Revistas
Revista:
EUROPEAN JOURNAL OF PUBLIC HEALTH
ISSN:
1101-1262
Año:
2023
Vol.:
33
N°:
1
Págs.:
35 - 41
Background Palliative sedation is a commonly accepted medical practice. This study aims to clarify how palliative sedation is regulated in various countries and whether this may impact its practice. Methods An online survey requesting regulations on palliative sedation was conducted in Belgium, Germany, Hungary, Italy, The Netherlands, Spain, Romania and the UK. Purposive sampling strategy was used to identify clinicians from different medical fields and legal experts for each country. Regulations were analyzed using the principles of the European Association for Palliative Care Framework on palliative sedation. Country reports describing how palliative sedation is regulated were elaborated. Results One hundred and thirty-nine out of 223 (62%) participants identified 31 laws and other regulations affecting palliative sedation. In Spain, 12 regional laws recognize palliative sedation as a right of the patient at the end of life when there are refractory symptoms. In Italy, the law of informed consent and advance directives specifically recognizes the doctor can use deep sedation when there are refractory symptoms. There are also general medical laws that, while not explicitly referring to palliative sedation, regulate sedation-related principles: the obligation of doctors to honour advance directives, informed consent, the decision-making process and the obligation to document the whole process. In Germany, the Netherlands and the UK, palliative sedation is also regulated through professional guidelines that are binding as good practice with legal significance. Conclusions Palliative sedation is considered in the general law of medical practice, in laws regarding the patient's autonomy, and through professional guidelines.
Revista:
EASTERN MEDITERRANEAN HEALTH JOURNAL
ISSN:
1687-1634
Año:
2022
Vol.:
28
N°:
8
Págs.:
614 - 621
The increasing number of people experiencing serious health-related suffering due to severe illness is an urgent issue in the WHO Eastern Mediterranean Region (EMR). Although palliative care can mitigate much of this suffer-ing, its current development and indicators to measure progress remain unknown. Aims: To describe the development of the Atlas of palliative care in the Eastern Mediterranean Region 2021. Methods: Recently, the WHO Regional Office for the Eastern Mediterranean, together with a network of palliative care experts, identified the best indicators and collected data across the Region. These indicators include national palliative care strategies, number of specialized palliative care services per population, inclusion of palliative care in the health ben-efits package and national health budget, and the use of pain medication. These and other useful information form the Atlas of palliative care in the Eastern Mediterranean Region 2021. Results: The Atlas shows that provision of specialized palliative care services and pain medication in the Region is low. Several of the indicators suitable to the region are new and include the level of public awareness of palliative care, inclu-sion of palliative care in health insurance plans, availability of centres of excellence for palliative clinical care, and availa-bility of grants to finance palliative care research. Conclusion: Adoption of favourable policies, educational initiatives, and the involvement of stakeholders, represent an opportunity for future development of palliative care in the EMR.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2022
Vol.:
21
N°:
1
Págs.:
168
Background Monitoring the development of palliative care (PC) illustrates the capacity of health systems to respond to the needs of people experiencing serious health-related suffering. Aim To analyse comparatively the situation of PC in the countries of the Easter Mediterranean region using context-specific indicators. Method An online questionnaire with 15 context-specific PC indicators investigating service provision, use of medicines, policy, education, and vitality was designed. Authors Institution 1 nominated in-country experts to complete the survey. Data were analysed using a comparative description of indicators per domain and a multivariate analysis. Results In-country experts were identified in 17/22 countries. 12/17 contributed to the survey. In total, 117 specialized PC services were identified. Specialized services per population ranges from 0.09 per 100,000 inhabitants in Lebanon and Saudi Arabia, Qatar and Kuwait; to zero services in the Occupied Palestinian Territories. On average, opioid consumption was 2.40 mg/capita/year. National PC strategies were reported in nine countries. In six countries, PC is officially accredited either as a specialty or sub-specialty, and PC mandatory courses are implemented in 36% of medical schools and 46% of nursing schools. National PC associations were documented in six countries. A higher pattern of development was identified in Jordan, Kuwait, Saudi Arabia, Oman, Lebanon, Qatar. Conclusions Despite a higher development in the Arabian Peninsula, the region is characterised by a very low provision of specialized PC services and opioid consumption. Policy improvements represent an opportunity to improve access to PC.
Revista:
EASTERN MEDITERRANEAN HEALTH JOURNAL
ISSN:
1020-3397
Año:
2022
Vol.:
28
N°:
8
Págs.:
560 - 568
Background: The World Health Organization Office for the Eastern Mediterranean Region (WHO/EMRO), and the re-cently created palliative care experts network for the Eastern Mediterranean Region (EMR), decided to develop region -spe-cific indicators for monitoring national palliative care development in the Region. Aims: To identify relevant and feasible macro-indicators for palliative care development for the EMR. Methods: 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. Indica-tors with CVI >= 0.7/1, and scoring >= 7/9 for the R and F averages were selected. Results: Twelve of the 22 countries in the Region were represented in the study. In the first round, 11 indicators were se-lected 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 prequalifi-cation 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). Conclusion: A baseline set of 15 region-specific indicators for measuring the development of palliative care were validated by experts in the EMR.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2021
Vol.:
61
N°:
4
Págs.:
812 - 816
Context: Palliative care is an emerging health care service essential for every health care system. Information on the current status of palliative care service delivery is needed in order to understand the gap between need for palliative care and current capacity to deliver.
Objectives: To estimate the number of providers delivering palliative care worldwide and the patients they served in 2017.
Methods: Estimates were obtained from a sample of countries from each World Bank income group using typical case purposive sampling methods. Reliable data from the United States, and eight additional countries were used for the high-income group. For low and middle-income countries (LMICs), in order to determine an estimate of the number of patients served 30 countries representative of palliative care service delivery in each region and income group were surveyed.
Results: Results from the mapping levels of palliative care development survey identified a total of approximately 25,000 palliative care service delivery teams globally. The total estimate of patients served in 2017 was approximately seven million.
Conclusion: Significant disparities in palliative care access exist both by region and income group. The European and Pan-American regions had most while the Eastern Mediterranean, Southeast Asian, and African regions had least. Much more needs to be done to develop and deliver palliative care in LMICs where 80% of the need for palliative care exists. With about 70% of operating palliative care services in high income countries and only 30% in LMICs, a major effort to develop palliative care in these settings is urgently needed.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2021
Vol.:
20
N°:
1
Págs.:
36
Background: Palliative 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.
Aim: To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above.
Methods: A 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.
Results: The 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.
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2021
Vol.:
18
N°:
20
Págs.:
10753
Background: The coverage of palliative care (PC) may be understood as a country's capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countries & PRIME; coverage capacities. Method: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. Results: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. Conclusion: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs.</p>
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2021
Vol.:
18
N°:
19
Págs.:
10345
Background: Palliative care is a priority for health systems worldwide, yet equity in access remains unknown. To shed light on this issue, this study compares populations' driving time to specialized palliative care services in three countries: Ireland, Spain, and Switzerland. Methods: Network analysis of the population's driving time to services according to geolocated palliative care services using Geographical Information System (GIS). Percentage of the population living within a 30-min driving time, between 30 and 60 minutes, and over 60 min were calculated. Results: The percentage of the population living less than thirty minutes away from the nearest palliative care provider varies among Ireland (84%), Spain (79%), and Switzerland (95%). Percentages of the population over an hour away from services were 1.87% in Spain, 0.58% in Ireland, and 0.51% in Switzerland. Conclusion: Inequities in access to specialized palliative care are noticeable amongst countries, with implications also at the sub-national level.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2021
Vol.:
62
N°:
2
Págs.:
293 - 302
Context. The 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.
Objectives. The aim of this study was to understand the regional development of palliative care in Colombia, through the application of international indicators.
Methods. Regional 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.
Results. Some 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.
Conclusion. Regional 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. (C) 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Autores:
Clark, D.; Baur, N.; Clelland, D.; et al.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2020
Vol.:
59
N°:
4
Págs.:
794-807.e4
Context: Palliative care is gaining ground globally and is endorsed in high level policy commitments, but service provision, supporting policies, education and funding are incommensurate with rapidly growing need.
Objectives: To describe current levels of global palliative care development and report on changes since 2006.
Methods: An online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI) and Universal Health Coverage (UHC).
Results: Numbers (percentages) of countries in each development category were: 1) no known palliative care activity 47 (24%); 2) capacity-building 13 (7%); 3a) isolated provision 65 (33%); 3b) generalized provision 22 (11%); 4a) preliminary integration into mainstream provision 21 (11%); 4b) advanced integration 30 (15%). Development levels were significantly associated with WBIL (rS= 0·4785), UHC (rS=0·5558) and HDI (rS=0·5426) with p < 0.001. Net improvement between 2006-2017 saw 32 fewer countries in categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b.
Conclusion: Palliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health related suffering amenable to palliative care interventions is predicted by 2060. With need rising, palliative care is not reaching the levels required by at least half the global population.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2020
Vol.:
60
N°:
4
Págs.:
746 - 753
Context. Approximately 170,000 children in need of palliative care die every year in Europe without access to it. This field remains an evolving specialty with unexplored development. Objectives. To conduct the first regional assessment of pediatric palliative care (PPC) development and provision using data from the European Association for Palliative Care atlas of palliative care 2019. Methods. Two surveys were conducted. The first one included a single question regarding PPC service provision and was addressed by European Association for Palliative Care atlas informants. The second one included 10 specific indicators derived from an open-ended interview and rating process; a specific network of informants was enabled and used as respondents. Data were analyzed and presented in the map of the figure. Results. Data on PPC service provision were gathered from 51 of 54 (94%) European countries. Additional data were collected in 34 of 54 (62%) countries. A total of 680 PPC services were identified including 133 hospices, 385 home care services, and 162 hospital services. Nineteen countries had specific standards and norms for the provision of PPC. Twenty-two countries had a national association, and 14 countries offered education for either pediatric doctors or nurses. In seven countries, specific neonatal palliative care referral services were identified. Conclusion. PPC provision is flourishing across the region; however, development is less accentuated in low-to-middle-income countries. Efforts need to be devoted to the conceptualization and definition of the models of care used to respond to the unmet need of PPC in Europe. The question whether specialized services are required or not should be further explored. Strategies to regulate and cover patients in need should be adapted to each national health system. (C) 2020 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
Revista:
PALLIATIVE MEDICINE
ISSN:
0269-2163
Año:
2020
Vol.:
34
N°:
8
Págs.:
1044 - 1056
Background: Service provision is a key domain to assess national-level palliative care development. Three editions of the European
Association for Palliative Care (EAPC) Atlas of Palliative Care monitored the changes in service provision across Europe since 2005.
Aim: To study European trends of specialized service provision at home care teams, hospital support teams, and inpatient palliative
care services between 2005 and 2019.
Design: Secondary analysis was conducted drawing from databases on the number of specialized services in 2005, 2012, and 2019.
Ratios of services per 100,000 inhabitants and increase rates on number of services for three periods were calculated. Analysis of
variance (ANOVA) analyses were conducted to determine significant changes and chi-square to identify countries accounting for the
variance. Income-level and sub-regional ANOVA analysis were undertaken.
Setting: 51 countries.
Results: Forty-two countries (82%) increased the number of specialized services between 2005 and 2019 with changes for home care
teams (104% increase-rate), inpatient services (82%), and hospital support teams (48%). High-income countries showed significant
increase in all types of services (p <¿0.001), while low-to-middle-income countries showed significant increase only for inpatient
services. Central¿Eastern European countries showed significant improvement in home care teams and inpatient services, while
Western countries showed significant improvement in hospital support a
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2019
Vol.:
58
N°:
3
Págs.:
445 - 453.e1
Context. International consensus on indicators is necessary to standardize the global assessment of palliative care (PC) development. Objectives. To identify the best indicators to assess current national-level PC development. Methods. Experts in PC development were invited to rate 45 indicators organized by domains of the World Health Organization Public Health Strategy in a two-round RAND/UCLA-modified Delphi process. In the first round, experts rated indicators by relevance, measurability, and feasibility (1-9). Ratings were used to calculate a global score (1-9). Indicators scoring >7 proceeded to the second round for fine-tuning of global scores. Median, confidence interval, Content Validity Index, and Disagreement Index were calculated. Indicators scoring a lower limit 95% confidence interval of >7 and a Content Validity Index of >= 0.30 were selected. Results. 24 experts representing five continents and several organizations completed the study. 25 indicators showed a high content validity and level of agreement. Policy indicators (n = 8) included the existence of designated staff in the National Ministry of Health and the inclusion of PC services in the basic health package and in the primary care level list of services. Education indicators (n = 4) focused on processes of official specialization for physicians, inclusion of teaching at the undergraduate level, and PC professorship. Use of medicines indicators (n = 4) consisted of opioid consumption, availability, and prescription requirements. Services indicators (n = 6) included number and type of services for adults and children. Additional indicators for professional activity (n = 3) were identified. Conclusion. The first list including 25 of the best indicators to evaluate PC development at a national level has been identified. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Revista:
WELLCOME OPEN RESEARCH
ISSN:
2398-502X
Autores:
Rhee, J. Y.; Garralda, E; Namisango, E.; et al.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2018
Vol.:
56
N°:
2
Págs.:
230 - 238
CONTEXT:
To date, there is no study comparing palliative care (PC) development among African countries.
OBJECTIVE:
To analyze comparatively PC development in African countries based on region-specific indicators.
METHODS:
Data were obtained from the APCA Atlas of PC in Africa and a comparative analysis conducted. Nineteen indicators were developed and defined through qualitative interviews with African PC experts and a two-round modified Delphi consensus process with international experts on global PC indicators. Indicators were grouped by the WHO public health strategy for PC dimensions. These indicators were then sent as a survey to key informants in 52/54 African countries. Through an expert weighting process and ratings from the modified Delphi, weights were assigned to each indicator.
RESULTS:
Surveys were received from 89% (48/54) of African countries. The top three countries in overall PC development were, in order, Uganda, South Africa, and Kenya. Variability existed by dimension. The top three countries in specialized services were Uganda, South Africa, and Nigeria; in policies, it was Botswana followed by parity among Ethiopia, Rwanda, and Swaziland; in medicines, it was Swaziland, South Africa, then Malawi; in education, it was equivalent between Uganda and Kenya, then Ghana and Zambia.
CONCLUSION:
Uganda, South Africa, and Kenya are the highest performing countries and were the only ones with composite scores greater than 0.5 (50%). However, not one country universally supersedes all others across all four PC dimensions. The breakdown of rankings by dimension highlights where even high-performing African countries can focus their efforts to further PC development.
Revista:
MEDICINA PALIATIVA
ISSN:
1134-248X
Año:
2018
Vol.:
25
N°:
3
Págs.:
119 - 120
Autores:
Rhee, J. Y. (Autor de correspondencia); Garralda, E; Namisango, E.; et al.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2018
Vol.:
21
N°:
3
Págs.:
342-353
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2018
Vol.:
21
N°:
10
Págs.:
1398-1407
Resumen Contexto: La Academia Pontificia de la Vida (PAV) es una institucion academica de la Santa Sede (Vaticano) cuyo objetivo es promover una vision catolica de la etica biomedica. La PAV invito a una serie de expertos en Cuidados Paliativos (CP) de todo el mundo, de todas las creencias, a desarrollar recomendaciones estrategicas para el desarrollo global de CP (Grupo PAL-LIFE). Diseno: Trece expertos internacionales reconocidos por su actividad promotora global de CP participaron en un estudio Delphi on-line. En un proceso de cuatro rondas, se pidio a los participantes que identificasen los grupos de interes o instituciones claves para la promocion de CP y que propusieran, para cada uno de ellos, recomendaciones estrategicas para el desarrollo de CP. Cada ronda incorporaba los comentarios de las rondas previas hasta lograr el consenso en las recomendaciones mas importantes. En una ultima fase, al grupo de expertos se le solicito la jerarquizacion por importancia de los grupos clave en una escala de 1 a 13. Tambien se solicitaron sugerencias concretas para la implementacion de las recomendaciones. Mediante analisis cluster se ordenaron los grupos de interes en dos niveles de importancia para el desarrollo de CP. Resultados: Trece recomendaciones fueron seleccionadas como las mas importantes (una por cada grupo clave). Las recomendaciones para los grupos mejor puntuados fueron: (1) Responsables Politicos: garantizar el acceso universal a los CP; (2) Academia: ofrecer cursos obligatorios de CP en el pregrado; (3) Profesionales sanitarios: promover una certificacion adecuada; (4) Hospitales e Instituciones sanitarias: asegurar el acceso a medicamentos de CP; y (5) Asociaciones de CP: ser promotoras eficaces y trabajar con los gobiernos en la implementacion de las recomendaciones internacionales sobre CP. Tambien se presentan recomendaciones para los ocho grupos clave restantes. Discusion: Este documento representa la posicion oficial de la PAV en lo que respecta a estrategias de promocion para el desarrollo de los CP en el mundo.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2018
Vol.:
55
N°:
5
Págs.:
1313 - 1320
CONTEXT:
Factors contributing to and impeding palliative care (PC) development in Africa can provide insights into current strategies for advancing PC.
OBJECTIVES:
To identify key factors affecting PC development in African countries from in-country PC experts' perspectives.
METHODS:
Sixteen PC experts from seven African countries undertook semi-structured interviews on PC development in their respective countries. An interpretive description approach was adopted, with data analyzed using constant comparison.
RESULTS:
Emerged themes included: drivers, strengths, challenges, and aspirations for PC development in Africa. Drivers included advocates and pioneering organizations, HIV/AIDS, culture of caregiving, and the World Health Assembly PC Resolution. Strengths included community health workers, the special role of nurses, diversity of services, and short training courses. Challenges included lack of PC education, lack of standardization in implementation, limited availability of and/or accessibility to morphine, poverty and disease burden, and lack of funding for PC. Aspirations included integration of PC, specialization in PC, nurse prescribing, and strong partnerships with Ministries of Health. Factors already highlighted in the literature were only briefly discussed.
CONCLUSION:
The key factors underpinning PC development in the seven countries contributed to the beginnings of PC in Africa, fueled by advocates that built on existing strengths to maximize opportunities
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2018
Vol.:
21
N°:
11
Págs.:
1621 - 1626
Background: In Europe in recent decades, university teaching of palliative medicine (PM) has evolved. In some countries it has been introduced as a compulsory subject in all medical schools, but in a majority of countries it remains an isolated subject at few universities. Objective: To explore how PM has been introduced into the curricula and how it is currently being taught at different European universities. Method: Case study method using face-to-face semistructured interviews with experienced PM professors, comparing how they have developed PM undergraduate programs at their universities. Results: An intentional sample of eight university professors from Spain, France, UK, Italy, Hungary, Sweden, Germany, and Poland was chosen. The introduction of PM in the universities depends on the existence of a favorable social and political context in relation to palliative care and the initiative of pioneers, trusted by students, to push this education forward. A PM curriculum frequently starts as an optional subject and becomes mandatory in a short period. In the reported universities, PM uses a wide variety of teaching methods, such as lectures, workshops, role-plays, and discussions. PM assessment included tests, discussions, reflections, portfolios, and research works. According to respondents' opinions, lack of recognition, funding, and accredited teachers, along with competition from other curricula, are the main barriers for palliative medicine teaching development at universities. Conclusion: Diverse paths and tools have been identified for PM teaching in Europe. The described cases may shed light on other medical schools to develop PM curricula.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2018
Vol.:
21
N°:
10
Págs.:
1389 - 1397
ackground: The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which aims to develop and promote Catholic teachings on questions of biomedical ethics. Palliative care (PC) experts from around the world professing different faiths were invited by the PAV to develop strategic recommendations for the global development of PC (PAL-LIFE group). Design: Thirteen experts in PC advocacy participated in an online Delphi process. In four iterative rounds, participants were asked to identify the most significant stakeholder groups and then propose for each, strategic recommendations to advance PC. Each round incorporated the feedback from previous rounds until consensus was achieved on the most important recommendations. In a last step, the ad hoc group was asked to rank the stakeholders' groups by order of importance on a 13-point scale and to propose suggestions for implementation. A cluster analysis provided a classification of the stakeholders in different levels of importance for PC development. Results: Thirteen stakeholder groups and 43 recommendations resulted from the first round, and, of those, 13 recommendations were chosen as the most important (1 for each stakeholder group). Five groups had higher scores. The recommendation chosen for these top 5 groups were as follows: (1) Policy makers: Ensure universal access to PC; (2) Academia: Offer mandatory PC courses to undergraduates; (3) Healthcare workers: PC professionals should receive adequate certification; (4) Hospitals and healthcare centers: Every healthcare center should ensure access to PC medicines; and (5) PC associations: National Associations should be effective advocates and work with their governments in the process of implementing international policy framework. A recommendation for each of the remaining eight groups is also presented. Discussion: This white paper represents a position statement of the PAV developed through a consensus process in regard to advocacy strategies for the advancement of PC in the world.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2017
Vol.:
20
N°:
12
Págs.:
1372-77
Background: Palliative care (PC) research in Africa has been proposed as a fifth dimension of the World Health Organization PC Public Health Strategy. We conducted a scoping review of published articles (2005-2016) on palliative care development (PCD) in African countries. Forty-seven articles were found across 26 countries.
Objective: To study whether the number of published articles on PCD in countries in Africa can be used as an indicator of PCD.
Design: This is a secondary analysis of a completed scoping review.
Measurements: Spearman correlations were applied to the number of published articles ("published articles") and the number of published articles with a coauthor from a high-income country (HIC) ("HIC published articles") with level of PCD using Lynch et al's updated world map (PC World Map) as a proxy. A subanalysis was undertaken for Anglophone versus non-Anglophone countries.
Results: There were positive Spearman correlations (r) between the PC World Map's levels and published articles (r¿=¿0.73; p¿<¿0.001), and with HIC published articles (r¿=¿0.68; p¿<¿0.001). For Anglophone countries, the r was statistically significant (p¿<¿0.001) at 0.69 and 0.70, versus 0.58 and 0.45 for non-Anglophone countries for published articles and HIC published articles, respectively. Kruskal-Wallis test showed a statistically significant difference between Anglophone and non-Anglophone countries for both published articles and HIC published articles (p¿<¿0.01).
Conclusion: Publish
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2017
Vol.:
22
N°:
11
Págs.:
1195-1204
Results: In total, 48/53 (91%) European countries responded to the survey. A total of 43 barriers and 65
opportunities were identified as being related to PC integration. Main barriers were (1) lack of basic PC training,
with a particular emphasis on the absence of teaching at the undergraduate level; (2) lack of official certification
for professionals; (3) lack of coordination and continuity of care for users and providers; (4) lack of PC
integration for noncancer patients; (5) absence of PC from countries¿ regulatory frameworks; and (6) unequal
laws or regulations pertaining to PC within countries. Innovations in education and new regulatory frameworks
were identified as main opportunities in some European countries, in addition to opportunities around the
implementation of PC in home care, nursing home settings, and the earlier integration of PC into patients¿ continuum
of care. With increasing provision of services, more challenges for the integration are detected ( p < 0.005).
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2017
Vol.:
12
N°:
10
Págs.:
e0184806
Introduction The goal of palliative care (PC) is to improve the quality of life of terminal stage patients and their families. The subject frequently appears in the mass-media and this helps create a socially accepted identity. The aim of this study is to describe and analyse PC related news items appeared in the Spanish written media. Methodology A descriptive cross-sectional study was designed. Considering diffusion, scope and the range in editorial policy criteria, four printed newspapers (PN) were selected, together with four exclusively digital media sources (DM). Through Mynews, a newspaper content depository, and the search tool for each DM website, articles published between 2009 and 2014 which included the terms "palliative care" and "palliative medicine" were sought. A questionnaire was created to characterise each article identified and a descriptive analysis was undertaken. Results A total of 627 articles were identified, of which 359 (57%) were published in PN (42% in the printed editions -PE- 16% in their online editions -OE-) and 268 (43%) in DM. In general, they appeared mainly in sections concerning Health (23%), Culture and Society (18%) and General/Home News (15%). In PE, just 2% were found in the Health section and nearly 70% in Culture and Society and General/Home News. Most of the articles were informative in nature and contained socio-political messages (90%). Statements by PC professionals were found in 35% of the articles and by politicians in 32%. The most frequent content was related to facing end of life (74%) and patient quality of life (70%). Conclusions The Spanish written media reflects the socio-political interest aroused by PC. Nevertheless, messages circulating about PC do not describe professional practice, or the contribution of the same for patients. Content more in line with the clinical practice might help contribute to the development of this new area of medicine.
Autores:
Siouta N; van Beek K; van der Eerden ME; et al.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2016
Vol.:
15
N°:
1
Págs.:
56
Based on our findings, a generic framework for integrated PC in cancer and chronic disease is proposed. This framework fosters integration of PC in the disease trajectory concurrently with treatment and identifies the importance of employing a PC-trained multidisciplinary team with a threefold focus: treatment, consulting and training.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2016
Vol.:
15
N°:
1
Págs.:
49
The results show that explications of IPC in the Spanish literature exist, but that there is insufficient evidence of its impact in clinical practice. This review may be of interest for Spanish-speaking countries and for others seeking to know the status of IPC in the literature in their home nations.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2016
Vol.:
52
N°:
3
Págs.:
370 - 377
The ranking method permitted a comparison of palliative care development between countries and shows changes over time. Recommendations for improving the ranking include improvements to the methodology and greater explanation of the levels and changes it reveals.
Autores:
Van Beck K; Siouta N; Preston N; et al.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2016
Vol.:
15
N°:
1
Págs.:
26
Overall, most of the identified guidelines/pathways highlighted the importance of the holistic approach of IPC. The studies that were found to fulfil at least 10/11 Emanuel's IPC criteria could serve as benchmarks of IPC.
Autores:
Siouta N; Van Beck K; Preston N; et al.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2016
Vol.:
15
N°:
1
Págs.:
18
The results illustrate that there is a growing awareness for the importance of integrated PC in patients with advanced CHF or COPD. At the same time, however, they signal the need for the development of standardized strategies so that existing barriers are alleviated.
Revista:
PALLIATIVE MEDICINE
ISSN:
0269-2163
Año:
2015
Vol.:
30
N°:
4
Págs.:
251 - 262
Although there has been a positive development in overall palliative care coverage in Europe between 2005 and 2012, the services available in most countries are still insufficient to meet the palliative care needs of the population.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2015
Vol.:
50
N°:
4
Págs.:
516 - 523.e2
CONTEXT:
The lack of palliative medicine (PM) education has been identified as a barrier to the development of the discipline. A number of international institutions have called for its implementation within undergraduate medical curricula.
OBJECTIVES:
The objectives are to describe the situation of undergraduate PM education in Europe and to propose a scoring system to evaluate its status.
METHODS:
This descriptive study was conducted with data provided by key experts from countries of the World Health Organization European Region (n = 53). A numerical scoring system was developed through consensus techniques.
RESULTS:
Forty-three countries (81%) provided the requested information. In 13 countries (30%), a PM course is taught in all medical schools, being compulsory in six of them (14%). In 15 countries (35%), PM is taught in at least one university. In 14 countries (33%), PM is not taught within medical curricula. A full professor of PM was identified in 40% of countries. Three indicators were developed to construct a scale (rank 0-100) of educational development: 1) proportion of medical schools that teach PM (weight = 32%); 2) proportion of medical schools that offer PM as a compulsory subject (weight = 40%); 3) total number of PM professors (weight = 28%). The highest level of PM educational development was found in Israel, Norway, the U.K., Belgium, France, Austria, Germany, and Ireland.
CONCLUSION:
PM is taught in a substantial number of undergraduate medical programs at European universities, and a qualified teaching structure is emerging; however, there is a wide variation in the level of PM educational development between individual countries.
Revista:
EUROPEAN JOURNAL OF PUBLIC HEALTH
ISSN:
1101-1262
Año:
2015
Vol.:
26
N°:
2
Págs.:
230 - 235
Background: With the goal of achieving greater unity and coherence, the Council of Europe developed a national palliative care (PC) policy framework-Recommendation (2003) 24. Although directed at member states, the policy spread to the wider World Health Organisation (WHO) European Region. This article aims to present the current situation relating to national PC health policies in European countries.
Methods: A cross-sectional survey was conducted in 53 European countries of the WHO European Region. Relevant data reported (i) the existence of official documents concerning the provision of PC; (ii) the role of health departments and policymakers in the evaluation of PC provision and (iii) the availability of financial resources for PC provision.
Results: In total, 46/53 (87%) EU and non-EU countries responded. PC legislation is established in 20 (71%) EU and nine (50%) non-EU countries. A total of 12 (43%) EU countries possess a PC plan or strategy in comparison with six (33%) non-EU countries. Individuals from Departments of Health and designated policymakers have established collaborative PC efforts. Quality systems have been initiated in 15 (54%) EU and four (22%) non-EU countries. Significant differences were not found in the reporting of payments for PC services between European regions.
Conclusion: An improvement in national PC policy in both EU and non-EU countries was observed. Future priorities include potential initiatives to improve relationships with policymakers, establish quality control programmes and ensure financial support for PC.
Revista:
EUROPEAN JOURNAL OF PALLIATIVE CARE
ISSN:
1352-2779
Año:
2014
Vol.:
21
N°:
6
Págs.:
306-308