Palliative care in low- and medium-resource countries

Abstract: Low- and medium-resource countries are facing a significant increase in the incidence of noncommunicable diseases such as cancer. Unfortunately, the majority of patients with cancer present with advanced disease, and disease-directed treatment may be unlikely to be effective and/or not available. Globally, there will be a growing need for palliative care services. There has been significant progress in the provision and integration of palliative care into the health care policy and systems. Nonetheless, palliative care services vary significantly between regions of the world and also between countries in the same region. Some common barriers to care include the lack of a trained workforce to provide palliative care, lack of availability of opioids or the restriction of their use, cultural attitudes of physicians and patients, and also funding. Despite these challenges, there are examples of low- and medium-resource countries that are providing excellent palliative care that is being integrated ...

Family Caregivers in Cancer: Roles and Challenges - PDQ for health professionals

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about challenges and helpful interventions for caregivers of cancer patients. It is intended as a resource to inform and assist clinicians who care for cancer patients.

Kaiser Permanente holds a wide array of these evidence-based information summaries on a variety of health topics within their online health encyclopedia, available on their website for whoever might want or need this information.

Introducing palliative care in Serbia

The Ministry of Health established the Palliative Care Task Force and adopted the National Strategy for Palliative Care to guide the development of palliative care across Serbia; partnerships with international organizations, local NGOs and supportive government actors helped secure buy-in at the national level; developing a legislative and political base was essential for creating a foundation on which to build the initiative; securing EU funding provided additional resources to support activities; incorporating a new palliative care philosophy within professional culture required extensive training, communication, advocacy and time; formalizing educational opportunities through university partnerships helped to ensure sustainability.

Integrating palliative care into primary care for patients with chronic, life-limiting conditions.

As longevity increases, individuals with chronic, life-limiting conditions will live longer with disease burden and functional decline. Nurse practitioners can integrate symptom management, early decision-making, and supportive care into the primary care setting to improve quality of life and decrease economic and emotional impact at the end of life.

Integrating a palliative approach into the management of chronic, life-threatening diseases: Who, How and When?

Palliative care has a great deal to offer individuals and families faced with chronic, life-threatening illnesses. Medical advances means that many people will live many  years with these illnesses; however, most will eventually die of these diseases  and should have the right and support to make  informed decisions about their care at the end-of-life. rather than dimming people’s hope, frankdiscussions about the prognosis and trajectory of these illnesses can help people enhance theirquality of both living and dying with these diseases.

Over the past 15 years, canada has made progress in providing high quality palliative care —particularly in the last months of life — to more of its citizens, but  palliative care is still not a mainstream service available to all.  The current model of leaving responsibility for palliative carewith primary care providers is highly flawed. Instead, canada must develop a national policy —similar to other countries, such as Norway ...

Humanitarian Health Ethics: please, participate to the first global multi-sectoral survey on "Palliative care during international humanitarian action"

On February 9, 2017, Humanitarian Health Ethics is launching the first global, multi-sectoral survey on: "Palliative care during international humanitarian action". https://qlite.az1.qualtrics.com/jfe3/form/SV_ai5RzCZI7YLnob3

Pilot tested and available in three languages (French, English, Arabic), this survey is intended for all involved in the delivery or oversight of humanitarian healthcare (as providers, policy-makers, or other) in the last two years. Through this survey, we hope to deepen understanding of current palliative care needs and practices in humanitarian action (related to public health emergencies, armed conflicts, forced migration settings, natural disasters), crucial information as SPHERE and others are increasingly considering the place of palliative care in humanitarian action. The survey takes approximately 15 minutes to complete via an online platform (QUALTRICS), and we will have interim results by April 25^th, and will close the survey 6 months after its launch (July 9^th).

Barriers to, and opportunities for, palliative care development in the Eastern Mediterranean Region

The 22 countries of WHO´s Eastern Mediterranean Region are experiencing an increase in the burden of non-communicable deseases (NCDs), including cancer. Of the six WHO regions, the Eastern Mediterranean Region is projected to have the greatest increase in cancer incidence in the next 15 years. With increasing numbers of deaths from cancer, palliative care should be available to relieve suffering in patients with advance desease and at the end of life. However, in the Eastern Mediterranean Reion, the palliative care available is variable and inconsistent. 

Increasing advance personal planning: the need for action at the community level

Advance personal planning is the process by which people consider, document and communicate their preferences for personal, financial and health matters in case they lose the ability to make decisions or express their wishes in the future.

There is a need for rigorous evidence to demonstrate wheter a community action approach is effective in estabilishing whole community adoption of advance personal planning. 

Communication and integration: a qualitative analysis of perspectives among Middle Eastern oncology healthcare professionals on the integration of complementary medicine in supportive cancer care

The use of complementary and traditional medicine (CTM ) in Middle Eastern countries is widespread, including among patients with cancer. Perspectives of oncology healthcare professionals (HCPs) in this region regarding the integration of CTM within conventional supportive cancer care were explored

Barriers to, and opportunities for, palliative care development in the Eastern Mediterranean Region

The 22 countries of WHO's Eastern Mediterranean Region are experiencing an increase in the burden of non-communicable diseases (NCDs), including cancer. Of the six WHO regions, the Eastern Mediterranean Region is projected to have the greatest increase in cancer incidence in the next 15 years. Furthermore, most cancers are diagnosed at a late stage, resulting in a lower cancer survival rate than in the European Region and the Region of the Americas. With increasing numbers of deaths from cancer, palliative care should be available to relieve suffering in patients with advanced disease and at the end of life. However, in the Eastern Mediterranean Region, the palliative care available is variable and inconsistent. Several barriers exist to the development and expansion of palliative care delivery in this region, including the absence of palliative care in national policies, little partnership working, insufficient palliative care education for health-care professionals and volunteers, poor ...

Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review

In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. The aimed of this review was to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide.

The key role of palliative care in response to the COVID-19 tsunami of suffering

Coronavirus disease 2019 (COVID-19) has brought a tsunami of suffering that is devastating even well resourced countries. The disease has wreaked havoc on health systems and generated immense losses for families, communities, and economies, in addition to the growing death toll. In this most challenging time, health responders can take advantage of palliative care know-how to focus on compassionate care and dignity, provide rational access to essential opioid medicines, and mitigate social isolation at the end of life and caregiver distress. 

Empowering Better End-of-Life Dementia Care (EMBED-Care): A mixed methods protocol to achieve integrated person-centred care across settings

It is known that the number of people with dementia continues to increase in the world. We also know that people with dementia live to advanced stages of the disease, so they will require comprehensive palliative care. The aim objetive of this work, is to promote a “step change” in care for people with dementia and their carers to enable delivery of timely person-centred care, to identify unmet needs and improve outcomes, including comfort and qualitive of life, towards end of life. Each of six-interdependent work streams (WSs) will deliver new knowledge and sequentially build a complex intervention to improve palliative dementia care.

Approaches to integrating palliative care into African health systems: a qualitative systematic review

Africa is characterized by a high burden of disease and health system deficits, with an overwhelming and increasing demand for palliative care (PC). Yet only one African country is currently considered to have advanced integration of palliative care into medical services and generalized PC is said to be available in only a handful of others. The integration of PC into all levels of a health system has been called for to increase access to PC and to strengthen health systems. Contextually appropriate evidence to guide integration is vital yet limited. This qualitative systematic review analyses interventions to integrate PC into African health systems to provide insight into the ‘how’ of PC integration. Forty articles were identified, describing 51 different interventions. This study found that a variety of integration models are being applied, with limited best practices being evaluated and repeated in other contexts. Interventions typically focused on integrating specialized PC ...

JICA Special Issue: Integrated Palliative and End of Life Care for People with Advanced Dementia or Frailty

This special issue now seems uncannily prescient in view of the devastating impact of COVID-19 on people with advanced dementia or severe frailty, particularly in care homes.

The pandemic has heightened awareness of the possibility of a sudden and rapid transition from relative health to a palliative or end of life stage. This has opened up conversations about the potential burden from intensive treatments that are likely to be futile and the benefits of advance care planning.

The collection of papers in this special issue will be of interest to readers involved in planning, commissioning or delivering palliative and end of life care services for our most vulnerable citizens at this time, whether at home or in a hospital, care home or hospice.

Read the full Guest Editorial and the collection of papers of this special issue

IFIC Scotland Integrated Care Matters: Build Back Better Webinar Series

The new report from the International Foundation for Integrated Care (IFIC), Realising the true value of integrated care describes the steps we must take to create a radically different future beyond Covid-19. The report is a powerful call to reset our compass to a new reality based on solidarity and collaboration for population health. IFIC Scotland and partners will explore this new future in series 5 of their Integrated Care Matters webinars.

Guest panelists, members of IFICs international Special Interest Groups, will share their experiences and insights and challenge us to design a better future that improves lives and opportunities for all. Each webinar will be accompanied by a topic resource with links to further information.

All who register will receive links to the recordings and topic resources.

Managing clinical uncertainty in older people towards the end of life: a systematic review of person-centred tools

Older people with multi-morbidities commonly experience an uncertain illness trajectory. Clinical uncertainty is challenging to manage, with risk of poor outcomes. Person-centred care is essential to align care and treatment with patient priorities and wishes. Use of evidence-based tools may support person-centred management of clinical uncertainty. We aimed to develop a logic model of person-centred evidence-based tools to manage clinical uncertainty in older people.

The role of community health workers in palliative care in a rural subdistrict in South Africa