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OBJECTIVES: In India, Palliative care remains inaccessible, especially in remote areas. This study aimed at exploring the experience of caregivers related to arranging palliative care at home, for personnel and family members of an armed force. MATERIALS AND METHODS: Qualitative study based on thematic analysis of semi-structured interviews with adult caregivers - either serving personnel or their dependent family members. RESULTS: Lack of palliative care in rural areas makes arranging home care challenging for Indian caregivers, especially in armed forces. The families stay alone and personnel cannot be there to look after loved ones. Constraints of leave, financial and legal problems, frequent movement and social isolation disrupt care as well as family and community support systems, leading to psycho-social problems and stress for the serving personnel as well as families. Educating staff, integrating palliative care into existing medical services, coordinating with other agencies to increase awareness and provide care at home, access to opioids, timely leave, reimbursement of expenses, increased family accommodation, guidance about benefits, and considerate implementation of transfer policy can help mitigate some of their problems. CONCLUSION: These caregivers face physical exhaustion, psycho-social, financial, legal, and spiritual issues- some common to all rural Indians and others unique to the armed forces. Understanding their experiences will help the providers find solutions, especially in relation to the unique needs of the men in uniform.
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BACKGROUND: In the traditional 'postcard' educational technique, learners write learning points on a postcard at the end of a face-to-face teaching session. The teacher subsequently posts them back to the learners in order to remind and reinforce learning. Cardiff University's Palliative Care Masters programme adapted the traditional postcard technique to suit a modern blended learning course, introducing the concept of 'virtual postcards'. METHODS: Students were asked to complete a postcard for face-to-face teaching sessions on 'symptom control' and were free to use their postcard as they wished, e.g. to draw pictures, to list key bullet points, etc. A selection of postcards were subsequently scanned and uploaded into the corresponding online module. These were visible to all students so that they could learn from each other's virtual postcards. RESULTS: Most students felt that the virtual postcards were a useful learning material (12% did not). Around half of the students felt that having a selection of the virtual postcards was preferable to all of them being uploaded (52%; 28% expressed no preference). Students were divided as to whether this would have become too monotonous to repeat for all topics in face-to-face teaching (40% felt that these should just be used for some topics, 18% had no preference, and 42% felt that these would be useful for all topics). DISCUSSION: In general, the students found virtual postcards useful as part of blended learning, and liked learning from other people's virtual postcards as well as from their own. There needs to be a balance between how often the technique is employed, and how many postcards are uploaded, to avoid information overload and losing value.
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Currículo , Estudantes , HumanosRESUMO
CONTEXT: One of the principle obstacles identified in suboptimal management of pain in worldwide cancer patients is inadequate assessment of pain which in turn leads to poor management. In Sri Lanka, this is heralded by the lack of medical or nursing professionals qualified in Palliative Medicine/Care to date in Sri Lanka. AIM: The aims of this clinical audit were to raise awareness and optimize the assessment of pain among resident patients of a tertiary care cancer hospital by oncology doctors. METHODS: A simple "pain and associated symptom chart" was designed for the doctors of the tertiary care cancer institution to document pain experienced by resident cancer patients in terms of intensity, both upon admission and on daily clerking. The expected standards were 100% documentation for each, regardless of the presence of pain on a visual analog scale (0-10). Documentation of the site and character of pain were expected to be 80% each. RESULTS: Despite conducting three audit cycles with staff training and clarifications in between, the pain assessment practices did not be improve significantly (P > 0.05). In the third/ultimate audit cycle, it was noted that 23.5% of the charts were marked as "0" pain intensity upon admission and have been neglected thereafter. CONCLUSIONS: Pain assessment practices of the tertiary care oncology unit concerned was suboptimal. Therefore, it is of utmost importance to explore obstacles and incorporate pain assessment as a mandatory routine practice in clinical oncology units.
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The objectives of the African Organisation for Research and Training in Cancer (AORTIC), both at its inception in the early 1980s, and at its reactivation in 2000 following a decade of inactivity, included bringing the products of decades of advances in cancer research to African populations through international collaboration. The historical perspective provided in this report illustrates progress in achieving these objectives through successive continent-wide activities over a period of 30 years, culminating in the organisation's most recent conference held in Durban, South Africa, 21-24 November 2013. The constant growth in the number of attendants and increasing diversity of the nations of their origin are consistent with advances, whereby the number of participants and the nations of their origin have grown from 24 in 1983 to almost 1000 in 2013, and from 14 to 70, respectively. While earlier AORTIC conferences used to assume the atmosphere of 'jamborees', more recent ones have morphed to problem-solving events, with the concerted collaboration of international organisations, including the World Health Organisation (WHO), International Union Against Cancer (UICC), the Africa Union (AU), the US National Cancer Institute (NCI), the International Psycho-Oncology Society (IPOS), and others. The topics of discussion at the Ninth AORTIC International Conference on Cancer in Africa in Durban were those of paramount importance for low- and middle-income countries: childhood cancers, cancers of the cervix, breast, and prostate, as well as cancer care challenges resulting from ignorance, neglect, and economic deprivation. The role of environmental factors that underlie Burkitt's lymphoma was the subject of the Epidemiology of Burkitt Lymphoma in East-African Children and Minors Workshop, highlighting the NCI research programme in East Africa, while the Workshop on Cost Effectiveness of Treatment of Cancer in Africa surmised that treating childhood cancers is affordable in Africa in spite of widespread economic deprivation. WHO representatives emphasised the organisation's commitment to the global control of non-communicable diseases (NCDs), including cancer, and promoted the new initiatives for the control of cervical cancer, one of the commonest and deadliest cancers in adult Africans. AU representative proffered the principles of 'demographic dividends' for Africa to be able to tackle its burden of NCDs. UICC, represented by its President, provided guidelines for cancer diagnosis and staging, and advised on its effort to improve global access to radiotherapy, especially in Africa, while IPOS led the discussions on mitigating the suffering that is associated with the late presentation of cancer in the region. Oral and poster presentations from various parts of the continent indicate the growth of basic science of cancer in the region, with studies revealing regional diversity in the frequencies of the triple-negative breast cancer. They also suggest a need for genome-wide association studies as well as the evaluation of single nucleotide polymorphisms that may be responsible for variable susceptibility in breast and prostate cancer in people of African descent. Finally, the AORTIC leadership announced its plan for the advancement of cancer control by intensifying cancer advocacy at all levels of governance in the region.
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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.
