Papers by Eduardo Garralda Domezain
The Lancet Global Health, 2018
Background Although there are global studies on palliative care development, none report region-s... more Background Although there are global studies on palliative care development, none report region-specific indicators of development for each country in Africa. We aimed to develop and deploy a set of indicators to measure the current state of palliative care development in Africa according to WHO's Public Health Strategy for integrating palliative care, including policies, availability and access to medicines, education, and service provision. Methods Qualitative interviews were conducted with 16 country experts between March and August, 2016. From those interviews, 367 indicators were derived, 130 after exclusion criteria and content analysis were performed. The country experts rated the indicators for validity and feasibility, a 14-member international committee of experts participated in a two-round modified UCLA-RAND Delphi consensus, and the coauthors ranked the indicators during November-December 2016. The final 19 indicators were further defined and sent to 66 key country informants from 51 African countries during January-March 2017. Findings Surveys were received from 48 countries. Uganda, South Africa, and Kenya have the highest number of specialised hospice and palliative care services (71% of identified palliative care services); 19% (9/48) have no identified hospice and palliative care services. 22% (12/48) indicated having stand-alone palliative care policies, and 42% (20/48) reported having a dedicated person for palliative care in the Ministry.
Journal of palliative medicine, 2018
The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which... more The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which aims to develop and promote Catholic teachings on questions of biomedical ethics. Palliative care (PC) experts from around the world professing different faiths were invited by the PAV to develop strategic recommendations for the global development of PC ("PAL-LIFE group"). Thirteen experts in PC advocacy participated in an online Delphi process. In four iterative rounds, participants were asked to identify the most significant stakeholder groups and then propose for each, strategic recommendations to advance PC. Each round incorporated the feedback from previous rounds until consensus was achieved on the most important recommendations. In a last step, the ad hoc group was asked to rank the stakeholders' groups by order of importance on a 13-point scale and to propose suggestions for implementation. A cluster analysis provided a classification of the stakeholders in differ...
Journal of palliative medicine, 2018
Resumen Contexto: La Academia Pontificia de la Vida (PAV) es una institución académica de la Sant... more Resumen Contexto: La Academia Pontificia de la Vida (PAV) es una institución académica de la Santa Sede (Vaticano) cuyo objetivo es promover una visión católica de la ética biomédica. La PAV invitó a una serie de expertos en Cuidados Paliativos (CP) de todo el mundo, de todas las creencias, a desarrollar recomendaciones estratégicas para el desarrollo global de CP ("Grupo PAL-LIFE"). Diseño: Trece expertos internacionales reconocidos por su actividad promotora global de CP participaron en un estudio Delphi on-line. En un proceso de cuatro rondas, se pidió a los participantes que identificasen los grupos de interés o instituciones claves para la promoción de CP y que propusieran, para cada uno de ellos, recomendaciones estratégicas para el desarrollo de CP. Cada ronda incorporaba los comentarios de las rondas previas hasta lograr el consenso en las recomendaciones más importantes. En una última fase, al grupo de expertos se le solicitó la jerarquización por importancia de l...
Current Opinion in Supportive & Palliative Care, 2018
Purpose of review The aim of this review is to understand how palliative care teaching (PCT) as a... more Purpose of review The aim of this review is to understand how palliative care teaching (PCT) as a patient-centered learning model, influences medical undergraduate students’ professional development. Recent findings To study PCT medical undergraduate students’ learning experiences, we have employed the medical teaching concept, ‘hidden curriculum,’ as a way of describing attitudes and behavior conveyed implicitly by palliative care educators. Fifteen studies were selected: ten of those studies used a qualitative approach; two are theoretical explanations of the topic explored, one guideline, one review and just one quantitative study, made up the review. Medical undergraduate students reported that after PCT, they felt they had acquired better attitudes for effective integration with the patient, such as empathy or holistic care; ethical principles, such as respect or humanization of their clinical practice; and commitment to an improvement in competences, such as self-awareness or ...
Journal of palliative medicine, Jan 9, 2018
In Europe in recent decades, university teaching of palliative medicine (PM) has evolved. In some... more In Europe in recent decades, university teaching of palliative medicine (PM) has evolved. In some countries it has been introduced as a compulsory subject in all medical schools, but in a majority of countries it remains an isolated subject at few universities. To explore how PM has been introduced into the curricula and how it is currently being taught at different European universities. Case study method using face-to-face semistructured interviews with experienced PM professors, comparing how they have developed PM undergraduate programs at their universities. An intentional sample of eight university professors from Spain, France, UK, Italy, Hungary, Sweden, Germany, and Poland was chosen. The introduction of PM in the universities depends on the existence of a favorable social and political context in relation to palliative care and the initiative of pioneers, trusted by students, to push this education forward. A PM curriculum frequently starts as an optional subject and becom...
Journal of pain and symptom management, Jan 14, 2018
To date, there is no study comparing palliative care (PC) development among African countries. To... more To date, there is no study comparing palliative care (PC) development among African countries. To analyze comparatively PC development in African countries based on region-specific indicators. Data were obtained from the APCA Atlas of PC in Africa and a comparative analysis conducted. Nineteen indicators were developed and defined through qualitative interviews with African PC experts and a two-round modified Delphi consensus process with international experts on global PC indicators. Indicators were grouped by the WHO public health strategy for PC dimensions. These indicators were then sent as a survey to key informants in 52/54 African countries. Through an expert weighting process and ratings from the modified Delphi, weights were assigned to each indicator. Surveys were received from 89% (48/54) of African countries. The top three countries in overall PC development were, in order, Uganda, South Africa, and Kenya. Variability existed by dimension. The top three countries in spec...
Journal of pain and symptom management, Jan 2, 2018
Factors contributing to and impeding palliative care (PC) development in Africa can provide insig... more Factors contributing to and impeding palliative care (PC) development in Africa can provide insights into current strategies for advancing PC. To identify key factors affecting PC development in African countries from in-country PC experts' perspectives. About 16 PC experts from seven African countries undertook semistructured interviews on PC development in their respective countries. An interpretive description approach was adopted, with data analyzed using constant comparison. Emerged themes included drivers, strengths, challenges, and aspirations for PC development in Africa. Drivers included advocates and pioneering organizations, HIV/AIDS, culture of caregiving, and the World Health Assembly PC resolution. Strengths included community health workers, the special role of nurses, diversity of services, and short training courses. Challenges included lack of PC education; lack of standardization in implementation; limited availability of and/or accessibility to morphine; pove...
Journal of palliative medicine, Jan 13, 2017
Indicators specific to the African context are important to measure palliative care (PC) developm... more Indicators specific to the African context are important to measure palliative care (PC) development accurately. To describe the process used to develop a set of PC macroindicators for Africa. Open-ended interviews on national PC development were conducted with five African Country Experts. Indicators were rated (1-4) by 14 Country Experts for validity and feasibility. An additional 11 interviews were conducted to ensure indicator saturation. Indicators scoring ≥3 proceeded to a modified two-round RAND/UCLA Delphi with global experts on PC development (International Committee). Finally, indicators were ranked by the project team. Sixteen country experts from 7 African countries and 14 International Committee members. One hundred three indicators were rated by Country Experts, and 58 proceeded to the Delphi. Thirty-eight indicators were rated as important by the International Committee, and the project team ranked 19 of these as most important. Service indicators (n = 6) included the...
PloS one, 2017
The goal of palliative care (PC) is to improve the quality of life of terminal stage patients and... more The goal of palliative care (PC) is to improve the quality of life of terminal stage patients and their families. The subject frequently appears in the mass-media and this helps create a socially accepted identity. The aim of this study is to describe and analyse PC related news items appeared in the Spanish written media. A descriptive cross-sectional study was designed. Considering diffusion, scope and the range in editorial policy criteria, four printed newspapers (PN) were selected, together with four exclusively digital media sources (DM). Through Mynews, a newspaper content depository, and the search tool for each DM website, articles published between 2009 and 2014 which included the terms "palliative care" and "palliative medicine" were sought. A questionnaire was created to characterise each article identified and a descriptive analysis was undertaken. A total of 627 articles were identified, of which 359 (57%) were published in PN (42% in the printed ed...
The Lancet Oncology, 2017
Since the last comprehensive review on the development of national palliative care in Africa was ... more Since the last comprehensive review on the development of national palliative care in Africa was undertaken 12 years ago, in 2005, we did a scoping review of peer-reviewed, published articles on palliative care development between 2005-16 for each African country. The scoping review was conducted by assessing the medical literature and including local expert recommendations of suggested articles. We did a basic quality assessment of the articles using the journals' impact factor, journal quartile, and the number of citations as suitable metrics for quality consideration. Articles published in English, Spanish, Portuguese, and French that mentioned at least one dimension of WHO's palliative care public health strategy (implementation of services, education, policies, or medicine availability) and vitality (activity by professionals or advocates) were included. Of the 518 articles found, 49 met the inclusion criteria. Information on 26 (48%) of 54 African countries was found. Most services were concentrated in Kenya, South Africa, and Uganda, and 14 (26%) countries showed an increase in services during this timeframe. Stand-alone palliative care policies exist in Malawi, Mozambique, Rwanda, Swaziland, Tanzania, and Zimbabwe. Postgraduate diplomas in palliative care are available in Kenya, South Africa, Uganda, and Tanzania. Restricted access to opioids, prescriber restriction laws, and a low prevalence of morphine use remain common barriers to adequate palliative care provision. Although information on palliative care is unevenly distributed, the available information showed an increased development of palliative care services in a subset of African countries. Despite this growth, however, there is still minimal to no identified palliative care development in most African countries.
Journal of palliative medicine, Jan 29, 2017
Palliative care (PC) research in Africa has been proposed as a fifth dimension of the World Healt... more Palliative care (PC) research in Africa has been proposed as a fifth dimension of the World Health Organization PC Public Health Strategy. We conducted a scoping review of published articles (2005-2016) on palliative care development (PCD) in African countries. Forty-seven articles were found across 26 countries. To study whether the number of published articles on PCD in countries in Africa can be used as an indicator of PCD. This is a secondary analysis of a completed scoping review. Spearman correlations were applied to the number of published articles ("published articles") and the number of published articles with a coauthor from a high-income country (HIC) ("HIC published articles") with level of PCD using Lynch et al's updated world map (PC World Map) as a proxy. A subanalysis was undertaken for Anglophone versus non-Anglophone countries. There were positive Spearman correlations (r) between the PC World Map's levels and published articles (r = 0.7...
Journal of Pain and Symptom Management, 2015
Context. The lack of palliative medicine (PM) education has been identified as a barrier to the d... more Context. The lack of palliative medicine (PM) education has been identified as a barrier to the development of the discipline. A number of international institutions have called for its implementation within undergraduate medical curricula. Objectives. The objectives are to describe the situation of undergraduate PM education in Europe and to propose a scoring system to evaluate its status. Methods. This descriptive study was conducted with data provided by key experts from countries of the World Health Organization European Region (n ¼ 53). A numerical scoring system was developed through consensus techniques. Results. Forty-three countries (81%) provided the requested information. In 13 countries (30%), a PM course is taught in all medical schools, being compulsory in six of them (14%). In 15 countries (35%), PM is taught in at least one university. In 14 countries (33%), PM is not taught within medical curricula. A full professor of PM was identified in 40% of countries. Three indicators were developed to construct a scale (rank 0e100) of educational development: 1) proportion of medical schools that teach PM (weight ¼ 32%); 2) proportion of medical schools that offer PM as a compulsory subject (weight ¼ 40%); 3) total number of PM professors (weight ¼ 28%). The highest level of PM educational development was found in Israel, Norway, the U.K., Belgium, France, Austria, Germany, and Ireland. Conclusion. PM is taught in a substantial number of undergraduate medical programs at European universities, and a qualified teaching structure is emerging; however, there is a wide variation in the level of PM educational development between individual countries.
Journal of Pain and Symptom Management, 2020
Context. Approximately 170,000 children in need of palliative care die every year in Europe witho... more Context. Approximately 170,000 children in need of palliative care die every year in Europe without access to it. This field remains an evolving specialty with unexplored development. Objectives. To conduct the first regional assessment of pediatric palliative care (PPC) development and provision using data from the European Association for Palliative Care atlas of palliative care 2019. Methods. Two surveys were conducted. The first one included a single question regarding PPC service provision and was addressed by European Association for Palliative Care atlas informants. The second one included 10 specific indicators derived from an open-ended interview and rating process; a specific network of informants was enabled and used as respondents. Data were analyzed and presented in the map of the figure. Results. Data on PPC service provision were gathered from 51 of 54 (94%) European countries. Additional data were collected in 34 of 54 (62%) countries. A total of 680 PPC services were identified including 133 hospices, 385 home care services, and 162 hospital services. Nineteen countries had specific standards and norms for the provision of PPC. Twenty-two countries had a national association, and 14 countries offered education for either pediatric doctors or nurses. In seven countries, specific neonatal palliative care referral services were identified. Conclusion. PPC provision is flourishing across the region; however, development is less accentuated in low-to-middleincome countries. Efforts need to be devoted to the conceptualization and definition of the models of care used to respond to the unmet need of PPC in Europe. The question whether specialized services are required or not should be further explored. Strategies to regulate and cover patients in need should be adapted to each national health system. J Pain Symptom Manage 2020;60:746e753.
International Journal of Environmental Research and Public Health
Background: Palliative care is a priority for health systems worldwide, yet equity in access rema... more Background: Palliative care is a priority for health systems worldwide, yet equity in access remains unknown. To shed light on this issue, this study compares populations’ driving time to specialized palliative care services in three countries: Ireland, Spain, and Switzerland. Methods: Network analysis of the population’s driving time to services according to geolocated palliative care services using Geographical Information System (GIS). Percentage of the population living within a 30-min driving time, between 30 and 60 minutes, and over 60 min were calculated. Results: The percentage of the population living less than thirty minutes away from the nearest palliative care provider varies among Ireland (84%), Spain (79%), and Switzerland (95%). Percentages of the population over an hour away from services were 1.87% in Spain, 0.58% in Ireland, and 0.51% in Switzerland. Conclusion: Inequities in access to specialized palliative care are noticeable amongst countries, with implications ...
Journal of Palliative Medicine, 2018
Background: Palliative care (PC) research in Africa has been proposed as a fifth dimension of the... more Background: Palliative care (PC) research in Africa has been proposed as a fifth dimension of the World Health Organization PC Public Health Strategy. We conducted a scoping review of published articles (2005–2016) on palliative care development (PCD) in African countries. Forty-seven articles were found across 26 countries. Objective: To study whether the number of published articles on PCD in countries in Africa can be used as an indicator of PCD. Design: This is a secondary analysis of a completed scoping review. Measurements: Spearman correlations were applied to the number of published articles (''published articles'') and the number of published articles with a coauthor from a high-income country (HIC) (''HIC published articles'') with level of PCD using Lynch et al's updated world map (PC World Map) as a proxy. A subanalysis was undertaken for Anglophone versus non-Anglophone countries. Results: There were positive Spearman correlations (r) between the PC World Map's levels and published articles (r = 0.73; p < 0.001), and with HIC published articles (r = 0.68; p < 0.001). For Anglophone countries, the r was statistically significant (p < 0.001) at 0.69 and 0.70, versus 0.58 and 0.45 for non-Anglophone countries for published articles and HIC published articles, respectively. Kruskal–Wallis test showed a statistically significant difference between Anglophone and non-Anglophone countries for both published articles and HIC published articles (p < 0.01). Conclusion: Published articles and HIC published articles on PCD in Africa had strong positive r's with the PC World Map. These measures may be considered as two indicators of PCD for countries in Africa, particularly for Anglophone countries.
Lancet Oncology, 2017
Since the last comprehensive review on the development of national palliative care in Africa was ... more Since the last comprehensive review on the development of national palliative care in Africa was undertaken 12 years ago, in 2005, we did a scoping review of peer-reviewed, published articles on palliative care development between 2005-16 for each African country. The scoping review was conducted by assessing the medical literature and including local expert recommendations of suggested articles. We did a basic quality assessment of the articles using the journals' impact factor, journal quartile, and the number of citations as suitable metrics for quality consideration. Articles published in English, Spanish, Portuguese, and French that mentioned at least one dimension of WHO's palliative care public health strategy (implementation of services, education, policies, or medicine availability) and vitality (activity by professionals or advocates) were included. Of the 518 articles found, 49 met the inclusion criteria. Information on 26 (48%) of 54 African countries was found. Most services were concentrated in Kenya, South Africa, and Uganda, and 14 (26%) countries showed an increase in services during this timeframe. Stand-alone palliative care policies exist in Malawi, Mozambique, Rwanda, Swaziland, Tanzania, and Zimbabwe. Postgraduate diplomas in palliative care are available in Kenya, South Africa, Uganda, and Tanzania. Restricted access to opioids, prescriber restriction laws, and a low prevalence of morphine use remain common barriers to adequate palliative care provision. Although information on palliative care is unevenly distributed, the available information showed an increased development of palliative care services in a subset of African countries. Despite this growth, however, there is still minimal to no identified palliative care devel
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PLOS one, 2017
Introduction
The goal of palliative care (PC) is to improve the quality of life of terminal stage... more Introduction
The goal of palliative care (PC) is to improve the quality of life of terminal stage patients and their families. The subject frequently appears in the mass-media and this helps create a socially accepted identity. The aim of this study is to describe and analyse PC related news items appeared in the Spanish written media.
Methodology
A descriptive cross-sectional study was designed. Considering diffusion, scope and the range in editorial policy criteria, four printed newspapers (PN) were selected, together with four exclusively digital media sources (DM). Through Mynews, a newspaper content depository, and the search tool for each DM website, articles published between 2009 and 2014 which included the terms "palliative care" and "palliative medicine" were sought. A questionnaire was created to characterise each article identified and a descriptive analysis was undertaken.
Results
A total of 627 articles were identified, of which 359 (57%) were published in PN (42% in the printed editions -PE- 16% in their online editions -OE-) and 268 (43%) in DM. In general, they appeared mainly in sections concerning Health (23%), Culture and Society (18%) and General/Home News (15%). In PE, just 2% were found in the Health section and nearly 70% in Culture and Society and General/Home News. Most of the articles were informative in nature and contained socio-political messages (90%). Statements by PC professionals were found in 35% of the articles and by politicians in 32%. The most frequent content was related to facing end of life (74%) and patient quality of life (70%).
Conclusions
The Spanish written media reflects the socio-political interest aroused by PC. Nevertheless, messages circulating about PC do not describe professional practice, or the contribution of the same for patients. Content more in line with the clinical practice might help contribute to the development of this new area of medicine.
Journal of Palliative Medicine, 2017
Background: Indicators specific to the African context are important to measure palliative care (... more Background: Indicators specific to the African context are important to measure palliative care (PC) development
accurately.
Objective: To describe the process used to develop a set of PC macroindicators for Africa.
Design: Open-ended interviews on national PC development were conducted with five African Country Experts. Indicators were rated (1–4) by 14 Country Experts for validity and feasibility. An additional 11 interviews were conducted to ensure indicator saturation. Indicators scoring ‡3 proceeded to a modified two-round RAND/ UCLA Delphi with global experts on PC development (International Committee). Finally, indicators were ranked by the project team.
Setting/Subjects: Sixteen country experts from 7 African countries and 14 International Committee members.
Results: One hundred three indicators were rated by Country Experts, and 58 proceeded to the Delphi. Thirtyeight indicators were rated as important by the International Committee, and the project team ranked 19 of these as most important. Service indicators (n = 6) included the number of types of services most important in Africa (e.g., hospices, home based) and coverage. Policy indicators (n = 4) included the existence of PC in national policies, guidelines, and budget and a responsible person. Education indicators (n = 3) consisted of inclusion of PC in medical and nursing curricula and recognition as a specialty. Medicine indicators (n = 4) focused on morphine availability, consumption, and prescribing barriers. Vitality indicators (n = 2) reflected the existence of a national association and its activity.
Conclusion: The process to develop African-specific PC indicators resulted in 19 indicators that were used to measure PC development as a comparative baseline for development in African countries.
Keywords: Africa; Delphi technique; global health; health status indicators; palliative care
Journal of Pain and Symptom Management, 2018
Context: Factors contributing to and impeding palliative care (PC) development in Africa can prov... more Context: Factors contributing to and impeding palliative care (PC) development in Africa can provide insights into current strategies for advancing PC. Objectives: To identify key factors affecting PC development in African countries from in-country PC experts' perspectives. Methods: Sixteen PC experts from seven African countries undertook semi-structured interviews on PC development in their respective countries. An interpretive description approach was adopted, with data analyzed using constant comparison. Results: Emerged themes included: drivers, strengths, challenges, and aspirations for PC development in Africa. Drivers included advocates and pioneering organizations, HIV/AIDS, culture of caregiving, and the World Health Assembly PC Resolution. Strengths included community health workers, the special role of nurses, diversity of services, and short training courses. Challenges included lack of PC education, lack of standardization in implementation, limited availability of and/or accessibility to morphine, poverty and disease burden, and lack of funding for PC. Aspirations included integration of PC, specialization in PC, nurse prescribing, and strong partnerships with Ministries of Health. Factors already highlighted in the literature were only briefly discussed. Conclusion: The key factors underpinning PC development in the seven countries contributed to the beginnings of PC in Africa, fueled by advocates that built on existing strengths to maximize opportunities. However, the current approach is high-risk in terms of its sustainability and strategies for maximizing existing resources and growing infrastructure support are needed moving forward
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Papers by Eduardo Garralda Domezain
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The goal of palliative care (PC) is to improve the quality of life of terminal stage patients and their families. The subject frequently appears in the mass-media and this helps create a socially accepted identity. The aim of this study is to describe and analyse PC related news items appeared in the Spanish written media.
Methodology
A descriptive cross-sectional study was designed. Considering diffusion, scope and the range in editorial policy criteria, four printed newspapers (PN) were selected, together with four exclusively digital media sources (DM). Through Mynews, a newspaper content depository, and the search tool for each DM website, articles published between 2009 and 2014 which included the terms "palliative care" and "palliative medicine" were sought. A questionnaire was created to characterise each article identified and a descriptive analysis was undertaken.
Results
A total of 627 articles were identified, of which 359 (57%) were published in PN (42% in the printed editions -PE- 16% in their online editions -OE-) and 268 (43%) in DM. In general, they appeared mainly in sections concerning Health (23%), Culture and Society (18%) and General/Home News (15%). In PE, just 2% were found in the Health section and nearly 70% in Culture and Society and General/Home News. Most of the articles were informative in nature and contained socio-political messages (90%). Statements by PC professionals were found in 35% of the articles and by politicians in 32%. The most frequent content was related to facing end of life (74%) and patient quality of life (70%).
Conclusions
The Spanish written media reflects the socio-political interest aroused by PC. Nevertheless, messages circulating about PC do not describe professional practice, or the contribution of the same for patients. Content more in line with the clinical practice might help contribute to the development of this new area of medicine.
accurately.
Objective: To describe the process used to develop a set of PC macroindicators for Africa.
Design: Open-ended interviews on national PC development were conducted with five African Country Experts. Indicators were rated (1–4) by 14 Country Experts for validity and feasibility. An additional 11 interviews were conducted to ensure indicator saturation. Indicators scoring ‡3 proceeded to a modified two-round RAND/ UCLA Delphi with global experts on PC development (International Committee). Finally, indicators were ranked by the project team.
Setting/Subjects: Sixteen country experts from 7 African countries and 14 International Committee members.
Results: One hundred three indicators were rated by Country Experts, and 58 proceeded to the Delphi. Thirtyeight indicators were rated as important by the International Committee, and the project team ranked 19 of these as most important. Service indicators (n = 6) included the number of types of services most important in Africa (e.g., hospices, home based) and coverage. Policy indicators (n = 4) included the existence of PC in national policies, guidelines, and budget and a responsible person. Education indicators (n = 3) consisted of inclusion of PC in medical and nursing curricula and recognition as a specialty. Medicine indicators (n = 4) focused on morphine availability, consumption, and prescribing barriers. Vitality indicators (n = 2) reflected the existence of a national association and its activity.
Conclusion: The process to develop African-specific PC indicators resulted in 19 indicators that were used to measure PC development as a comparative baseline for development in African countries.
Keywords: Africa; Delphi technique; global health; health status indicators; palliative care
…
The goal of palliative care (PC) is to improve the quality of life of terminal stage patients and their families. The subject frequently appears in the mass-media and this helps create a socially accepted identity. The aim of this study is to describe and analyse PC related news items appeared in the Spanish written media.
Methodology
A descriptive cross-sectional study was designed. Considering diffusion, scope and the range in editorial policy criteria, four printed newspapers (PN) were selected, together with four exclusively digital media sources (DM). Through Mynews, a newspaper content depository, and the search tool for each DM website, articles published between 2009 and 2014 which included the terms "palliative care" and "palliative medicine" were sought. A questionnaire was created to characterise each article identified and a descriptive analysis was undertaken.
Results
A total of 627 articles were identified, of which 359 (57%) were published in PN (42% in the printed editions -PE- 16% in their online editions -OE-) and 268 (43%) in DM. In general, they appeared mainly in sections concerning Health (23%), Culture and Society (18%) and General/Home News (15%). In PE, just 2% were found in the Health section and nearly 70% in Culture and Society and General/Home News. Most of the articles were informative in nature and contained socio-political messages (90%). Statements by PC professionals were found in 35% of the articles and by politicians in 32%. The most frequent content was related to facing end of life (74%) and patient quality of life (70%).
Conclusions
The Spanish written media reflects the socio-political interest aroused by PC. Nevertheless, messages circulating about PC do not describe professional practice, or the contribution of the same for patients. Content more in line with the clinical practice might help contribute to the development of this new area of medicine.
accurately.
Objective: To describe the process used to develop a set of PC macroindicators for Africa.
Design: Open-ended interviews on national PC development were conducted with five African Country Experts. Indicators were rated (1–4) by 14 Country Experts for validity and feasibility. An additional 11 interviews were conducted to ensure indicator saturation. Indicators scoring ‡3 proceeded to a modified two-round RAND/ UCLA Delphi with global experts on PC development (International Committee). Finally, indicators were ranked by the project team.
Setting/Subjects: Sixteen country experts from 7 African countries and 14 International Committee members.
Results: One hundred three indicators were rated by Country Experts, and 58 proceeded to the Delphi. Thirtyeight indicators were rated as important by the International Committee, and the project team ranked 19 of these as most important. Service indicators (n = 6) included the number of types of services most important in Africa (e.g., hospices, home based) and coverage. Policy indicators (n = 4) included the existence of PC in national policies, guidelines, and budget and a responsible person. Education indicators (n = 3) consisted of inclusion of PC in medical and nursing curricula and recognition as a specialty. Medicine indicators (n = 4) focused on morphine availability, consumption, and prescribing barriers. Vitality indicators (n = 2) reflected the existence of a national association and its activity.
Conclusion: The process to develop African-specific PC indicators resulted in 19 indicators that were used to measure PC development as a comparative baseline for development in African countries.
Keywords: Africa; Delphi technique; global health; health status indicators; palliative care
of development for each country in Africa. We aimed to develop and deploy a set of indicators to measure the current
state of palliative care development in Africa according to WHO’s Public Health Strategy for integrating palliative
care, including policies, availability and access to medicines, education, and service provision.
Methods Qualitative interviews were conducted with 16 country experts between March and August, 2016. From those
interviews, 367 indicators were derived, 130 after exclusion criteria and content analysis were performed. The country
experts rated the indicators for validity and feasibility, a 14-member international committee of experts participated
in a two-round modified UCLA-RAND Delphi consensus, and the coauthors ranked the indicators during November–
December 2016. The final 19 indicators were further defined and sent to 66 key country informants from 51 African
countries during January–March 2017.
Findings Surveys were received from 48 countries. Uganda, South Africa, and Kenya have the highest number
of specialised hospice and palliative care services (71% of identified palliative care services); 19% (9/48) have no identified
hospice and palliative care services. 22% (12/48) indicated having stand-alone palliative care policies, and 42% (20/48)
reported having a dedicated person for palliative care in the Ministry. Zambia, Uganda, South Africa, Kenya, Ghana, and
Egypt reported some official form of physician accreditation. Opioid consumption per capita was low (75% of countries
had <1 mg consumption per head per year) compared to the global average (62 mg), with the highest consumption
in Mauritius, South Africa, Namibia, and Morocco. 54% (26/48) reported having a national palliative care association.
These data were used to build the African Palliative Care Association (APCA) Atlas of Palliative Care in Africa, the first
comparative, quantitative, African-specific report on national palliative care development in African countries.
Interpretation There is limited palliative care development in Africa, but there is also a significant improvement
in the number of countries with hospice and palliative care services, compared to previous reports. Improvements in
advocacy were identified, with more than half of countries reporting a national palliative care association. Governments
need to take the steps to improve education, increase the number of services, and ensure safe access to opioids.
Funding Arnhold Institute of Global Health at the Icahn School of Medicine at Mount Sinai, the African Palliative
Care Association, the International Association for Hospice and Palliative Care, and the Institute for Culture and
Society at the University of Navarra.