Improving access to quality palliative care

14 April, 2019

Dear HIFA colleagues,

'There is limited access to quality Palliative Care (PC) for advanced cancer patients being treated in Sub Saharan Africa due to limited PC knowledge among health care providers', say the authors of this conference abstract. 'Monthly telementoring sessions consisting of case presentations, discussions, and didactic lectures' proved to be 'a feasible, cost effective, pragmatic approach to disseminate PC knowledge without the need for travel'.

Citation, abstract and a comment from me below.

CITATION: ECHO palliative care in Africa (ECHO-PACA): Improving access to quality palliative care.

Journal of Clinical Oncology. Conference: 2018 Annual Meeting of the American Society of Clinical Oncology, ASCO 2018. United States. 36 (15 Supplement 1) (no pagination), 2018. Date of Publication: May 2018.

Yennu S.; Amos C.E.; Weru J.; Addo E.B.V.N.D.; Arthur J.A.; Soyannwo O.; Chidebe R.C.W.; Bruera E.; Reddy S.

https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.6545

ABSTRACT

Background: There is limited access to quality Palliative Care (PC) for advanced cancer patients being treated in Sub Saharan Africa due to limited PC knowledge among health care providers in the region. The goal of this innovative project was to improve access by offering cost-effective training to these providers using Project ECHO (Extension for Community Healthcare Outcomes), an established telementoring and support program. Our aim was to evaluate feasibility, attitudes, knowledge, and efficacy of participants of ECHO-PACA to deliver PC.

Method(s): An interdisciplinary team at the UT MD Anderson Cancer Center, guided by PC providers in Sub Saharan Africa, developed a standardized curriculum based on PC needs in the region. Participants were then recruited and monthly telementoring sessions consisting of case presentations, discussions, and didactic lectures began in July 2016. Program participants included 14 clinics and teaching hospitals from Ghana, Kenya, Nigeria, South Africa, and Zambia, with sessions offering participants the ability to interact and learn new skills in PC. Participants were surveyed at the beginning, mid-point and end of the 16 month program to evaluate changes in self-perceived efficacy in pain assessment and management, Identification of signs/symptoms of imminent death, Identifying and addressing challenging communication issues related to end of life.

Result(s): Median participation per session was 30. Median duration of monthly meetings was 90 minutes. 33 of 40 initial participants (83%) completed the survey. There was significant improvement in appropriate use of nonopioid analgesics for persistent pain (p = .03), titrating opioids to optimize pain control (p = .03), Identification of signs/symptoms of imminent death (p = .05), and Identifying and addressing challenging communication issues related to end of life (p = .02).

Conclusion(s): ECHO-PACA was a feasible, cost effective, pragmatic approach to disseminate PC knowledge without the need for travel, which has the potential to increase access to quality PC through enhancing the skills of providers in resource challenged areas of Sub Saharan Africa. Further studies are needed to evaluate ECHO-PACA impact on patient outcomes.

COMMENT (NPW): It's important to acknowledge that there are health care providers in Africa with huge experience and expertise of palliative care in low-resource settings, such as HIFA member Anne Merriman (Director of Hospice Africa). It's not clear whether the present study engaged this expertise. Notwithstanding, there is a huge level of avoidable suffering among patients approaching the end of life, and this is partly related to lack of expertise where it is needed. Misconceptions about (and access to) opiates are part of this. HIFA is keen to start a new project on Palliative Care with WHO and others, subject to funding. Full sponsorship of a HIFA project costs £5k per year. Please contact me if you are interested.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org