Development Of Palliative Care Research Articles

Perceptions of nurses caring for children with life-limiting conditions in an acute setting in the Republic of Ireland.

Despite international developments in paediatric palliative care (PPC), nurses continue to report feeling unprepared, anxious and overwhelmed when caring for patients with palliative care needs. There is an identified need throughout the literature for improved education in the area of PPC, as well as the need to improve the support available to families and health professionals in order to provide this specialised care effectively. To examine the insights of nurses within the acute setting who are caring for children with life-limiting conditions, who have complex and/or palliative care needs in Ireland. This was a qualitative study which used purposive, convenience sampling to gain participants (N=14) and semi-structured interviews to gather data. Thematic analysis was used to discuss the material under five core themes. Results are discussed under the five core themes of: 'nurses' emotive journey when caring for children with life-limiting conditions', 'the barriers faced in caring for children with life-limiting conditions in the acute setting', 'the facilitators to caring for children with life-limiting conditions in the acute setting', 'education and training', and, 'how nurses cope when a child dies'. Each participant of this study described a particular affection towards caring for children with complex healthcare needs within the acute setting. However, many of the obstacles faced by nurses in the acute setting when providing this care were reported upon, these included inefficient training, education and support, an inadequate nursing environment to provide the desired level of care and the emotional toll of providing such an intense level of care.

The evolution and development of palliative and hospice care

Palliative and Hospice Care initially developed in Great Britain. It was founded by Cicely Saunders for the humane care of terminally ill cancer patients and her institution was established as the first modern hospice in England. The concept developed gradually into a systematic medical program for terminal ill patients and was subsequently been generalised worldwide. The palliative and hospice care model currently in Taiwan of China is characterised by the joint participation of the government and society. This experience and knowledge is expected to contribute to the system of palliative and hospice care in the process of being established in the mainland of China.

Nurses’ Knowledge and Attitudes towards Palliative Care: A Study in a Western Province in Indonesia

Background: The delay in the development of palliative care in Indonesia is also related to the dearthof studies related to palliative care in Indonesia, including the study of nurses’ knowledge and attitudestowards palliative care. Efforts are needed to explore the knowledge and attitudes of nurses aboutpalliative care. This research was aimed to identify the determinants of related factors to knowledge andattitudes of nurses towards palliative care.Methods: A quantitative research with cross sectional study design was used for research. Data wascollected by using several well-reported questionnaires, namely the the Palliative Care Quiz for Nurses(PCQN) questionnaire to assess level of knowledge, and the Frommelt Attitudes Toward Care ofthe Dying Scale (FATCOD) Form-B questionnaire to analyze nurses’ attitudes. With the SystematicRandom Sampling, 256 nurses participated in this online survey. The respondent’s response rate whichwas 94.9%.Conclusions: This research showed that there was no significant relationship between knowledgeand nurses’ attitudes about palliative care. However, there was a significant relationship between age,and training of palliative with nurses’ knowledge of palliative care. Level of education, and nurses‘employment status with nurses’ attitudes about palliative care also showed a significant relationship.Further analysis revealed that level of education was the only predictor which related to nurses’ attitudesabout palliative care.

How Do We Start Palliative Care for Patients With End-Stage Liver Disease?

Patients with end-stage liver disease undergo repetitive patterns of recovery and deterioration and are burdened with uncertainty. Although quality of life is low in patients with end-stage liver disease and their family members, few studies have been conducted to identify what palliative care should be provided for them. This integrative review aimed to explore palliative care for patients with end-stage liver disease, focusing on the components and outcome measurements for further research. After searching for studies on palliative care for end-stage liver disease published between 1995 and 2017, 12 studies that met the inclusion criteria were analyzed. The common components of palliative care for patients with liver disease were: (a) an interdisciplinary approach, (b) early palliative care, (c) discussion goals of care with patient and family members, (d) symptom management, and (e) psychosocial support. It was reported that patients who were provided palliative care had improved itching, well-being, appetite, anxiety, fatigue, and depression, increased the number of do-not-resuscitate orders, palliative care consultations, and decreased length of stay. These findings could guide the development of palliative care for end-stage liver disease patients.

НОРМАТИВНЫЕ ПРАВОВЫЕ ОСНОВЫ ОКАЗАНИЯ ПАЛЛИАТИВНОЙ МЕДИЦИНСКОЙ ПОМОЩИ В РОССИЙСКОЙ ФЕДЕРАЦИИ

Palliative care as a separate type of medical care was enshrined in legislation 10 years ago. However, the law-making process is still ongoing. The guidelines for this type of medical care for adults and children have been approved twice. It must be noted amendments to the Federal Law in 2019 (which significantly expanded the definition and consolidated the "varieties" for the provision of palliative care), and the interdepartmental Regulation on the organization of the provision of this type of assistance was approved (which now includes not only the guidelines for this type of medical care for adults and children, but also provides for the guidelines for interdepartmental interaction). In addition, since 2019, regional programs for the development of palliative care in the constituent entities of the Russian Federation are being developed. Together with these documents, an action plan was approved for the implementation of the Strategy for the Development of Healthcare of the Russian Federation for the period up to 2025, in which the development of palliative care is designated as activities; action plan has been approved ("road map") "Improving the quality and availability of palliative care" until 2024 was approved, among the tasks of which: improving legal regulation, increasing the availability and quality of painkillers, developing infrastructure for providing palliative care in the constituent entities of constituent entities of the Russian Federation, training of specialists (medical personnel, clinical psychologists, social workers), public awareness about the provision of this type of medical care, the implementation of a multidisciplinary approach. This publication includes an overview of the legislation governing the functioning of the palliative care system in the Russian Federation.

Exploring the status of and demand for palliative day-care clinics and day hospices in Germany: a protocol for a mixed-methods study

BackgroundTo date, the establishment and development of palliative day-care clinics and day hospices in Germany have been completely unsystematic. Research is needed to gain insight into these services and to ensure their accessibility and quality. Accordingly, the ABPATITE research project aims at: (1) identifying the characteristics of palliative day-care clinics and day hospices in Germany, (2) determining demand and preferences for these services, and (3) proposing recommendations (with expert agreement) for the needs-based establishment and development of these services.MethodsThe research is a multi-perspective, prospective, observational study following a mixed-methods approach across three study phases. In phase 1a, qualitative expert interviews will be conducted to capture the facility-related characteristics of palliative day-care clinics and day hospices in Germany; the results will feed into a questionnaire sent to all such institutions identified nationwide. In phase 1b, a questionnaire will be sent to local statutory health insurance providers, to gain insight into their contracts and accounting and remuneration models. In phase 2a, a service preference survey will be conducted with patients and family caregivers. In phase 2b, semi-structured interviews with management staff will explore the factors that promote and hinder the provision of service. In phase 2c, the external perspective will be surveyed via focus groups with local actors involved in hospice and palliative care. In phase 3a, focus groups with representatives from relevant areas will be conducted to develop recommendations. Finally, in phase 3b, recommendations will be agreed upon through a Delphi survey.DiscussionThe empirically developed recommendations should enable the establishment and development of day hospices and palliative day-care clinics in Germany to be better managed, more oriented to actual demand, and more effectively integrated into wider health care services. Importantly, the findings are expected to optimize the overall development of hospice and palliative care services.Trial registration:The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00021446; date of registration: April 20, 2020). The study is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number.

Decision making in the end-of-life care of patients who are terminally ill with cancer \u2013 a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers

BackgroundIn Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients.MethodsQualitative descriptive–exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan.ResultsWhen making decisions regarding end-of-life care, professionals consider: 1. Patient’s clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional skills and expertise: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent ambiguity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not ask patients directly for their preferences. Fear of confrontation with family members and lawsuits leads healthcare workers to carry out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in the absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare.ConclusionsTo improve end-of-life decision making, Colombian healthcare workers and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers’ perspectives are needed to complement physicians’ perceptions and practices.

Palliative care for cancer in Turkey: A comprehensive review of the literature.

e24088 Background: Palliative care is patient and family-centered care provided to optimize the quality of life in serious illness, and is an essential health service under Universal Health Coverage. Given the burden of cancer and other chronic disease diseases along with demographic changes, the need for palliative care is growing in Turkey. This study aimed to review of the available scientific literature on palliative cancer care needs, models and outcomes Turkey. Methods: A comprehensive literature review was conducted with English and Turkish keywords in PubMed, Scopus, Embase, ScienceDirect, Web of Science, Google Scholar, The Turkish Academic Network and Information Centre databases, Turkish Ministry of Health documents, Turkish Council of Higher Education’s doctoral thesis, and renowned national and international palliative care as well as cancer conferences 01/ 2000 to 07/ 2020. Results: Out of 27489 papers identified, 320 met the criteria for inclusion. The main focus of these studies was; historical development in palliative care, legislative regulation, professional training, use of opioids, symptom management, care for patients, palliative care centers, public awareness, psychosocial support, and end of life ethics. The majority of this literature used descriptive design, although a few case-control, cohort, and randomized control trials were also found. Our analysis showed that the development of PC in Turkey can be divided into three period. The first (early initiatives, before 2000), the second (dissemination phase, 2000-2010), and the third stage (government & societial engagement, after 2010). Several studies also analyzed the barriers such as low public & professional awareness, disconnection from cancer care, the opioidfobia and the lack of trained palliative care providers. The lack of integration of palliative care to cancer care is a major challenge for palliative care implementation. Conclusions: This review presents the evidence of the significant progress in PC during the last 20 years and the opportunities for further progress. Bringing research into practice is needed for shaping the integration of palliative care to cancer care in Turkey. The stakeholders and policy makers should not neglect the need for PC under the current pressure of COVID-19 pandemic on health and economy.

Cuidados paliativos en Latinoamérica

Objetivo: esta revisión describió el desarrollo de los cuidados paliativos en Latinoamérica basado en la educación, disponibilidad de opioides, investigación, políticas públicas e implementación de servicios. Metodología: se realizó una búsqueda de los artículos publicados en las bases de datos PubMed, Scopus, Ovid Medline, Lilacs, Google Scholar, y se aplicó un límite temporal de 10 años. Se seleccionaron 33 referencias bibliográficas. Resultados: el número de publicaciones que se identificaron dedicadas al desarrollo de cuidados paliativos en Latinoamérica fue escaso. Pese a que los resultados evidenciaron un crecimiento de los cuidados paliativos, reflejado en las políticas de salud pública, educación, disponibilidad de opioides e implementación de los servicios en todos los niveles de atención, además de la investigación y creación de asociaciones regionales, persistió la inequidad entre los países. No existen políticas de salud en cuidados paliativos, en algunos casos, o no se pusieron en marcha. La disponibilidad de servicios para brindar la atención a la población fue insuficiente y persistió la dificultad del acceso a opioides para el alivio de síntomas. No se logró el compromiso de la academia para masificar la educación de pregrado y posgrado, y la investigación no contó con apoyo y financiamiento. Conclusiones: el desarrollo de los cuidados paliativos en Latinoamérica es aún escaso e irregular, por lo que es necesario seguir sensibilizando a los tomadores de decisiones de políticas públicas a nivel nacional, personal sanitario, organismos internacionales, ONG nacionales e internacionales y comunidad para lograr el crecimiento deseado.

Palliative Care in Latin America: Are We Making Any Progress? Assessing Development Over Time Using Macro Indicators.

Monitoring and reporting palliative care development serves to identify progress as well as remaining challenges for improvement. To report on the updated status of palliative care development in Latin America, develop and apply a new index to measure progress, and enable cross-country comparisons. We conducted a secondary analysis of the data collected for the 1st (2012) and 2nd (2020) editions of the Atlas of Palliative Care in Latin America using indicators on Policy, Education, Access to Medicines and Service Provision. The ALCP indicators were reviewed and the ALCP Index-II was constructed adding the z-score for each indicator and used to rank the countries' development as High, Moderate or Low. Seventeen Latin American countries. The number of countries with a national palliative care plan increased from five (29%) to nine (53%); Percentage of medical schools with palliative care as an independent subject at the undergraduate level grew from 4.2% to 17.1%; Distributed Opioid Morphine Equivalence increased from 6.6 to 7.1 mg/capita; and Number of services increased from 1.5 to 2.6/million. The number of palliative care services was correlated to the proportion of medical schools which included palliative care (Rs1=0.48; Rs2=0.34); and with morphine equivalence/capita (Rs1=0.61; Rs2=0.72), but not associated with the existence of a national plan (p1=0.234; p2=0. 074). Using the ALCP Index-II, Uruguay, Chile, Costa Rica, Panama, Brazil, and Argentina ranked the highest while the other ranked in the middle or lowest groups. Uruguay registered the highest score (7.5), Honduras the lowest (-3.59). The dispersal in the values was larger than the one registered in 2012, showing more heterogeneity. Significant advances in palliative care development in Latin America have been achieved. The ALCP-II Index is useful for assessing and comparing palliative care development across countries.

Palliative Care Development in the Asia Pacific Region: A Review of Assessment Indicators

ContextOrganizations such as Asia Pacific Hospice Palliative Care Network functions to promote quality palliative care development through training and education, research collaboration and variety relevant projects and events for all in the Asia and Pacific region. ObjectivesTo summarise and further compare existing development indicators used in Asia Pacific region for palliative care. MethodsThe current review used Whittemore and Knafl ’s framework for integrative reviews. PubMed, Embase, CINAHL and Google Scholar databases were searched for eligible studies. This review focused on palliative care development according to the domains and indicators identified by the World Health Organization Public Health Strategy and ATLANTES Palliative Care Research Group. Joanna Briggs Institute critical appraisal checklists were adopted to assess the methodological quality of included studies. ResultsTen studies were included and two main findings were identified: 1) There was a strong evidence of educational preparation, use of medicines and service provision for palliative care development in Asia Pacific and 2) Professional activities and policy geared towards palliative care development were limited and had relative emphasis at a country-level in Asia Pacific. ConclusionPalliative care development is largely influenced by policies and funding structures as well as by cultural views and beliefs of stakeholders. It is expected that individuals, stakeholders and practitioners in Asia Pacific might have differing views and cultural beliefs when compared to the European or western counterparts. The lack of details and documentation in the region and inadequate reporting measures impacts on the development of strong palliative care framework.

Palliative Medicine Specialization in Latin America: A Comparative Analysis

BackgroundFormal recognition of palliative medicine as a specialty has been one of the main drivers in the development of palliative care. AimTo provide a comparative, comprehensive overview on the status of palliative medicine as medical specialty across Latin America. MethodsWe conducted a comparative study of 19 Latin American countries. Key informants and persons in charge of the specialization training programs were identified and interviewed. We collected data on general recognition as specialty (title, process of certification) and on training program characteristics (title, start year, requirements, training length, and type full time or part time). ResultsEight of 19 countries (42%) Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Venezuela reported palliative medicine as medical specialty. Thirty-five (sub)specialization training programs in palliative medicine were identified in the region (eight as a specialty and 27 as a subspecialty), the majority in Colombia (43.5%) and Brazil (33.7%). A total of 20% of the programs have yet to graduate their first cohort. Length of clinical training as specialty varied from two to four years, and from 520 hours to three years for a subspecialty. ConclusionDespite long-standing efforts to improve quality of care, and significant achievements to date, most Latin American countries have yet to develop palliative medicine as medical specialty. Specialty and sub-specialty training programs remain scarce in relation to regional needs, and the programs that do exist vary widely in duration, structure, and content.

Changing Mortality and Place of Death in Response to Refugee Influx: A Population-Based Cross-Sectional Study in Jordan, 2005-2016.

Background: Jordan faces complex health care challenges due to refugee influx and an aging population. Palliative care planning and delivery require data to ensure services respond to changing population needs. Objectives: To determine the trend in mortality and place of death in Jordan. Design: Population-based study. Setting/Subjects: Death registry data of adult decedents (n = 143,215), 2005-2016. Measurements: Descriptive statistics examined change in demographic and place of death (categorized as hospital and nonhospital). Binomial logistic regression compared the association between hospital deaths and demographic characteristics in 2008-2010, 2011-2013, and 2014-2016, with 2005-2007. Results: The annual number of deaths increased from 6792 in 2005 to 17,018 in 2016 (151% increase). Hospital was the most common place of death (93.7% of all deaths) in Jordan, and percentage of hospital deaths increased for Jordanian (82.6%-98.8%) and non-Jordanian decedents (88.1%-98.7%). There was an increased likelihood of hospital death among Jordanian decedents who died from nonischemic heart disease (odd ratio [OR]: 1.11, 95% confidence interval [CI]: 1.09-1.13, p < 0.001), atherosclerosis (OR: 1.10, 95% CI: 1.08-1.13, p < 0.001), renal failure (OR: 1.05, 95% CI: 1.02-1.08, p < 0.001), hemorrhagic fevers (OR: 1.09, 95% CI: 1.06-1.13, p < 0.001), and injury (OR: 1.18, 95% CI: 1.06-1.33, p < 0.001) in the period 2014-2016, compared with 2005-2007. There were similar increases in the likelihood of hospital death among non-Jordanians in 2014-2016 for the following conditions: malignant neoplasms (except leukemia), nonischemic heart disease, atherosclerosis, injury, and HIV, compared with 2005-2007. Conclusions: Country-level palliative care development must respond to both internal (aging) and external (refugee influx) population trends. Universal Health Coverage requires palliative care to move beyond cancer and meet population-specific needs. Community-based services should be prioritized and expanded to care for the patients with nonischemic heart disease, atherosclerosis, renal failure, hemorrhagic fevers, and injury.

Attitudes and educational needs of emergency doctors providing palliative and end-of-life care in Hong Kong: a cross-sectional analysis based on a self-report study

BackgroundDue to the ageing population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are coming under the spotlight. The objectives of this study were to evaluate the attitudes of emergency doctors in providing palliative and EOL care in Hong Kong, and to investigate the educational needs of emergency doctors in these areas.MethodsA questionnaire was used to study the attitudes of ED doctors of six different hospitals in Hong Kong. The questionnaire recorded the attitudes of the doctors towards the role of palliative and EOL care in EDs, the specific obstacles faced, their comfort level and further educational needs in providing such care. The attitudes of emergency doctors of EDs with EOL care services were compared with those of EDs without such services.ResultsIn total, 145 emergency doctors completed the questionnaire, of which 60 respondents were from EDs with EOL care services. A significant number of participants recognized that the management of the dying process was essential in ED. Providing palliative and EOL care is also accepted as an important competence and responsibility, but the role and priority of palliative and EOL care in ED are uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Doctors from EDs with EOL care services are more comfortable in providing such care and discuss it with patients and their relatives. Further educational needs were identified, including the management of physical complaints, communication skills, and EOL care ethics.ConclusionsThe study identified obstacles in promoting palliative and EOL care in the EDs Hong Kong. With the combination of elements of routine ED practice and a basic palliative medicine skill set, it would promote the development of palliative and EOL care in Emergency Medicine in the future.

The impact of COVID-19 on palliative care workers across the world: A qualitative analysis of responses to open-ended questions.

With over two million deaths and almost 100 million confirmed cases, the COVID-19 pandemic has caused a "tsunami of suffering." Health care workers, including palliative care workers, have been severely impacted. This study explores how the COVID-19 pandemic has impacted palliative care workers around the world and describes the coping strategies they have adopted to face their specific situation. We conducted a qualitative analysis of written, unstructured comments provided by respondents to a survey of IAHPC members between May and June 2020. Free text was exported to MAX QDA, and a thematic analysis was performed by reading the comments and developing a coding frame. Seventy-seven palliative care workers from 41 countries submitted at least one written comment, resulting in a data corpus of 10,694 words and a total of 374 coded comments. Eight main themes are emerged from the analysis: palliative care development, workforce impact, work reorganization, palliative care reconceptualization, economic and financial impacts, increased risk, emotional impact, and coping strategies. The pandemic has had a huge impact on palliative care workers including their ability to work and their financial status. It has generated increased workloads and placed them in vulnerable positions that affect their emotional well-being, resulting in distress and burnout. Counseling and support networks provide important resilience-building buffers. Coping strategies such as team and family support are important factors in workers' capacity to adapt and respond. The pandemic is changing the concept and praxis of palliative care. Government officials, academia, providers, and affected populations need to work together to develop, and implement steps to ensure palliative care integration into response preparedness plans so as not to leave anyone behind, including health workers.

Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development

BackgroundPalliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology.AimTo identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above.MethodsA process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy.ResultsThe literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines.ConclusionMeaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

Exploring the needs and experiences of palliative home care from the perspectives of patients with advanced cancer in China: a qualitative study.

The needs and experiences of palliative home care for patients with advanced cancer have received little research attention. We aimed to explore the needs and experiences of palliative home care among patients with advanced cancer in China. This qualitative study was conducted using semi-structured interviews with patients with advanced cancer. Participants (n = 15) were recruited from an oncology palliative care unit and a hospice outpatient unit, and were selected using purposive sampling from October 2019 to March 2020. Interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Two researchers coded the interviews independently in NVivo 12 and developed major themes and subthemes by inductive and constant comparison. Five themes were identified: (1) physical need; (2) psychological experience; (3) spiritual need; (4) social need; and (5) information need. Patients need to manage their symptoms (especially cancer pain), prolong life as long as possible, reconstruct their attitudes to adapt to their roles, be socially supported, be respected, maintain spiritual peace, and obtain more information about illness and home care. The current palliative home care services are imperfect, and patients face substantial challenges, including physical symptoms, psychological/spiritual distress, and inadequate social support and information. Our findings may provide evidence and a reference for the development of palliative home care in China.

Oncology-Based Palliative Care Development: The Approach, Challenges, and Solutions From North-East Region of India, a Model for Low- and Middle-Income Countries.

BACKGROUNDAccess to palliative care within healthcare systems of low- and middle-income countries (LMICs) has never been more pronounced than in current times. The Lancet Commission Report (2018) estimates that 80% of global serious health-related suffering (SHS), which demands access to palliative care for its relief, are in LMICs. Cancer is a major contributor to SHS and a rapidly growing burden in LMICs. Similar to many LMICs, cancer is a leading cause of death in India. The North-East Region (NER) of India has a high prevalence of cancer and paucity of services for cancer and palliative care.OBJECTIVESTo describe the strategies used to initiate and strengthen palliative care services integrated with the comprehensive cancer care initiatives in the state of Assam in NER.METHODSAfter an initial assessment of the status of palliative care in the NER, a multipronged strategy was adopted that aligned with the WHO framework recommended for initiating palliative care services. A core team working with a government and private collaborative strategized and activated supportive policies, education, and training and improved access and availability to essential drugs, while implementing the components synchronously within the state.SIGNIFICANCEThis project demonstrates an informed regional adaptation of the WHO model. It highlights the strengths of integrating palliative care within cancer care program right from its inception. It emphasizes the sustainability of services activated across public healthcare systems, as compared with the donor- or champion-driven initiatives. The outcome of this project underlines the relevance of this model for LMIC regions with similar health systems and sociocultural and economic contexts.

Higher Prevalence of Dementia but No Change in Total Comfort While Dying among Nursing Home Residents with Dementia between 2010 and 2015: Results from Two Retrospective Epidemiological Studies.

Important policy developments in dementia and palliative care in nursing homes between 2010 and 2015 in Flanders, Belgium might have influenced which people die in nursing homes and how they die. We aimed to examine differences between 2010 and 2015 in the prevalence and characteristics of residents with dementia in nursing homes in Flanders, and their palliative care service use and comfort in the last week of life. We used two retrospective epidemiological studies, including 198 residents in 2010 and 183 in 2015, who died with dementia in representative samples of nursing homes in Flanders. We found a 15%-point increase in dementia prevalence (p-value < 0.01), with a total of 11%-point decrease in severe to very severe cognitive impairment (p = 0.04). Controlling for residents’ characteristics, in the last week of life, there was an increase in the use of pain assessment (+20%-point; p < 0.03) but no change in total comfort. The higher prevalence of dementia in nursing homes with no change in residents’ total comfort while dying emphasizes an urgent need to better support nursing homes in improving their capacities to provide timely and high-quality palliative care services to more residents dying with dementia.

The Development of Palliative Care in Colombia: An Analysis of Geographical Inequalities Through the Application of International Indicators

ContextThe national evaluation of an individual country is a tool used to improve the universal provision of palliative care. The evaluation of a country's internal situation, by means of an analysis of the development of palliative care by region, may also be an instrument for improvement. ObjectivesThe aim of this study was to understand the regional development of palliative care in Colombia, through the application of international indicators. MethodsRegional development was analyzed for Colombia, with a country-specific adaptation of the evaluation method used in the latest edition of the Palliative Care World Map (Clark D, 2020), the need for palliative care per death with serious health-related suffering (Knaul FN, 2019), and the coverage of specialized services, following European standards (Centeno, 2016). A total of 33 of the country's regions were classified. ResultsSome 41% of the people who die in Colombia need palliative care. The average figure for specialized services is 0.5/100,000 inhabitants, with a maximum coverage of 51%. In Colombia, there are 12 regions with a generalized level of provision; six regions with isolated provision, nine regions developing their capacity, four with no known activity, and two at an advanced level of palliative care integration. The regions with the highest level of palliative care development coincide with higher demand and coverage of specialized services. ConclusionRegional palliative care development is unequal and unbalanced. Applying international indicators to levels of regional development allows for the identification of geographical inequalities and highlights low palliative care development, especially in the rural areas of the country.