Putting the ‘public’ into public health: Innovative partnerships in palliative and end of lifeCare: The Kenya experience

Palliative care should not be seen as a luxury, but as a necessary essential service. It should not be only for the few who can afford it, or for those living in better socioeconomic conditions. The Kenya Hospice and Palliative Care Association works together with its stakeholders such as the Ministry of Health, government hospitals, mission hospitals, hospices, and community-based organizations, and training institutions to ensure that there is greater awareness of and access to palliative care across the country. In the past 7 years, there has been a significant improvement in palliative care in Kenya focusing on availability, accessibility, and affordability of services through scaling up existing services as well as integrating palliative care into the public health care system. This paper briefly outlines this development while highlighting the challenges faced in the geographical context of sub-Saharan Africa.     

The Declaration of Venice: palliative care research in developing countries

In May 2006 at the Fourth Research Forum of the European Association for Palliative Care (EAPC) in Venice Italy, recognizing that the World Health Organization definition of palliative care calls for "impeccable assessment and treatment of physical symptoms and of psychological, social and spiritual problems," the EAPC and the International Association for Hospice and Palliative Care (IAPC) introduced a declaration to develop a global palliative care research initiative.     

The International Association for Hospice and Palliative Care list of essential medicines for palliative care

The World Health Organization (WHO) requested that the International Association for Hospice and Palliative Care (IAHPC) develop a list of essential drugs for palliative care to be included in the WHO list of essential drugs. This report describes the process by which this specialized list was developed and the outcomes of that process.     

Palliative medicine teaching program at the University of Cape Town: integrating palliative care principles into practice

The article describes the development of the postgraduate palliative medicine programs at the University of Cape Town (UCT) through collaboration with the Palliative Medicine Division from the University of Wales College of Medicine in Cardiff, United Kingdom. The course is presented as a distance-learning program supported by web-based learning with three face-to-face teaching sessions during the course. UCT recognized the urgent need to assist African doctors in developing the medical skills required to care for an ever-increasing population of patients and their families who are faced with terminal illness and the physical, emotional, psychosocial, and spiritual distress associated with end-of-life issues. Since 2001, 139 postgraduate students have registered for the course, 10% of whom are from African countries other than South Africa. Using the experience from UCT in distance-learning programs, the Hospice Palliative Care Association developed an interdisciplinary course, "Introduction to Palliative Care." This course recognizes that, although improvement in patient care and palliative care will come as undergraduate training in palliative care is established, it is essential that previously qualified health care professionals are able to enhance their palliative care knowledge, skills, and attitudes. Trainers provide support to participants over a six-month period and assist in the transference of knowledge and skills into the workplace.     

Facts and indicators on palliative care development in 52 countries of the WHO European region: results of an EAPC Task Force

The European Association for Palliative Care Task (EAPC) Force on the Development of Palliative Care in Europe was created in 2003 and the results of its work are now being reported in full, both here and in several other publications. The objective of the Task Force is to assess the degree of palliative care development in the European Region as defined by the World Health Organization (WHO). The Task Force is a collaboration between EAPC, the International Observatory on End of Life Care, Help the Hospices and the International Association for Hospice and Palliative Care. The University of Navarra have collaborated in the dissemination of results and is involved in further developments of this group. Four studies, each with different working methods, made up the study protocol: a literature review, a review of all the existing palliative care directories in Europe, a qualitative ;Eurobarometer' survey and a quantitative ;Facts Questionnaire' survey. The work of the Task Force covers the entire WHO European Region of 52 countries. In this article we present a comparative study on the development of palliative care in Europe, drawing on all four elements of the study.Different models of service delivery have been developed and implemented throughout the countries of Europe. For example, in addition to the UK, the countries of Germany, Austria, Poland and Italy have a well-developed and extensive network of hospices. The model for mobile teams or hospital support teams has been adopted in a number of countries, most notably in France. Day Centres are a development that is characteristic of the UK with hundreds of these services currently in operation. The number of beds per million inhabitants ranges between 45-75 beds in the most advanced European countries, to only a few beds in others. Estimates on the number of physicians working full time in palliative care are shown. The countries with the highest development of palliative care in their respective subregions as measured in terms of ratio of services per one million inhabitants are: Western Europe - UK (15); Central and Eastern Europe - Poland (9); Commonwealth of Independent States - Armenia (8). This paper also presents indicators on the development of palliative care based on the bibliometric analysis of scientific journals and on the vitality of the palliative care movement in each country.     

Ensuring palliative medicine availability: the development of the IAHPC list of essential medicines for palliative care

In response to a request from the World Health Organization (WHO), the International Association for Hospice and Palliative Care (IAHPC) developed a List of Essential Medicines for Palliative Care based on the consensus of palliative care workers from around the world. IAHPC designed a process of five steps, which included developing a set of ethical guidelines; identifying the most common symptoms in palliative care; identifying a list of medications to treat those symptoms; carrying out a survey using a modified Delphi process with participants from developed and developing countries; and convening a meeting of representatives from regional, international, and scientific organizations to develop the final list. Twenty-one symptoms were identified as the most common in palliative care, and an initial list of 120 medications resulted from the initial survey. Seventy-one participants from developing and developed countries responded to the Delphi survey and agreed on the effectiveness and safety of 48 medications for 18 of the 21 symptoms. The final step included discussions among representatives from 26 organizations, which led to the finalization of the list. The IAHPC List of Essential Medicines for Palliative Care includes 33 medications, of which 14 are already included in the WHO Model List. The participants agreed that there is too little evidence to recommend medications for five of the symptoms and suggested that further research be carried out to solve this need. The IAHPC and all the organizations involved in this process welcome suggestions on ways to continue to improve the List of Essential Medicines for Palliative Care and to improve access to medications for patients in need.     

Hospice and palliative care: an expert interview with Louis W. Sullivan, MD. Interview by Perry G. Fine

At the National Hospice and Palliative Care Organization's 6th Clinical Team Conference on Hospice and Palliative Care, held April 21-23, 2005, in Atlanta, Georgia, Perry G. Fine, MD, Professor in the Department of Anesthesiology at the University of Utah in Salt Lake City and Vice President of Medical Affairs for the National Hospice and Palliative Care Organization interviewed Louis W. Sullivan, MD, former Secretary of the US Department of Health and Human Services and currently President Emeritus of Morehouse School of Medicine, Chair of the Sullivan Commission-a commission to increase diversity among health professionals, Chair of the National Health Museum, Cochair of the President's Commission on HIV/AIDS, and Chair of the President's Commission on Black Colleges and Universities, as well as Chair of Medical Education for South African Blacks. Dr. Fine and Dr. Sullivan discussed the importance of hospice and palliative care, along with some of the practical issues facing clinicians who wish to use the hospice care system.     

The Asia Pacific hospice Palliative Care Network: supporting individuals and developing organizations

The Asia Pacific Hospice Palliative Care Network is a network of individuals and organizations involved in hospice and palliative care in Asia and the Pacific. It currently has 938 members in 28 countries, of whom 793 are individual members and 145 are organizations. Since its formation in 2001, its chief activities are the support of individuals working in palliative care services and the development of links between organizations involved in palliative care within each of its sectors. The Network actively encourages the formation of umbrella bodies or national associations within each sector. Education and training is provided through the services of faculty from countries with better developed palliative care services. A diploma course has also been developed in response to regional needs.     

The Cleveland Clinic Foundation Harry R. Horvitz Palliative Care Center

In 1994, the Harry R. Horvitz Palliative Care Center opened as a dedicated inpatient palliative care unit within a comprehensive Palliative Care Program in the United States. The program is designated by the World Health Organization as a national and international demonstration project in the provision of palliative care. The mission of the program and the inpatient unit is to provide excellent care for patients with advanced cancer and their families throughout the illness and during bereavement. The need for the 23-bed inpatient unit was documented by the increasing number of cancer deaths each year and the complex physical and psychosocial problems patients and families experience throughout the course of their illness. Health care professionals specially trained in palliative care are an essential component of a dedicated program within a cancer center.     

Palliative care: what is it?

Palliative care developed during the hospice movement. Hospice was associated as a rest place for weary travelers in ancient times, many of whom were ill. Hospice first became associated with the dying in France in 1842; the first modern hospice, St. Christopher's Hospice, was established in London by Dame Cicely Saunders in 1967. It was the first facility founded as a "place" to care for the dying. In 1974, the first U.S. hospice was established in Connecticut based on a home care model. In 1975, Balfour Mount, MD, founded the Palliative Care Service in The Royal Victoria Hospital in Montreal; the concept of "palliative care" in North America was established (Sheehan & Forman, 1996). The traditional view of palliative care indicates that symptomatic and supportive care are generally withheld until all attempts to treat the underlying disease and other medical problems are exhausted. Many times, palliative care is offered with little time left for living. Palliative care should be considered in conjunction with active treatment, and, as death nears, palliative care becomes more important as active treatment while cure become less important.     

The worldwide palliative care alliance: networking national associations

Hospice and palliative care has a history of collaboration. National associations of hospice and palliative care are now developing across the world and have produced a new partnership, the Worldwide Palliative Care Alliance. The alliance aims to support the scale-up of services across the world and share best practice across national associations. The alliance facilitates World Hospice and Palliative Care Day and advocacy activities such as the use of the Korea Declaration. There are a number of work groups covering areas such as education and training, organizational development, and quality and standards, which aim to assist national associations and hospice and palliative care services to develop. A third worldwide summit of national associations is planned for 2007.     

The International Association for Hospice and Palliative Care: international activities and future initiatives

The International Association for Hospice and Palliative Care (IAHPC) is a global organization dedicated to the development and improvement of palliative care. The mission of IAHPC is to increase the availability and access to high quality hospice and palliative care for patients and families throughout the world. It does this by promoting communication, facilitating and providing education, and by becoming an information resource for patients, professionals, health care providers and policy makers around the world. This report describes activities of the IAHPC throughout the word and planned future initiatives.     

Stimulant laxatives and opioid-induced constipation

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).     

Fentanyl (transmucosal)

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).     

Anti-epileptic drugs

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also?available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).     

Role of the palliative care pharmacist: an example from North Derbyshire,UK

Abstract

The palliative care pharmacist in North Derbyshire provides a clinical pharmacy service, as defined in our earlier paper (1), to patients receiving specialist palliative care at Ashgate Hospice and at Chesterfield and North Derbyshire Royal Hospital (CNDRH) where the pharmacist is based. In the hospital, the service is provided directly to the out-patient Palliative Care Clinic patients and via support and advice to other generic ward and dispensary-based pharmacists extends indirectly to other patients. It is proposed to extend the role into the community when funding permits.     

PC-FACS

PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care), an electronic publication of the American Academy of Hospice and Palliative Medicine, provides palliative care clinicians with concise summaries of the most important findings from more than 50 medical and scientific journals. Each month, structured summaries and insightful commentaries on 6-10 articles help palliative care clinicians stay on top of the research that is critical to contemporary practice. PC-FACS is free to AAHPM members. Following are excerpts from recent issues, and comments from readers are welcomed at resources@aahpm.org.     

Implementation of the Adelaide Hills Palliative Care project

The Rural Palliative Care Program (RPCP) is currently being implemented in eight pilot sites across Australia, under the banner of the National Palliative Care Program. It is one of a number of initiatives commissioned by the Department of Health and Ageing that are designed to achieve the goals of the National Palliative Care Strategy. Specifically the RPCP is testing service components that aim to improve access to palliative care for people living in rural and remote communities. With facilitation from the Australian Divisions of General Practice (ADGP), each project and the program as a whole, is undergoing a formal evaluation by the Centre for Health Service Development (CHSD), University of Wollongong. A key question being investigated is whether any systemic improvements in palliative care delivery are sustainable beyond completion of the 3-year program. This paper gives the background to the RPCP. The Adelaide Hills Palliative Care Project is discussed as an example of how strategies are derived and applied in order to test key service components pertinent to the delivery of palliative care in a rural setting.     

Pc-facs

PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care), an electronic publication of the American Academy of Hospice and Palliative Medicine, provides palliative care clinicians with concise summaries of the most important findings from more than 50 medical and scientific journals. Each month, structured summaries and insightful commentaries on 6-10 articles help palliative care clinicians stay on top of the research that is critical to contemporary practice. PC-FACS is free to AAHPM members and members can earn up to 3 CME credits quarterly. Following are excerpts from recent issues, and comments from readers are welcomed at resources@aahpm.org.     

Developing collaborative person-centred practice: a pilot project on a palliative care unit

Maximizing interprofessional collaborative patient-centred practice holds promise for improving patient care and creating satisfying work roles. In Canada's evolving health care system, there are demands for increased efficiency, cost-effectiveness, and quality improvement. Interprofessional collaboration warrants re-examination because maximizing interprofessional collaboration, especially nurse-physician collaboration, holds promise for improving patient care and creating satisfying work roles. A palliative care team seized the opportunity to pilot a different approach to patient and family care when faced with a reduction in medical staff. Grounded in a collaborative patient-centred practice approach, the Canadian Hospice Palliative Care Association's National Model to Guide Hospice Palliative Care (2002), and outcomes from program retreats and workgroups, a collaborative person-centred model of care was developed for a 12-bed pilot project. Preliminary findings show that the pilot project team perceived some specific benefits in continuity of care and interprofessional collaboration, while the presence of the physician was reduced to an average of 3.82 hours on the pilot wing, compared with 8 hours on the non-pilot wings. This pilot study suggests that a person-centred model, when focused on the physician-nurse dyad, may offer improved efficiency, job satisfaction and continuity of care on a palliative care unit. Incorporating all team members and developing strategies to successfully expand the model across the whole unit are the next challenges. Further research into the impact of these changes on the health care professionals, management and patients and families is essential.