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA; (J.A.C.); (R.O.-C.)
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Radbruch L, De Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, Blanchard C, Bruera E, Buitrago R, Burla C, Callaway M, Munyoro EC, Centeno C, Cleary J, Connor S, Davaasuren O, Downing J, Foley K, Goh C, Gomez-Garcia W, Harding R, Khan QT, Larkin P, Leng M, Luyirika E, Marston J, Moine S, Osman H, Pettus K, Puchalski C, Rajagopal MR, Spence D, Spruijt O, Venkateswaran C, Wee B, Woodruff R, Yong J, Pastrana T. Redefining Palliative Care-A New Consensus-Based Definition. J Pain Symptom Manage 2020; 60:754-764. [PMID: 32387576 PMCID: PMC8096724 DOI: 10.1016/j.jpainsymman.2020.04.027] [Citation(s) in RCA: 334] [Impact Index Per Article: 83.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/14/2020] [Accepted: 04/24/2020] [Indexed: 01/03/2023]
Abstract
CONTEXT The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. OBJECTIVE The main objective of this article is to present the research behind the new definition. METHODS The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition. RESULTS The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC. CONCLUSION Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.
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Affiliation(s)
- Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, Texas, USA
| | - Felicia Knaul
- University of Miami Institute for Advanced Study of the Americas, Coral Gables, Florida, USA
| | | | - Zipporah Ali
- Kenian Hospice and Palliative Care Association, Nairobi, Kenya
| | - Sushma Bhatnaghar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Charmaine Blanchard
- Wits Centre for Palliative Care, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Eduardo Bruera
- Department of Palliative Rehabilitation and Integrative Medicine, MD Anderson Cancer Center Houston, Houston, Texas, USA
| | - Rosa Buitrago
- School of Pharmacy, University of Panama, Panama City, Panama
| | | | | | | | - Carlos Centeno
- Department of Palliative Medicine, Clinica Universidad de Navarra, Navarra, Spain
| | - Jim Cleary
- Department of Medicine, IU Simon Cancer Center, IU School of Medicine, Indianapolis, Indiana, USA
| | - Stephen Connor
- Worldwide Hospice Palliative Care Alliance, London, United Kingdom
| | - Odontuya Davaasuren
- General Practice and Basic Skills Department, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Julia Downing
- International Children's Palliative Care Network, Cape town, South Africa
| | | | - Cynthia Goh
- Division of Palliative Medicine at the National Cancer Centre Singapore, Singapore
| | - Wendy Gomez-Garcia
- Clínica de Linfomas and LMA Cuidados Paliativos and Terapia Metronómica, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Richard Harding
- Centre for Global Health Palliative Care, King's College London, London, United Kingdom
| | - Quach T Khan
- Palliative Care Department, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Phillippe Larkin
- Institut universitaire de formation et de recherche en soins, Universite de Lausanne, Lausanne, Switzerland
| | - Mhoira Leng
- Department of Palliative Care, Makerere University, Kampala, Uganda
| | | | - Joan Marston
- International Children's Palliative Care Network, Cape town, South Africa
| | - Sebastien Moine
- Health Education and Practices Laboratory, University Parisse, Villetaneuse, France
| | - Hibah Osman
- Palliative and Supportive Care Program at the American University of Beirut Medical Center, Beirut, Lebanon
| | - Katherine Pettus
- International Association for Hospice and Palliative Care, Houston, Texas, USA
| | - Christina Puchalski
- George Washington University's Institute for Spirituality and Health, Washington, District of Columbia, USA
| | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences, Trivandrum, Kerala, India
| | | | - Odette Spruijt
- Australasian Palliative Link International, Melbourne, Australia
| | | | - Bee Wee
- Sir Michael Sobell House, Oxford University Hospital, Oxford, United Kingdom
| | | | - Jinsun Yong
- College of Nursing Catholic, University of Korea, Seoul, South Korea
| | - Tania Pastrana
- Department of Palliative Medicine, University Hospital Aachen, Aachen, Germany
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9
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Arias-Casais N, Garralda E, Pons JJ, Marston J, Chambers L, Downing J, Ling J, Rhee JY, de Lima L, Centeno C. Mapping Pediatric Palliative Care Development in the WHO-European Region: Children Living in Low-to-Middle-Income Countries Are Less Likely to Access It. J Pain Symptom Manage 2020; 60:746-753. [PMID: 32437945 DOI: 10.1016/j.jpainsymman.2020.04.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/18/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Approximately 170,000 children in need of palliative care die every year in Europe without access to it. This field remains an evolving specialty with unexplored development. OBJECTIVES To conduct the first regional assessment of pediatric palliative care (PPC) development and provision using data from the European Association for Palliative Care atlas of palliative care 2019. METHODS Two surveys were conducted. The first one included a single question regarding PPC service provision and was addressed by European Association for Palliative Care atlas informants. The second one included 10 specific indicators derived from an open-ended interview and rating process; a specific network of informants was enabled and used as respondents. Data were analyzed and presented in the map of the figure. RESULTS Data on PPC service provision were gathered from 51 of 54 (94%) European countries. Additional data were collected in 34 of 54 (62%) countries. A total of 680 PPC services were identified including 133 hospices, 385 home care services, and 162 hospital services. Nineteen countries had specific standards and norms for the provision of PPC. Twenty-two countries had a national association, and 14 countries offered education for either pediatric doctors or nurses. In seven countries, specific neonatal palliative care referral services were identified. CONCLUSION PPC provision is flourishing across the region; however, development is less accentuated in low-to-middle-income countries. Efforts need to be devoted to the conceptualization and definition of the models of care used to respond to the unmet need of PPC in Europe. The question whether specialized services are required or not should be further explored. Strategies to regulate and cover patients in need should be adapted to each national health system.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
| | - Eduardo Garralda
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Juan José Pons
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Department of History, History of Art and Geography, University of Navarra, Pamplona, Spain
| | - Joan Marston
- Palliative Treatment for Children (PatchSA), Rondebosch, South Africa
| | | | - Julia Downing
- International Children's Palliative Care Network, Bristol, United Kingdom
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
| | - John Y Rhee
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Department of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard, Boston, Massachusetts, USA
| | - Liliana de Lima
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Medical School International Association for Hospice and Palliative Care, Houston, Texas, USA
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
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10
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Affiliation(s)
- Julia Downing
- J Downing (corresponding author): International Children's Palliative Care Network, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Joan Marston
- J Marston, E Fleming: International Children's Palliative Care Network, Assagay, South Africa
| | - Edwina Fleming
- J Marston, E Fleming: International Children's Palliative Care Network, Assagay, South Africa
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11
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Affiliation(s)
- Caprice Knapp
- Departments of Epidemiology and Health Policy Research, Institute for Child Health Policy, University of Florida, Gainesville, Florida, USA
| | - Vanessa Madden
- Departments of Epidemiology and Health Policy Research, Institute for Child Health Policy, University of Florida, Gainesville, Florida, USA
| | - Joan Marston
- Hospice Palliative Care Association of South Africa, Pinelands, South Africa
| | - Rosemary Midson
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | | | - Elizabeth Shenkman
- Departments of Epidemiology and Health Policy Research, Institute for Child Health Policy, Gainesville, Florida, USA
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12
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Pettus K, De Lima L, Maurer M, Husain A, Connor S, Torode J, Ling J, Downing J, Rajagopal MR, Radbruch L, Pastrana T, Luyirika EB, Goh C, Marston J, Cleary J. Ensuring and Restoring Balance on Access to Controlled Substances for Medical and Scientific Purposes: Joint Statement from Palliative Care Organizations. J Pain Palliat Care Pharmacother 2018; 32:124-128. [PMID: 30198811 DOI: 10.1080/15360288.2018.1488792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The central principle of "balance" represents the dual obligation of governments to establish a system of control that ensures the adequate availability of controlled substances for medical and scientific purposes while simultaneously preventing their nonmedical use, diversion, and trafficking, two primary goals of the international control system. On the one hand, although strong opioids, including morphine, are absolutely necessary for the relief of severe pain, legitimate access to opioids for pain treatment and palliative care is lacking in the majority of the world's countries. On the other hand, in a few high-income countries with higher consumption of prescription opioids, diversion and nonmedical use are increasingly prevalent. This report presents examples of unbalanced systems and a joint statement from global and regional palliative care organizations to promote development of balanced systems for optimal public health outcomes. Although nonmedical use of controlled substances poses a risk to society, the system of control is not intended to be a barrier to their availability for medical and scientific purposes, nor to interfere in their legitimate medical use for patient care. As representatives of palliative care organizations, we urge heads of state to act and to take measures to ensure and restore balanced systems in their countries and call on public health leaders and regulators to work together.
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Marston J, Boucher S, Downing J. International Children's Palliative Care Network: A Global Action Network for Children With Life-Limiting Conditions. J Pain Symptom Manage 2018; 55:S104-S111. [PMID: 28800998 DOI: 10.1016/j.jpainsymman.2017.03.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
The International Children's Palliative Care Network (ICPCN) is a global network of individuals and organizations working together to reach the estimated 21 million children with life-limiting conditions and life-threatening illnesses. The drive to establish the ICPCN was born from the recognition of the gaps in service provision for children's palliative care and the need to collaborate, network, and share resources. Established in 2005 during a meeting in Seoul, South Korea, the ICPCN has developed over the years into an established network with a global membership. The history of the organization is described, including some of the key events since its inception. Working in collaboration with others, ICPCN has five key focus areas: Communication; Advocacy; Research; Education; and Strategic development, and is the only international charity working globally for the rights of children with palliative care needs. Activities in these areas are discussed, along with the inter-connection between the five areas. Without the ICPCN, palliative care for children would not have developed as far as it has over the years and the organization is committed to ongoing work in this area until all children requiring palliative care have access to quality services, wherever they live around the world.
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Affiliation(s)
- Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa
| | - Sue Boucher
- International Children's Palliative Care Network, Assagay, South Africa
| | - Julia Downing
- International Children's Palliative Care Network, Kampala, Uganda.
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Ghoshal A, Talawadekar P, Palleri A, Marston J, Muckaden M. Impact of Educational Training in Improving Skills, Practice, Attitude, and Knowledge of Healthcare Workers in Pediatric Palliative Care: Children's Palliative Care Project in the Indian State of Maharashtra. Indian J Palliat Care 2018; 24:411-425. [PMID: 30410252 PMCID: PMC6199824 DOI: 10.4103/ijpc.ijpc_43_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The “Children's Palliative Care Project” was initiated in October 2010 in the Indian state of Maharashtra with a view to improve the quality of life of children with life-limiting conditions. This study evaluates its education and training component through a questionnaire. Materials and Methods: A cross-sectional survey was carried out pre-/post-training among 258 doctors, nurses, social workers, and counselors at three sites in Maharashtra in March 2015. Descriptive statistics were used for data analysis. Results: Sixty-two participants responded. Posttraining, doctors and the nurses had a better level of knowledge, skill set, and attitude; whereas social workers and counselors fared better with prevailing care practices. Participants advocated using morphine only when other analgesics had failed and suggested ways for better service delivery of care. Conclusion: The study gives a rough idea of the prevailing practice of pediatric palliative care among the health-care workers (who participated in the survey) and suggests practical ways to improve it.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pradnya Talawadekar
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil Palleri
- Department of Palliative Medicine, Institute of Palliative Medicine, Kozhikode, Kerala, India
| | - Joan Marston
- ICPCN Global Ambassador for Children's Palliative Care, Clinical Manager Hospice Bloemfontein, Bloemfontein 9301, Free State, South Africa
| | - MaryAnn Muckaden
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Sasaki H, Bouesseau MC, Marston J, Mori R. A scoping review of palliative care for children in low- and middle-income countries. BMC Palliat Care 2017; 16:60. [PMID: 29178866 PMCID: PMC5702244 DOI: 10.1186/s12904-017-0242-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ninety-eight percent of children needing palliative care live in low- and middle-income countries (LMICs), and almost half of them live in Africa. In contrast to the abundance of data on populations in high income countries, the current data on populations in LMICs is woefully inadequate. This study aims to identify and summarize the published literature on the need, accessibility, quality, and models for palliative care for children in LMICs. METHODS A scoping review was performed following the method of Arksey and O'Malley. Systematic searches were conducted on PubMed and Google Scholar using the main keywords, 'children AND palliative care OR terminal care OR hospice OR end of life AND developing countries OR LMICs.' Additional publications were obtained by handsearching. Papers were only included if they reported on the need, accessibility, quality, and models for palliative care for children in LMICs. RESULTS Fifteen papers met the inclusion criteria for review. Of these, 10 assessed need, seven examined availability and/or accessibility, one assessed quality, and one examined the models. We found an urgent need for palliative care, particularly in the training for health workers and improving poor availability and/or accessibility to palliative care in terms of factors such as medication and bereavement support. The best practice models demonstrated feasibility and sustainability through cooperation with governments and community organizations. The quality of pain management and emotional support was lower in LMICs compared to HICs. CONCLUSION Although we found limited evidence in this review, we identified common challenges such as the need for further training for health workers and greater availability of opioid analgesics. While efforts to change the current systems and laws applying to children in LMICs are important, we should also tackle underlying factors including the need to raise awareness about palliative care in public health and improve the accuracy of data collection.
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Affiliation(s)
- Hatoko Sasaki
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535 Japan
| | - Marie-Charlotte Bouesseau
- Service Delivery and Safety, World Health Organization, 20 Avenue Appia, 1211, 27 Geneva, Switzerland
| | - Joan Marston
- International Children’s Palliative Care Network, 2 Langenhoven Street, Dan Pienaar, Bloemfontein, 9301 South Africa
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535 Japan
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Powell RA, Schwartz L, Nouvet E, Sutton B, Petrova M, Marston J, Munday D, Radbruch L. Palliative care in humanitarian crises: always something to offer. Lancet 2017; 389:1498-1499. [PMID: 28422014 DOI: 10.1016/s0140-6736(17)30978-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Richard A Powell
- MWAPO Health Development Group, PO Box 459-00621, Village Market, Nairobi, Kenya.
| | - Lisa Schwartz
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Elysée Nouvet
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | | | - Mila Petrova
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Daniel Munday
- Palliative Medicine and Health Services Research, International Nepal Fellowship, Kathmandu, Nepal
| | - Lukas Radbruch
- University Hospital Bonn, Bonn, Germany; Center of Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany
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Connor SR, Downing J, Marston J. Estimating the Global Need for Palliative Care for Children: A Cross-sectional Analysis. J Pain Symptom Manage 2017; 53:171-177. [PMID: 27765706 DOI: 10.1016/j.jpainsymman.2016.08.020] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/07/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022]
Abstract
CONTEXT The need for children's palliative care (CPC) globally is unknown. To understand the scope of the need and to advocate to meet it, more accurate estimates are needed. OBJECTIVES The objective of this study was to create an accurate global estimate of the worldwide need for CPC based on a representative sample of countries from all regions of the world and all World Bank income groups. METHODS This work builds on previously published methods developed by the International Children's Palliative Care Network, United Nations Children's Fund, and World Health Organization and tested in three African countries. The study used a cross-sectional design with quantitative data obtained from primary and secondary data sources. Estimation of the need used prevalence data from the Institute for Health Metrics and Evaluation, mortality data from the World Health Organization for the specific diseases known to require CPC, and Joint United Nations Programme on HIV/AIDS (UNAIDS) data on HIV prevalence. Representative data were analyzed for 23 countries representing 59.5% of the world's population. RESULTS The findings show estimated need for CPC ranged from almost 120 per 10,000 children in Zimbabwe to slightly more than 20 per 10,000 in the United Kingdom. Overall, among the over 21 million with conditions that will benefit annually from a palliative care approach, more than eight million need specialized CPC worldwide. CONCLUSION The estimation of need for CPC is a critical step in meeting the needs of children with life-threatening conditions and provides a sound platform to advocate for closure of the unacceptably wide gaps in coverage.
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Affiliation(s)
- Stephen R Connor
- Worldwide Hospice Palliative Care Alliance and International Children's Palliative Care Network , Fairfax Station, Virginia, USA.
| | - Julia Downing
- International Children's Palliative Care Network , Kampala, Uganda
| | - Joan Marston
- International Children's Palliative Care Network , Bloemfontein, South Africa
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Downing J, Kiman R, Boucher S, Nkosi B, Steel B, Marston C, Lascar E, Marston J. Children's palliative care now! Highlights from the second ICPCN conference on children's palliative care, 18-21 May 2016, Buenos Aires, Argentina. Ecancermedicalscience 2016; 10:667. [PMID: 27610193 PMCID: PMC5014554 DOI: 10.3332/ecancer.2016.667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Indexed: 01/15/2023] Open
Abstract
The International Children's Palliative Care Network held its second international conference on children's palliative care in Buenos Aires, Argentina, from the 18th-21st May 2016. The theme of the conference was 'Children's Palliative Care…. Now!' emphasising the need for palliative care for children now, as the future will be too late for many of them. Six pre-conference workshops were held, addressing issues connected to pain assessment and management, adolescent palliative care, ethics and decision-making, developing programmes, the basics of children's palliative care, and hidden aspects of children's palliative care. The conference brought together 410 participants from 40 countries. Plenary, concurrent, and poster presentations covered issues around the status of children's palliative care, genetics, perinatal and neonatal palliative care, the impact of children's palliative care and the experiences of parents and volunteers, palliative care as a human right, education in children's palliative care, managing complex pain in children, spiritual care and when to initiate palliative care. The 'Big Debate' explored issues around decision-making and end of life care in children, and gave participants the opportunity to explore a sensitive and thought provoking topic. At the end of the conference, delegates were urged to sign the Commitment of Buenos Aires which called for governments to implement the WHA resolution and ensure access to palliative care for neonates, children and their families, and also commits us as palliative care providers to share all that we can and collaborate with each other to achieve the global vision of palliative care for all children who need it. The conference highlighted the ongoing issues in children's palliative care and participants were continually challenged to ensure that children can access palliative care NOW.
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Affiliation(s)
- J Downing
- International Children's Palliative Care Network, New Bond House, Bond Street, Bristol, UK; Palliative Care, Makerere University, PO Box 7072, Kampala, Uganda
| | - R Kiman
- Paediatric Palliative Care, Hospital Nacional Prof A Posadas, Av Pres Arturo U Illia, Villa Sarmiento, Buenos Aires, Argentina
| | - S Boucher
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
| | - B Nkosi
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
| | - B Steel
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
| | - C Marston
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
| | - E Lascar
- Hospital de Niños Dr Ricardo Gutiérrez, C1425EFD Autonomous City of Buenos Aires, Argentina
| | - J Marston
- International Children's Palliative Care Network, Cluster Box 3050, Assagay, 3624, South Africa
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Naicker SN, Richter L, Stein A, Campbell L, Marston J. Development and pilot evaluation of a home-based palliative care training and support package for young children in southern Africa. BMC Palliat Care 2016; 15:41. [PMID: 27061570 PMCID: PMC4826506 DOI: 10.1186/s12904-016-0114-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 04/01/2016] [Indexed: 11/16/2022] Open
Abstract
Background The leading cause of death among young children in southern Africa is complications due to HIV infection and, in South Africa, over a third of all deaths of children younger than five are associated with HIV infection. There is a great and urgent need for children’s palliative care in Africa, whether HIV-related or not. It is often not possible for sick children and their carers to attend clinics and hospitals cannot accommodate children for long periods of time. As a result children are often cared for in their own homes where caregivers require support to provide informed and sensitive care to reduce children’s suffering. Home-care places a heavy burden on families, communities and home- and community-based care workers. Methods This project involved the development and pilot evaluation of a training and support package to guide home and community-based care workers to help caregivers of seriously ill young children at home in southern Africa. A number of research methods were used, including a cross-sectional survey of content experts using the Delphi technique, participatory action research with photo elicitation and qualitative thematic analysis. Results Because the palliative care needs of these children are complex, the package focuses on delivering 9 key messages essential to improving the quality of care provided for young children. Once the key messages were developed, culturally relevant stories were constructed to enhance the understanding, retention and enactment of the messages. The various research methods used, including literature reviews, the Delphi technique and photo-elicitation ensured that the content included in the package was medically sound and culturally relevant, acceptable, feasible, and comprehensive. The end product is a home-based paediatric palliative care training and support package in English designed to help train community workers who are in a position to support families to care for very sick young children at home as well as to support families in looking after a very sick child. Conclusion A pilot study to assess the training and support package found it to be useful in delivering the key messages to caregivers. The training component was found to be feasible. It is concluded that the package offers a practical means of integrating palliative care with home-based care. Further implementation and evaluation is needed to establish its utility and impact. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0114-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Naomi Naicker
- Human Sciences Research Council, Human & Social Development Programme, 5th Floor, The Atrium, 430 Peter Mokaba Ridge, Berea, Durban, South Africa. .,WITS/MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Linda Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, 1 York Road, Parktown, Johannesburg, South Africa.,Human Sciences Research Council, 5th Floor, The Atrium 430 Peter Mokaba Ridge, Berea, Durban, South Africa
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.,Wits/MRC Rural Public Health and Health Transitions Research Unit [Agincourt], School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura Campbell
- School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Joan Marston
- International Children's Palliative Care Network, Assagay, KwaZulu-Natal, South Africa
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Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, Harding R. Children's palliative care in low- and middle-income countries. Arch Dis Child 2016; 101:85-90. [PMID: 26369576 DOI: 10.1136/archdischild-2015-308307] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/27/2015] [Indexed: 11/03/2022]
Abstract
One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, London, UK Makerere University, Kampala, Uganda
| | | | - Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa
| | - Cornelius Huwa
- Palliative Care Support Trust, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Affiliation(s)
- Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa.
| | - Liliana De Lima
- International Association of Hospice and Palliative Care, Houston, TX, USA
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North K, Marston J, Muckaden M, Talawadekar P, Paleri A, Thambo L, Tauzie J. P-158 Empowering children in the development of children’s palliative care in india and malawi. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-001026.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Downing J, Knapp C, Muckaden MA, Fowler-Kerry S, Marston J. Priorities for global research into children's palliative care: results of an International Delphi Study. BMC Palliat Care 2015; 14:36. [PMID: 26238244 PMCID: PMC4522976 DOI: 10.1186/s12904-015-0031-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/16/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is an urgent need to develop an evidence base for children's palliative care (CPC) globally, and in particular in resource-limited settings. Whilst the volume of CPC research has increased in the last decade, it has not been focused on countries where the burden of disease is highest. For example, a review of CPC literature in sub Saharan Africa (SSA) found only five peer-reviewed papers on CPC. This lack of evidence is not confined to SSA, but can be seen globally in specific areas, such as an insufficient research and evidence base on the treatment of pain and other symptoms in children. This need for an evidence base for CPC has been recognised for some time, however without understanding the priorities for research in CPC organisations, many struggle with how to allocate scarce resources to research. METHOD The International Children's Palliative Care Network (ICPCN) undertook a Delphi study between October 2012 and February 2013 in order to identify the global research priorities for CPC. Members of the ICPCN Scientific Committee formed a project working group and were asked to suggest areas of research that they considered to be important. The list of 70 areas for research was put through two rounds of the Delphi process via a web-based questionnaire. ICPCN members and affiliated stakeholders (n = 153 from round 1 and n = 95 from round 2) completed the survey. Participants from SSA were the second largest group of respondents (28.1 % round 1, 24.2 % round 2) followed by Europe. RESULTS A list of 26 research areas reached consensus. The top five priorities were: Children's understanding of death and dying; Managing pain in children where there is no morphine; Funding; Training; and Assessment of the WHO two-step analgesic ladder for pain management in children. CONCLUSIONS Information from this study is important for policy makers, educators, advocates, funding agencies, and governments. Priorities for research pertinent to CPC throughout the world have been identified. This provides a much needed starting place for the allocation of funds and building research infrastructure. Researchers working in CPC are in a unique position to collaborate and produce the evidence that is needed.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, Assagay, South Africa.
- Makerere University, PO Box 7072, Kampala, Uganda.
| | - Caprice Knapp
- Pennsylvania State University, University Park, State College, PA, 16801, USA.
| | | | | | - Joan Marston
- International Children's Palliative Care Network, Assagay, South Africa.
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Connor S, Sisimayi C, Downing J, King E, Lim Ah Ken P, Yates R, Marston J. Assessment of the need for palliative care for children in South Africa. Int J Palliat Nurs 2014; 20:130-4. [PMID: 24675539 DOI: 10.12968/ijpn.2014.20.3.130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNICEF and the International Children's Palliative Care Network undertook a joint analysis in three sub-Saharan countries-Zimbabwe, South Africa, and Kenya-to estimate the palliative care need among their children and to explore these countries' capacities to deliver children's palliative care (CPC). This report concerns the findings from South Africa. The study adopted a cross-sectional mixed-methods approach using both quantitative and qualitative data obtained from primary and secondary sources. CPC need was estimated using prevalence and mortality statistics. The response to the need and existing gaps were analysed using data obtained from a literature review, interviews with key persons, and survey data from service providers.The findings show very limited CPC service coverage for children in the public sector. In addition, services are mainly localised, with minimal reach. Less than 5% of the children needing care in South Africa are receiving it, with those receiving it being closer to the end of life. Barriers to the delivery of CPC include fear of opioid use, lack of education on CPC, lack of integration into the primary care system, lack of policies on CPC, and lack of community and health professional awareness of CPC needs and services. Estimating the need for CPC is a critical step in meeting the needs of children with life-threatening conditions and provides a sound platform to advocate for closure of the unacceptably wide gaps in coverage.
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Affiliation(s)
- Stephen Connor
- International Palliative Care Consultant, Open Society Foundations, New York, USA, and Senior Fellow, Worldwide Palliative Care Alliance, London, UK
| | - Chenjari Sisimayi
- Managing Consultant, Psychosocial Support, Research and Training Centre, Harare, Zimbabwe
| | - Julia Downing
- Education and Research Consultant, International Childrens Palliative Care Network, London, UK
| | - Evelyn King
- Consultant, HIV and AIDS Section, UNICEF Headquarters, New York, USA
| | - Patricia Lim Ah Ken
- Specialist, Protection, Care and Support, HIV and AIDS Section, UNICEF Headquarters
| | - Rachel Yates
- formerly Senior Advisor, Protection, Care and Support, HIV and AIDS Section, UNICEF Headquarters
| | - Joan Marston
- Chief Executive Officer, International Childrens Palliative Care Network, Bloemfontein, South Africa
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Downing J, Marston J, Muckaden M, Boucher S, Cardoz M, Nkosi B, Steel B, Talawadekar P, Tilve P. Transforming children's palliative care-from ideas to action: highlights from the first ICPCN conference on children's palliative care. Ecancermedicalscience 2014; 8:415. [PMID: 24761156 PMCID: PMC3971869 DOI: 10.3332/ecancer.2014.415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Indexed: 11/21/2022] Open
Abstract
The International Children’s Palliative Care Network (ICPCN) held its first international conference on children’s palliative care, in conjunction with Tata Memorial Centre, in Mumbai, India, from 10–12 February 2014. The theme of the conference, Transforming children’s palliative care—from ideas to action, reflected the vision of the ICPCN to live in a world where every child who needs it, can access palliative care, regardless of where they live. Key to this is action, to develop service provision and advocate for children’s palliative care. Three pre-conference workshops were held on 9 February, aimed at doctors, nurses, social workers, and volunteers, and focused around the principles of children’s palliative care, and in particular pain and symptom management. The conference brought together 235 participants representing 38 countries. Key themes identified throughout the conference included: the need for advocacy and leadership; for education and research, with great strides having been taken in the development of an evidence base for children’s palliative care, along with the provision of education; the importance of communication and attention to spirituality in children, and issues around clinical care, in particular for neonates. Delegates were continually challenged to transform children’s palliative care in their parts of the world and the conference culminated in the signing of the ICPCN Mumbai Declaration. The Declaration calls upon governments around the world to improve access to quality children’s palliative care services and made a call on the Belgian government not to pass a bill allowing children to be euthanised in that country. The conference highlighted many of the ongoing developments in children’s palliative care around the world, and as she closed the conference, Joan Marston (ICPCN CEO) challenged participants to take positive action and be the champions that the children need, thus transforming children’s palliative care.
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Affiliation(s)
- J Downing
- International Children's Palliative Care Network and Makerere University, PO Box 72518, Kampala, Uganda
| | - J Marston
- ICPCN, Bleomfontein 9301, South Africa
| | - Ma Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashta 400012, India
| | | | - M Cardoz
- Children's Palliative Care Project, Indian Association of Palliative Care, Mumbai, Maharashta 400012, India
| | - B Nkosi
- ICPCN, Johannesburg 2000, South Africa
| | - B Steel
- ICPCN, Durban 4000, South Africa
| | - P Talawadekar
- Children's Palliative Care Project, Indian Association of Palliative Care, Mumbai, Maharashta 400012, India
| | - P Tilve
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashta 400012, India
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Downing J, Boucher S, Nkosi B, Steel B, Marston J. Transforming children's palliative care through the International Children's Palliative Care Network. Int J Palliat Nurs 2014; 20:109-14. [PMID: 24675535 DOI: 10.12968/ijpn.2014.20.3.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Joan Marston
- Chief Executive, International Childrens Palliative Care Network (ICPCN)
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Savva N, Krasko O, Knapp C, Downing J, Fowler-Kerry S, Marston J. How Can We Improve Pain Control in Children over the World? Results of International Multiprofessional ICPCN Survey. Pain Med 2014; 15:1238-9. [DOI: 10.1111/pme.12396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Natallia Savva
- Russian Foundation of Children's Palliative Care; Moscow Russia
| | - Olga Krasko
- United Institute of Informatics Problems; Minsk Belarus
| | | | - Julia Downing
- ICPCN; Kent United Kingdom
- ICPCN; Makerere University; Kampala Uganda
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Downing J, Marston J, Fleming E. Children's palliative care: considerations for a physical therapeutic environment. J Palliat Care 2014; 30:116-124. [PMID: 25058989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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North K, Marston J, Tauzie J, Thambo L. P106 Empowering children and guardians in Malawi. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000591.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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North K, Marston J, Thambo L, Tauzie J, Paleri A, Talawadeka P, Muckaden M, Chipulta F. P95 Above and beyond - the power of international partnerships. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000591.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Downing J, Marston J. Commentary on children's palliative care. Ann Palliat Med 2013; 2:105-107. [PMID: 25841936 DOI: 10.3978/j.issn.2224-5820.2013.04.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/26/2013] [Indexed: 06/04/2023]
Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network and Makerere University, PO Box 7072, Kampala, Uganda.
| | - Joan Marston
- International Children's Palliative Care Network, Cluster Box 3050, Asagay, 3610, South Africa
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Downing JD, Marston J, Selwyn C, Ross-Gakava L. Developing children's palliative care in Africa through beacon centres: lessons learnt. BMC Palliat Care 2013; 12:8. [PMID: 23419095 PMCID: PMC3584905 DOI: 10.1186/1472-684x-12-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 02/13/2013] [Indexed: 11/10/2022] Open
Abstract
Much progress has been made in the provision of palliative care across sub-Saharan Africa, however much still remains to be done, particularly in the area of children's palliative care (CPC). The Beacon Centres programme was set up in 2009, aimed at improving access to CPC in South Africa, Uganda and Tanzania through more and better-trained health professionals and CPC clinical services of a high standard. Having identified sites in each country to develop into CPC Beacon Centres, Navigators were identified who would be the 'champions' for CPC in those sites and lead a programme of training, mentorship and support. Five navigators (2 in Uganda and Tanzania and 1 in South Africa) were trained between September and December 2009. Following this they undertook CPC needs assessments at the 3 centres and set up and delivered a six-month CPC training programme, providing mentorship and support to students to enable them to integrate CPC into their workplaces. To date, 188 participants have commenced the six-month course, with 80 having completed it. CPC has been integrated into the activities of the centres and a CPC virtual resource centre set up in South Africa. The achievements from the Beacon project have been great and the work of the navigators immense, but as in all projects it has not been without its challenges. Lessons learnt include issues around: the focus of the project; the length and nature of the training; assessment; accreditation; the choice of navigators; mentoring; administrative support; co-ordination; the choice of project sites; and the integration of CPC into services. The need for CPC is not going to go away and it is therefore important that models of scaling-up are found that are not only practical, feasible, affordable and sustainable, but that focus on the outcome of improved CPC for all those who need it. It is hoped that the lessons shared from the Beacon Project will help in developing and implementing such models.
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Affiliation(s)
- Julia D Downing
- Makerere University, Kampala, Uganda
- International Children’s Palliative Care Network, PO Box 7072, Kampala, Uganda
| | - Joan Marston
- International Children’s Palliative Care Network, PO Box 7072, Kampala, Uganda
- Beacon Centre Coordinator, Cluster Box 3050, 3610, Asagay, South Africa
| | - Casey Selwyn
- Research Intern, The Diana, Princess of Wales Memorial Fund, County Hall, Westminster Bridge Road, SE1 7PB, London, England
| | - Laura Ross-Gakava
- Palliative Care Initiative, The Diana, Princess of Wales Memorial Fund, County Hall, Westminster Bridge Road, SE1 7PB, London, England
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Marston J, Downing J, Boucher S. Innovation in expanding access to children's palliative care in developing countries. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Boucher S, Marston J, Downing J. ICPCN reaching out to the world through advocacy, networking, information sharing and research. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Downing J, Marston J, Boucher S. Piloting of an e-learning programme on children's palliative care. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Knapp C, Woodworth L, Wright M, Downing J, Drake R, Fowler-Kerry S, Hain R, Marston J. Pediatric palliative care provision around the world: a systematic review. Pediatr Blood Cancer 2011; 57:361-8. [PMID: 21416582 DOI: 10.1002/pbc.23100] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 01/27/2011] [Indexed: 11/05/2022]
Abstract
Pediatric palliative care is recommended by many organizations. Yet, there is no information available on the progress that has been made in providing this care or the gaps that still exist in provision around the world. We conducted a systematic review to address this gap in knowledge. The systematic review identified 117 peer-reviewed and non-peer reviewed resources. Based on this information, each country was assigned a level of provision; 65.6% of countries had no known activities, 18.8% had capacity building activities, 9.9% had localized provision, and 5.7% had provision that was reaching mainstream providers. Understanding the geographic distribution in the level of provision is crucial for policy makers and funders.
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Affiliation(s)
- Caprice Knapp
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
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Knapp C, Madden V, Marston J, Midson R, Murphy A, Shenkman E. Innovative pediatric palliative care programs in four countries. J Palliat Care 2009; 25:132-136. [PMID: 19678466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Over the past three decades, pediatric palliative care programs have been developed and refined throughout the world. The purpose of this study was to provide information on experiences from four of those programs, yet we acknowledge that there are many other innovative programs that deserve recognition for the services they provide to children and families. This study is limited in that it is unable to compare outcomes from the four programs, such as patient-reported quality of life, that might help to better understand the impact of pediatric palliative care. Nonetheless, information sharing can inspire and educate others with the overarching goal of globally advancing pediatric palliative care.
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Affiliation(s)
- Caprice Knapp
- Department of Epidemiology, Institute for Child Health Policy, University of Florida, Gainesville, Florida, USA
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Ezer T, Marston J. Comprehensive care: palliative care and legal services in South Africa. HIV AIDS Policy Law Rev 2007; 12:66-67. [PMID: 18459224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A fundamental and neglected part of the global response to HIV and AIDS, palliative care is also a critical entry-point for legal services. As Tamar Ezer and Joan Marston write, providing legal services to patients in palliative care can both protect human rights and improve health outcomes.
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Marston J. Building patient rapport. Developing positive attitudes toward the dentist and staff. J Ala Dent Assoc 1998; 79:32-3. [PMID: 9495185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Marston J. Building patient rapport: developing positive attitudes toward the dentist and staff. R I Dent J 1997; 30:18. [PMID: 9495924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Marston J. The traits of a true professional. N Y State Dent J 1996; 62:50-3. [PMID: 8920037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Marston J. Building patient rapport: developing positive attitudes toward the dentist and staff. Northwest Dent 1995; 74:45-46. [PMID: 9462092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Barnes RD, Pottinger BE, Marston J, Flecknell P, Ward RH, Kalter S, Heberling RL. Immunological tolerance induced by in utero injection. J Med Genet 1983; 20:41-5. [PMID: 6341592 PMCID: PMC1048984 DOI: 10.1136/jmg.20.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Intrauterine injection of human whole blood into rabbit and rhesus monkey fetuses was found to result in long lasting unresponsiveness to human serum albumin. Intrauterine injection of viable allogeneic bone marrow cells into rabbit fetuses was without any apparent harmful effect and also resulted in permanent unresponsiveness demonstrated by donor red cell survival studies. The implication of these findings in respect of using this approach towards the correction of certain inherited diseases in man is discussed.
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Marston J. Practical Remarks upon the Prevalence and Treatment of Syphilis. West J Med 1863. [DOI: 10.1136/bmj.1.112.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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