2017; Volume 18, No 9, September
Media Watch: an annotated list of recent articles about palliative care in the news media and the literature
Implementation of palliative care in Palestine: Cultural and religious perspectives
PALLIATIVE MEDICINE AND HOSPICE CARE | Online – Accessed 28 July 2017 – The Palestinians living in the West Bank and Gaza suffer from the same barriers reported by the neighboring Arab countries including the lack of support by health policies and education, little or no knowledge of the principles and practices of palliative care (PC) among healthcare providers and patients and their families. In addition to the weak healthcare system and the scarcity of resources and unavailability of medications especially opioids, the Palestinians have additional barriers due to the peculiar political situation since the West Bank and Gaza, governed by the Palestinian Authority, are still under Israeli occupation. Introducing and implementing PC for Palestinians in the West Bank and Gaza require integrated local and international efforts and support. At the local level, Palestinian ministries and stakeholders should place PC on their priority list. Additional budget should be allocated to the Ministry of Health to capacity build the human resources and the premises of the Palestinian healthcare system. The extra budget should be invested in improving cancer screening, early and proper diagnosis, and follow-up, which consequently will decrease the number of terminally ill patients who are in need of PC. Moreover, professional and well-structured training programs should be conducted especially in hospitals with oncology and geriatric departments to improve the qualifications of the healthcare providers and to train them to adopt the skills and the attitudes that are part of PC. The international community such as WHO, Middle East Cancer Consortium and other cancer-related organizations could significantly contribute to this training. Furthermore, a national policy and legislation regarding PC provided at hospitals and homes should be implemented and integrated with the healthcare system and the health insurance to warrant the availability and access to opioids.
Pediatric palliative care initiative in Cambodia
FRONTIERS IN PUBLIC HEALTH | Online – 28 July 2017 – Cancer care with curative intent remains difficult to manage in many resource-limited settings such as Cambodia. Cambodia has a small workforce with limited financial and healthcare resources resulting in delayed diagnoses and availability of limited therapeutic tools. Thus, palliative care (PC) becomes the primary form of care in most cases. Although PC is becoming an integral part of medical care in developed countries, this concept remains poorly understood and utilized in developing countries. Angkor Hospital for Children serves a relatively large pediatric population in northern Cambodia. Approximately two-thirds of the patients admitted to the hospital were deemed candidates to receive PC. In an effort to develop a pediatric PC team utilizing existing resources and intensive training, the authors’ focus group recruited already existing teams with different healthcare expertise and other motivated members of the hospital. During this process, they also formed a PC training team of local experts to maintain ongoing PC education. Feedback from patients and healthcare providers confirmed the effectiveness of these efforts. In conclusion, palliative and sustainable care was offered effectively in a resource-limited setting with adequately trained and motivated local providers. In this article, the steps and systems used to overcome challenges in Cambodia are summarized in the hope that our experience urges governmental and non-governmental agencies to support similar initiatives.
Spiritual care in the ICU: Perspectives of Dutch intensivists, ICU nurses, and spiritual caregivers
JOURNAL OF RELIGION & HEALTH | Online – 11 August 2017 – This study shows that spiritual care (SC) is not yet an integrated part of daily intensive care unit (ICU) care at a national level, despite the finding that the majority of intensivists, ICU nurses, and spiritual caregivers think SC contributes positively to the well-being of patients and relatives in the ICU. Additional findings included other similarities, but also differences in experiences with SC in the ICU from the perspectives of healthcare workers (HCW) and spiritual caregivers, and barriers that both HCW and spiritual caregivers encounter in ICU care. Moreover, this study points toward improvement of internal communication and interdisciplinary collaboration, expansion of knowledge of SC provision, and provision of evidence-based SC practice.
End-of-life care in Germany
New structures in neurology: Palliative care for neurological patients
NEUROLOGY INTERNATIONAL OPEN, 2017; 1(03): e117-e126. Although patients with incurable neurological diseases suffer from a variety of distressing symptoms and may die from their neurological condition and associated complications, palliative and hospice care (P&HC) for these patients to date remains rare. Initial estimates indicate on average 10 percent of all patients suffering from a neurological disease need P&HC. However, within German neurology departments, only few physicians and nurses are specialized in P&HC and only about 3 percent of patients cared for in P&HC structures suffer from neurological diseases (in contrast to the approximately 80 percent of patients suffering from oncological diseases). This rather low number is due to the gradual increase in the awareness of P&HC needs for neurological patients and a currently predominant supply of oncological patients in P&HC structures that are primarily aimed at these patients. Correspondingly, the special aspects of neurological patients are currently not adequately addressed in the palliative training curricula of healthcare professionals. Rather, patients with advanced neurological conditions are medically cared for by general practitioners and by the existing inpatient and outpatient neurology structures, which may also offer sub-specialty services. Consequently, adequate care for severely affected neurological patients becomes difficult as soon as these patients are hardly able to visit these structures because home-based specialist treatment is currently rendered and financed only to a limited degree. Novel, yet to date rare approaches, mostly of international origin, suggest these patients may benefit from specialized home-based services, combining neurological and palliative care expertise.
Development of palliative care in China: A tale of three cities
THE ONCOLOGIST | Online – 24 July 2017 – With a population of 1.3 billion, China is the most populous country in the world and cancer is the leading cause of death. However, only 0.7 percent of hospitals offer palliative care (PC) services. The authors describe the program development and infrastructure of the PC programs at three Chinese institutions, using these as examples to discuss strategies to accelerate PC access for cancer patients in China. The three examples of PC delivery in China ranged from a comprehensive program that includes all major branches of PC in Chengdu, a program that is predominantly inpatient‐based in Kunming, and a smaller program at an earlier stage of development in Beijing. Despite the numerous challenges related to the limited training opportunities, stigma on death and dying, and lack of resources and policies to support clinical practice, these programs were able to overcome many barriers to offer PC services to patients with advanced diseases and to advance this discipline in China through visionary leadership, collaboration with other countries to acquire PC expertise, committed staff members, and persistence.
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Prevalence and characteristics of prisoners requiring end-of-life care: A prospective national survey
PALLIATIVE MEDICINE | Online – 8 August 2017 – Overall, France has been reluctant to promote palliative care (PC) units in the prison sector, probably because terminally ill prisoners are supposed to be released, given that the law provides for this option. Prison palliative and hospice care units have been created in the U.S. and the U.K., and many promising practices have already been proposed, such as the use of peer volunteers, multi-disciplinary teams, special health units inside the prison, staff training, and partnerships with community hospices. Nevertheless, figures are not easily available to plan for resources. This study contributes to providing important data regarding end-of-life care (EoLC) in prisons in France and could serve as an example for other countries, although the methodology would need to be adapted to the context and legislation in other countries. Although the law allows for compassionate release, there are more ill prisoners requiring EoLC in jail than expected. Some should remain in prison regardless, particularly those whose only social ties are in prison, or those with a high risk of criminal reoffending. Knowledge of the profile of prisoners (medical, social, and jurisdictional) and the estimated prevalence of ill prisoners requiring PC could help define healthcare needs for dying prisoners in agreement with humanitarian values and the Right to Health & Medical Care promulgated by the European Commission of Human Rights and the United Nations Bill of Human Rights. This is the first national study to focus on prisoners requiring EoLC in France.
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Media Watch is intended as an advocacy, education and research tool. The weekly report, published by Barry R. Ashpole, a Canadian communications consultant and educator, monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. Each month, this section of the IAHPC Newsletter will publish an abstract or summary of an article or report of special interest noted in recent issues of Media Watch (see below).
Read the current and back issues of the weekly report.