Media Watch

2017; Volume 18, No 3, March

Media Watch: an annotated list of recent articles about palliative care in the news media and the literature

Providing palliative care to patients with cancer: Addressing the needs in Kenya

Asia-Pacific Journal of Oncology Nursing, 2017; 4 (1): 45-49. Cancer is the third highest cause of death in Kenya, preceded by infectious and cardiovascular diseases, and in most cases, diagnosed in later stages. Nurses are the primary caregivers, assessing and managing these patients in the clinic, in inpatient settings, and in rural and remote communities. While cancer rates remain high, the burden to the patient, the caregiver, and society as a whole continues to rise. Kenya's poverty complicates cancer even further. Many Kenyans are unaware of cancer's signs and symptoms, and limited diagnostic and treatment centers are available. Despite these barriers, there is still hope and help for those in Kenya, who suffer from cancer. The World Health Organization has stated that palliative care (PC) is a basic human right and nurses providing this care in Kenya are making efforts to support cancer patients' ongoing needs, in order to promote compassionate PC and prevent suffering. The purpose of this paper is to address the PC needs of patients with cancer in Kenya by providing education to nurses and influencing health-care policy and education at micro and macro levels. A case study weaved throughout will highlight these issues.

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What is the value of palliative care provision in low-resource settings?

BMJ Global Health | Online – 14 February 2017 – Palliative care (PC) is a human right, yet there are significant disparities in the worldwide provision of PC services for individuals with life-limiting illness. Of the 40 million people globally in need of PC, just 14% receive it, largely in high-income countries. While proven to be “cost-effective” in high-income settings based on principles of cost avoidance, the costs of illness for incurable disease in low-resource settings is largely unknown. The critical absence of PC services in low-resource settings results in significant costs being absorbed by the individual, family and local community. This results in intractable, devastating and perpetuating financial losses that are passed on to future generations and function as a catalyst in the poverty cycle while stunting local economic growth. In considering the direct, indirect and broader societal costs of incurable disease in low-resource countries, PC should be considered as a poverty-reduction strategy.

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A nationwide study in Taiwan

Branding palliative care units by avoiding the terms “palliative” and “hospice”

INQUIRY: The Journal of Health Care Organization, Provision & Financing | Online – 24 January 2017 – The term “palliative care” (PC) has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with PC. For example, using the term “supportive care” instead of “palliative care” in naming PC units has been proposed in several studies. In Taiwan, terms other than “palliative” and “hospice” are already widely used in the names of PC units. With this in mind, this study investigated the characteristics of PC unit names in order to better understand the role of naming in PC. The authors found a clear phenomenon of avoiding use of the terms “palliative” and “hospice” in the naming of PC units, a phenomenon that reflects the stigma attached to the terms “palliative” and “hospice” in Taiwan. At the time of the study (September, 2016), there were 55 PC units in Taiwan. Only 20% of the PC unit names included the term “palliative,” while 25.2% included the term “hospice.” Religiously affiliated hospitals were less likely to use the terms “palliative” and “hospice.” There was also a lower prevalence of use of the terms “palliative” and “hospice” for naming PC units in private hospitals than in public hospitals.

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End-of-life care and opioid use in India: Challenges and opportunities

Journal of Global Oncology | Online – 25 January 2017 – In 2011, the WHO estimated that 20 million people required end-of-life palliative care (PC), of whom 78% lived in low- and middle-income countries. In a country like India, which contains 17.5% of the world population, end-of-life PC is almost non-existent, as was noted in the 2015 Quality of Death Index by The Economist Intelligence Unit. According to estimates from India, approximately 10 million people may require PC services, of whom 1 million have cancer and 7 million have other life-limiting conditions. It is estimated that the yearly incidence of cancer in India will increase from 1 million in 2015 to 1.7 million by 2035. The 2015 Global Burden of Disease data estimated that 675,000 persons die with a diagnosis of cancer every year in India. The gravity of the situation could not be any more evident than in the fact that more than 26,000 individuals suffering from cancer, AIDS, paralysis, and other chronic illnesses ended their life in 2013, accounting for nearly 20% of all deaths caused by self-harm in India. Ease of access to opioid pain medications is an integral component of effective PC service. In India, poppy plants are grown only in three states and are under strict government licensing. The government-owned company Opium & Alkaloid Works has only two factories processing raw materials from poppy plants into morphine sulphate powder for the entire country. Manufacturers obtain the compound from the factory, which is then converted into tablets and injections. Total morphine consumption in India was a paltry 278 kg in 2014. If a patient with terminal cancer requires 75 mg of morphine per day for pain relief for approximately 90 days, this amount of 278 kg is only sufficient to adequately treat 40,000 patients.

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Palliative care in humanitarian medicine

Palliative Medicine | Online – 23 January 2017 – Palliative care (PC) interventions have historically been neglected in the practice of humanitarian medicine. This may come as a surprise since it is a sombre reality medical practitioners are frequently witness to death and dying in their response to humanitarian crises. At the World Health Assembly (WHA) in May 2014, the World Health Organization affirmed a commitment to develop and implement policies that integrate PC services across the continuum of care. Three days following the close of the WHA, the Centers for Disease Control & Prevention released cumulative data estimating that 187 people had died from Ebola in Liberia, Sierra Leone, and Guinea. By the end of the summer, this number had increased tenfold. The exceptionally high mortality rates associated with the West African Ebola outbreak have prompted further reflection on the role of PC in humanitarian crises. A similar trend was seen during the height of the HIV/AIDS epidemic in the late 1990s, as health actors were faced with the need to focus on PC in the absence of affordable anti-retroviral treatment (ART). In addition to high mortality situations such as the Ebola and pre-ART HIV epidemics, a substantial proportion of medical humanitarian programmes still focus on the treatment of common diseases in protracted crises in settings with limited health infrastructure. Without the necessary capacity – or the required political commitment – in such circumstances, it is often not possible to deliver clinical care of the same breadth and standard as can be expected in higher resource settings.

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Compassionate communities and their role in end-of-life care

University of Ottawa Journal of Medicine | Online – Accessed 28 January 2017 – Death is a universal experience that has often been underrepresented in discussion between loved ones and the healthcare system. Given the need for support throughout all aspects of end-of-life care, an emerging paradigm shift shows Compassionate Communities as a new standard for placing responsibility back in the community and promoting respectful and compassionate care. Development of Compassionate Communities promotes quality end-of-life care designed to meet the individualized needs of the dying as well as their caregivers.

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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.

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