Development Of Palliative Care Research Articles

The use of and need for data and information by health professionals supporting the delivery of palliative cancer care services in sub-Saharan Africa: A qualitative study.

The ability to develop and evaluate approaches to the management of advanced cancer in sub-Saharan Africa is limited by the lack of local, reliable and valid data to ensure that practice is evidence-based, replicable and reflects the needs of the population served. A secondary qualitative analysis of in-depth interviews with 59 health professionals delivering palliative cancer care in Nigeria, Uganda and Zimbabwe were conducted to determine the use and needs for data and information for patient care and service delivery. Framework analysis was used, informed by a conceptual model for data use in low and middle-income countries. Three meta-themes include: (1) Current practice in data gathering and use; (2) Gaps for capturing, storing information and supporting communication, and; (3) Needs and opportunities for data use. Deficits in current data access and use were identified, alongside targets for improving the quality, accessibility and utility of data to inform the development of palliative cancer care. The availability and use of relevant and reliable data relating to the current provision of palliative cancer care are requisite for the contextually appropriate and effective development of health services. The requirements and constraints articulated by participants can guide future development and optimisation of digital health approaches for palliative cancer care in the participating countries, with relevance to the wider sub-Saharan Africa region.

Obstacles in the Practice of Palliative Care Consultation Services in Grade A Tertiary Hospitals

Objective To explore the obstacles in palliative care consultation services and put forward the suggestions for improving the services in grade A tertiary hospitals. Methods A semi-structured interview was conducted with 17 medical workers who had requested palliative care consultation services in Peking Union Medical College Hospital. Results The palliative care consultation services were hindered by five obstacle factors including insufficient knowledge of patients and their families about palliative care,unsound understanding of medical workers about palliative care,poor implementation of consultation opinions,limited labor of palliative care team,and poor economic benefits from palliative care.In view of such obstacles,the following suggestions were put forward,which included increasing the acceptance of palliative care by patients and their families,enriching the knowledge of medical staff on palliative care,establishing a new cooperation model between consultation team and medical staff,strengthening the institutional guarantee for the development of palliative care,and establishing and perfecting the laws and policies related to palliative care. Conclusion Although there are many difficulties in the in-hospital palliative care consultation services in grade A tertiary hospitals,the demand and expectation of medical staff for palliative care are still increasing.

Assessment of prevention and treatment programs efficiency for oncological diseases (on the example of the central Ukraine regions)

Annotation. Oncology remains a global problem for humanity. International efforts to overcome it aim at implementing programs for prevention and early detection of neoplasms. The article is devoted to the study and analysis of the results of the implementation of programs to fight oncological diseases in Ukraine in the period until 2022. We have performed a one-time exploratory and descriptive research by the means of processing the materials of state and targeted regional programs to fight oncological diseases, which were implemented in the regions of the center of the Ukraine (Dnipropetrovsk, Kirovohrad, Poltava, Vinnytsia, Cherkasy regions), and we have assessed the level of their funding and implementation results. The study was conducted on the basis of information provided by the Health Departments of regional state administrations in 2021, as well as data obtained from the websites of these Health Departments. Statistical methods (analysis of relative values, calculation of absolute growth rate), structural-logical analysis and systematic approach were used. The research established that the implementation of programs for the prevention and control of oncological diseases made it possible to achieve positive dynamics of the main indicators of providing oncological care to the population (decrease in the one-year mortality rate, decrease in the neglect rate, increase in the percentage of patients covered by special treatment). However, against the background of positive trends, the level of funding programs in the field of cancer prevention remains insufficient. According to the findings of our research, certain gaps in oncology programs were revealed, namely: insufficient attention to the development of palliative medical care for cancer patients and problems of oncology in children. The obtained data serve as the basis for the development of measures to improve the work of the oncology service in Ukraine.

Palliative care journal publications by country as a metric for palliative care development level

ObjectiveThere is a growing interest in developing a scientific research metric to assess the level of palliative care (PC) development in countries. This study assesses a metric based on publishing...

Inclusion of essential components of the World Health Organization palliative care development model in national palliative care plans: A documentary analysis in 31 countries

ContextThe World Health Organization has proposed a new model for the development of palliative care. Whether the current national palliative care plans of Member States are aligned or need to be reformed to meet the new model is unknown. MethodsWe conducted a documentary analysis of national palliative care plans based on an analytic framework structured with the elements recommended by the World Health Organization: (a) building a plan, (b) plan components, and (c) plan implementation. We conducted a categorical analysis of national plans by subgroups according to income and development level of palliative care. FindingsWe identified 112 countries with a palliative care plan, of which 31 were included in the analysis. Of these 31 plans, only 8 had the six components proposed by the World Health Organization, 29 reported an implementation strategy, 23 were aligned with the country's national public health plan, and 15 allocated financial resources for plan implementation. All the national plans assessed included the component provision of palliative care in integrated health services; 93%, education and training; 83%, research; 80%, empowered people and communities; 54%, health policies related to palliative care, and 48% use of essential medicines. ConclusionsNational palliative care plans include the two new development components, but few are fully aligned with the 2021 World Health Organization's model.

CN29 Integration and development of palliative care in a comprehensive cancer centre: A quality improvement project

In the region of Stockholm, we have one comprehensive cancer centre, and two other hospitals, responsible for cancer treatment, support and follow-up. In addition, there´s over 40 specialized palliative care ( SPC ) home-care teams in the region, that are responsible for symptom management and support when needed during the cancer care trajectory. Research from the region regarding cancer care, concluded that there´s risk for aggressive care at End-of life (EOL), fragmentation between caregivers (the oncology team and SPC at home), and a lack of clear goals-of care. In line with ongoing strategic work at Karolinska comprehensive cancer centre (KCCC), we found areas in need of improvement; EOL care, as well as collaboration between KCC and SPC at home. A nurse-led, multi-professional group initiated a project, aiming to improve palliative care and collaboration between KCCC and SPC at home. The planned activities directed towards EOL care, strives to implement structured protocols for EOL nursing care, as well as systematic registration and evaluation of quality indicators for EOL care. Further, we conducted a workshop with the emergency department (ER), KCCC, as well as SPC at home. Implementation and test of a tool to assess frailty in older patients have started. In addition planning of a pilot project, where a digital joint meeting with patient, SPC at home and KCCC, in order to integrate decisions and goals-of-care, are ongoing. The first descriptive baseline data, indicate an underreporting of quality indicators at EOL and a lack of awareness and knowledge of palliative care, among both nurses and physicians. The majority of patients with cancer that visits ER, are in a palliative phase, thus there is a need for collaboration between ER, KCC and SPC. Another finding during the first quarter of this project is that goals-of-care needs to be person-centred and integrated between caregivers. Further results of this ongoing project will be reported, alongside with a description of challenges and barriers for integration. Preliminary results highlights both educational needs, and need for further integration, to improve quality of care, in all stages of the cancer care trajectory.

Region-specific macro-indicators for palliative care development in the Eastern Mediterranean Region: a Delphi study.

The World Health Organization Office for the Eastern Mediterranean Region (WHO/EMRO), and the recently created palliative care experts network for the Eastern Mediterranean Region (EMR), decided to develop region-specific indicators for monitoring national palliative care development in the Region. To identify relevant and feasible macro-indicators for palliative care development for the EMR. Palliative care experts from the EMR were nominated and invited to complete a 2-round Delphi study to rate macro-indicators from previous studies and propose new ones based on the EMR regional characteristics. All indicators were assessed according to regional relevance (R) and feasibility (F). A content validity index (CVI) was calculated. Indicators with CVI ≥ 0.7/1, and scoring ≥ 7/9 for the R and F averages were selected. Twelve of the 22 countries in the Region were represented in the study. In the first round, 11 indicators were selected and 13 new ones proposed. In the second round, 15 indicators matched R, F and CVI criteria. Top-scored indicators were: existence of a current national palliative care strategy (R = 8, F = 8, CVI = 1); ratio of specialized services (for adults and children) in the country per population (R = 8, F = 7, CVI = 1); allocation of funds for palliative care in the national health budget by the Ministry of Health or equivalent government agency (R = 8, F = 6, CVI = 1); education for prequalification of doctors/nurses (R = 8, F = 8, CVI = 0.9); and availability of morphine and other strong opioids (R =8, F = 8, CVI= 0.9). A baseline set of 15 region-specific indicators for measuring the development of palliative care were validated by experts in the EMR.

Barriers and Opportunities for Palliative Care Development in Pakistan

Cohesive Journal of Microbiology & Infectious Disease Barriers and Opportunities for Palliative Care Development in Pakistan Noureen* Master’s degrees in Public Health and Political Science, Quiad-e-Azam University, Pakistan *Corresponding author: Noureen, Master’s degrees in Public Health and Political Science, Quaid-e-Azam University, Islamabad, Pakistan Submission: August 10, 2022; Published: August 26, 2022 DOI: 10.31031/CJMI.2022.06.000630 ISSN 2594-0190 Volume6 issues1

Progress Update: Development of Palliative Care From 2017 to 2020 in Five Countries in Eurasia.

In the early 2000s, palliative care was largely unknown in the Eurasian region. For a period of twenty years starting around 2002, Open Society Foundations (OSF) supported palliative care pioneers in the region to establish palliative care services, train health providers, and advocate for the integration into health services. To report on the development of palliative care in Armenia, Georgia, Moldova, Tajikistan and Ukraine during the period 2017-2021 and explore the impact of OSF's sustained funding for palliative care in these countries. Activities and developments to 2017 were described in country-specific papers in 2018. A retrospective case study analysis was used to examine how palliative care developed in each country. We reviewed theories of change, funding and advocacy strategies, implemented activities and interventions, and their outputs and outcomes, and compared them to legal, policy and service developments in practice. By the mid-2010s, each country had laid the foundations for rolling out palliative care-basic policies and guidelines were in place; palliative care medications were available; key health providers were trained; and training capacity and models of care had been created-but service availability remained limited. In subsequent years, advocates increasingly embraced public advocacy to hold governments accountable for meeting their commitments and to include palliative care in universal health insurance. By 2021, Armenia, Moldova, and Ukraine had significantly scaled up service availability and palliative care was firmly embedded in universal health coverage in Moldova and Ukraine whereas progress in Georgia and Tajikistan was more modest. Experiences in these countries suggest that a strategy that initially emphasizes training, technical assistance, and engagement to create the building blocks for palliative care combined with or followed by public advocacy and campaigning to demand roll out of services can result in significant advances. Continued progress, however, is not guaranteed, especially considering the COVID-19 pandemic and dwindling donor support.

Emotional Management of Healthcare Professionals in Palliative Care Settings

Palliative care has developed in Russia since the 1990s as an adopted Western institutional form within the ideological framework of a 'good death,' which suggests a holistic approach to patient suffering. The development of palliative care was not linear and has received systematic governmental support only over the last ten years. Psychological care and quality of life were only legally included in palliative care in 2019. As a consequence of the existing structural constraints in most organizations, all of the emotional labour is done by medical professionals often lacking training in the management of emotions. In this case, a key role is played by the leaders of the organization. The main objective of this work is to demonstrate how the management of emotions at the level of personal interactions is connected with the management of emotions at the organizational level. Emotion management in palliative care settings is analysed based on empirical evidence collected during the periods 2018–2019 and 2020–2021. During the research thirty-four interviews with specialists in the field of palliative care were collected. Materials are analysed through dramatic and cultural theories of emotions and theories of rituals. Key emotion management mechanisms in palliative care settings at the organizational level include team building and coordination; maintenance of collective emotions and collective solidarity; and the management of the space of the organization. At the individual level, emotional labour is carried out in accordance with the ideological framework of a 'good death.' Emotional labour is most often done through deep performance and is aimed at overcoming negative emotions such as anger, fear, or disgust. Management of emotions at the organizational level allows, first, to overcome the existing structural limitations; second, to adjust the volume and content of the emotional labour of employees.

Contribution of Eastern Mediterranean Region countries to palliative care journals from 1991 to 2020 and its relationship to the development of palliative care

BackgroundPalliative care (PC) is in an early stage of development in the Eastern Mediterranean Region (EMR) of the World Health Organization. A metric based on publishing in specialized PC journals may be useful in assessing PC development. This study was conducted to describe the contribution of EMR countries to PC research and to study the relationship between this contribution and the levels of PC development.MethodsThe Scopus database was used to search 21 PC journals (1991–2020) for articles with at least one EMR-affiliated author independently of his/her position in the article. As an indicator, the 3-year average articles per million population per year (AAMY) was calculated. Changes over time were calculated through a regression analysis. The relationship between the AAMY and the level of PC development and opioid consumption were assessed through Mann-Witney test using the worldmap PC development categories as a proxy, and Spearman analysis, respectively.ResultsThe number of articles published during the 30-year period was 31,108 of which 402 (1.3%) were EMR-affiliated. There was a steady rise in the AAMY of the EMR (R2 = 0.894). The number of EMR-affiliated articles increased from 3 in the period 1991–1995 to 191 in 2016–2020. The 2018–2020 AAMY was significantly higher in countries with greater PC development than in those without (median [IQR] = 0.0975 [0.0254–0.1802] and 0.0098 [0–0.0256], p = 0.042). Also, it was significantly higher in countries that progressed to a higher level of PC development between 2006 and 2017 (p = 0.0159). There was a significant positive correlation between the average opioid consumption for the years 2017–2019 and the AAMY for the same period (p = 0.0043).ConclusionsThere is a slow steady progress in the contribution of EMR countries to PC journals, which corresponds to the level of PC development and its progress in the region. A metric based on the contribution to specialized PC journals may be a useful indicator of PC development.

Advancing Global Palliative Care Over Two Decades: Health System Integration, Access to Essential Medicines, and Pediatrics.

Between 2000 and 2020 Open Society Foundations was one of very few funders that supported global palliative care development and advocacy. 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. 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. 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. 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.

Association between the Development of Hospice and Palliative Care and Government-Funded Research Priority: Taiwan-Based Example.

In recent years, hospice and palliative care (HPC) has grown, developed, and changed in response to the humanistic and social needs for supporting those with incurable illnesses. As a relatively new discipline, research is needed in HPC, and the priority setting of research is essential to help direct finite resources to support research. To promote creative research in different fields including HPC, the Taiwan government subsidized institutions to conduct research. In this study, we obtained data from the Government Research Bulletin, an open-source online system containing complete information about government subsidized studies since 1993 to investigate the development of research priority in HPC in Taiwan. In total, 552 studies were recorded during 1993–2021, with a continued upward trend. An association was found between research priority and the promulgation of new HPC regulations. The type of diseases in research extended from cancer to all advanced chronic conditions. The increased diversity in out-of-hospital settings of palliative research was also observed. Numerous studies have focused on education, and the theme gradually shifted from “training and education for healthcare professionals” to “public education”. Here, the results may serve as a basis to understand the commonalities of research and enhance dialog in HPC research.

International Research Status and Trend of Community Palliative Care:A Study Based on Cite Space

Objective To systematically analyze the international progress of community palliative care and to provide reference for promoting the development of community palliative care in China.Methods We searched the Web of Science core collection of the English-language papers associated with community palliative care published from January 1,2014 to November 1,2021 and then used CiteSpace 5.8.R1 to establish the cooperation and co-occurrence networks.Results A total of 1509 papers were included in this study.The annual number of published papers and the citations associated with community palliative care showed an increasing trend.The country,institution,and author publishing the most papers in this field were the United States,the King's College London,and Irene J Higginson at the King's College London,respectively.The research hotspot was identified as hospice of end-of-life patients like cancer patients,which aimed at improving the quality of life.The care will be expanded to dementia patients and old people.Research subjects involve family caregiver and palliative care worker.The predicted focuses of future studies include intervention methods and efficacy,patients' preference,and advance care planning.Conclusions Community palliative care has been rapidly developing in recent years and expanding from patients to the whole population for a full-life care.The Chinese researchers need to strengthen international exchange and cooperation and to learn the diverse development approaches for the whole population,thereby promoting the practice and development of community palliative care in China.

Impact of an Evidence-Based Pediatric Palliative Care Program on Nurses' Self-Efficacy.

Background The purpose of this study was to determine the effect of a 1-day evidence-based pediatric palliative care continuing professional development program on nurses' and advanced practice registered nurses' perceived self-efficacy regarding palliative care. Method The revised Pediatric Palliative Care Questionnaire was administered to participants before and after a 7½-hour program. A multimodal approach was used to teach topics specific to pediatric palliative care. Results Thirty-one participants completed questionnaires. Notably, most of the participants had provided palliative or end-of-life care, but few had previous education specific to pediatrics. The self-efficacy scores of the participants significantly increased after program attendance (Z = 3.53, p < .001). Conclusion Continuing professional development in pediatric palliative care improves nurses' and advanced practice registered nurses' confidence in their skills to provide this care. Findings of this study support the need for pediatric-specific education in nursing training programs and continuing professional development offerings. Continuing education may be the key to improving access to high-quality care for children living with serious illness and their families. [J Contin Educ Nurs. 2022;53(6):264-272.].

Evaluation of the need for hospital-based pediatric palliative care in a single center

Introduction/Aim: Cancer is one of the leading causes of death for children . Evidence suggests that these children experience substantial suffering from physical and emotional symptoms. Over the past two decades, paediatric palliative care has emerged as an approach that aims to ease suffering for children and their families coping with any life-threatening illness. Our aim is to encourage the expansion of palliative care centers for children with cancer and integration of these into healthcare services to assist clinicians and policy makers in developing services that address these needs.&#x0D; Material and Method: Our study is a single-center retrospective cohort study. The records of 39 patients who were followed up in the pediatric oncology clinic between 2010-2021 and died were reviewed retrospectively.&#x0D; Results: The age of diagnosis of patients was the most in the 6-12 range (n=16; 41%) and the least in the adolescent (n=11; 28.2%) age range. The cause of death was related to a disease in 79.5%. Treatment-related deaths were seen in eight patients, four of which were chemotherapy toxicity, two were engraftment failure in autologous hematopoietic stem cell transplantation, and two were post-transplant GVHD. 76.9% of the patients died in the intensive care unit.&#x0D; Conclusion: In our study, patients with cancer and those who lost their lives were evaluated retrospectively in terms of symptom load, invasive procedures, and psychosocial needs and the need for end-of-life palliative care. Many studies have confirmed that the timely integration of palliative care into routine oncological care has many advantages, such as improvements in physical and psychological symptoms, quality of life and prognosis, as well as reducing costs. In Turkey, palliative treatment is tried to be provided to late stage pediatric cancer patients by pediatric intensive care units and pediatric oncologists. This both increases the workload of physicians and causes intensive care bed occupation. The development and expansion of palliative care on late stage pediatric cancer patients will contribute significantly to the quality of life of both children and their families.

CENTER OF PALLIATIVE MEDICINE AT KHARKIV NATIONAL MEDICAL UNIVERSITY: MODERN CHALLENGES AND DEVELOPMENT STRATEGIES

In most countries of the world, palliative care is an integral part of quality medical care, which includes comprehensive medical, social, psychological, and spiritual support for critically ill patients and their relatives. According to the WHO, every year about 20 million people worldwide need palliative care at the end of their lives. There are many more who need palliative care until the last year of their lives. Thus, the total number of people who need palliative care annually is about 40 million. It is estimated that of the 20 million people in need of end-of-life palliative care, 78% live in low- and middle-income countries; about 67% are elderly and about 6% are children. However, only 14% of people who need end-of-life palliative care receive it. Palliative care considers the principle of respect for patients' decisions and aims to provide practical support to their family members during illness and in the event of a patient's death to overcome grief over the loss of a loved one. The WHO's global strategy for health care, based on human approach and integration, is to strengthen palliative care programs for patients with various diseases. Despite the fact that some steps have already been taken in Ukraine towards the development of palliative care, there are still some problems: lack of qualified medical staff; lack of relationships between primary and secondary, tertiary care and coordination; imperfect system of informing medical workers about ensuring the right to anesthesia for seriously ill patients; lack of a sufficient number of pharmacies licensed to operate controlled medicines; lack of interagency programs in the field of palliative care.

Development of palliative care, unstoppable in pediatrics

Development of palliative care, unstoppable in pediatrics

Palliative care in Uganda: quantitative descriptive study of key palliative care indicators 2018-2020

BackgroundThe first and most recent nationwide audit of palliative care services in Uganda was conducted in 2009. Since then, Uganda has made great strides in palliative care development, including policy, education, and services implementation. This study provides an overview of the availability of palliative care services in the country and the challenges and gaps in Uganda prior to the global COVID-19 pandemic. This lays the foundation for better understanding the challenges and changes needed to support palliative care development and access in the wake of the pandemic.MethodsWe conducted a descriptive quantitative study of secondary data on nationwide morphine distribution, collated a list of accredited facilities, and analyzed key palliative care indicators collected through the mHealth surveillance project present at a subset of accredited facilities. Descriptive statistical analysis involved non-parametric tests using SPSS, mapping geographical distribution of available palliative care services using Geographic Information Systems software, and identification of challenges from the subset of accredited facilities.ResultsThere were 226 accredited palliative care facilities across Uganda’s 135 districts in 2020. Thirty districts lacked any accredited palliative care facility. The estimated population coverage was 88.5%. The majority (68.1%) of accredited facilities were public, and private facilities received slightly more pain-relieving morphine. There was an alternating trend in the volumes of morphine delivered to public and private facilities. More than a third of the patients were diagnosed with non-communicable diseases, highlighting their significance alongside cancer and HIV/AIDS as conditions requiring palliative care. Palliative care accredited facilities offered six types of services: outreach, home visits, psychosocial, legal, bereavement, and spiritual support, but only for an average of 7 months a year due to lack of facilitation and transportation.ConclusionPalliative care in Uganda developed in quality, volume, and geographic coverage since 2009. The shift in palliative care patients’ primary diagnosis from HIV/AIDS to non-communicable diseases marks an important epidemiologic transition. Although accredited facilities are present in most administrative districts, more research is needed to evaluate the actual accessibility of these services. The existing services, both private and public, are limited by the amount of pain-relieving morphine, financial and transport resources. More quality data collected on key palliative care indicators is needed into geographical accessibility of palliative care services, morphine availability trends, and patient diagnoses in order to improve the provision of palliative care in Uganda.

Analysis of Factors Influencing Polish Students' Opinions on Euthanasia.

Due to the continuous development of palliative care and methods of pain relief in the last moments of patients’ lives, we are faced with the question of how long we should take measures to delay inevitable death for, without providing prolonged therapy against the patient’s will. For terminally ill and people experiencing unimaginable suffering, euthanasia is considered as one of the possible options for a dignified farewell. The aim of the study was to determine the views on euthanasia in a group of students from Polish universities. Questionnaire responses were analyzed for 9686 students (79.9% of women and 20.1% of men) aged 18–35 years. Respondents were asked to complete their own questionnaire on demographic data and attitudes toward euthanasia in the case of severe terminal illness or paralysis preventing independent living. Euthanasia was significantly more acceptable among women (85% vs. 75%, p < 0.0001; 69% vs. 62%, p < 0.0001) and non-believers [98% vs. 97% (denominations other than Christian), 84% (other forms of Christianity), 69% (Roman Catholic); p < 0.0001] in every case considered. Religious affiliation was the factor that most influenced attitudes toward euthanasia. Among the other elements influencing attitudes toward euthanasia, residence and field of study were distinguished. Considering the large sample size and specific conclusions, the article should be an important argument in the discussion on euthanasia.