Lessons from the Literature

Volume 23, Number 8: August 2022

On My Radar: Underserved & vulnerable populations

Barry Ashpole has ended Media Watch but has begun releasing, on occasion instead of weekly, a selection of articles from the medical periodicals that focus specifically on end-of-life care for underserved and vulnerable populations. We will be publishing examples from each. This is his first.

Place of Death and Associated Factors in 12 Latin American Countries: A total population study using death certificate data. J Global Health 2022; 12: 04031.

Little is known about place of death in Latin America, although this data are crucial for health system planning. Data from the most recent year available was compiled for Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Ecuador, Mexico, Paraguay, Peru, and Uruguay: a sample of 2,994,685 deaths. A strong variation was found, with home deaths ranging from 20% (Brazil) to 67.9% (Guatemala), and hospital deaths from 22.3% (Guatemala) to 69.5% (Argentina). Factors such as policy and health care system seem to have a crucial impact on where people die in Latin America.
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Progress Update: Development of Palliative Care from 2017 to 2020 in Five Countries in Eurasia. J Pain Symptom Manage 2022:64(2): 100-109. DOI: 10.1016/j.jpainsymman.2022.04.177

By 2021, Armenia, Moldova, and Ukraine had significantly scaled up service availability and palliative care was firmly embedded in universal health coverage in Moldova and Ukraine whereas progress in Georgia and Tajikistan was more modest. Experiences in these countries suggest that a strategy that initially emphasizes training, technical assistance, and engagement to create the building blocks for palliative care combined with or followed by public advocacy and campaigning to demand roll out of services can result in significant advances.
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Estimating the Impact of Inpatient Palliative Care Consultations on Health Care Costs in a Low- and Middle-Income Country. J Palliat Med; published online June 22, 2022. DOI: 10.1089/jpm.2021.0637

Daily hospital costs were 10% lower for patients in Lebanon who received a PC consult (n = 346) compared with controls (n = 698), a difference that was more pronounced among patients who died during their hospitalization and when the consult was conducted earlier in the hospital course. The group that received a palliative care consult also had a shorter length of stay, fewer readmissions, and fewer emergency visits after discharge.

Face and Content Validity, Acceptability, Feasibility, and Implementability of a Novel Outcome Measure for Children with Life-Limiting or Life-Threatening Illness in Three Sub-Saharan African Countries. Palliat Med 2022; 36(7): 1140-1153. DOI: 10.1177/02692163221099583

This study set out to determine face and content validity, comprehensiveness, comprehensibility, acceptability and feasibility, and implementability of the Children’s Palliative Care Outcome Scale (C-POS), the first measure developed for children with life-limiting and -threatening illness, in Kenya, South Africa, and Uganda. It concludes that C-POS is feasible, comprehensible, and acceptable for use in clinical settings.

Editor’s note: Find the C-POS used on the African Palliative Care Association website.

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