yuki takao ighi student challenges competition 2013 – 27 th november supervisor: prof. mark thursz...
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Yuki Takao
IGHI Student Challenges Competition 2013 – 27th November
Supervisor: Prof. Mark Thursz
BARRIERS TO END OF LIFE CARE IN THE GAMBIA:How can we reduce unnecessary suffering?
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Presentation Overview
Background My BSc project with PROLIFICA Objectives Results Future aims and further research
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Background:Palliative Care in the African Setting
What is “end of life/palliative care”?
Largely neglected in Africa, lack of research…
…less than 5% of Africans in need are benefiting from palliative care (Grant et al; 2011)
The rising cancer burden Half a million deaths/year (Sepulveda et al; 2003 )
Over the next 50yrs, cancer rates are expected to grow by 400% (Morris K; 2003)
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PROLIFICA
PROLIFICA: Prevention of Liver Fibrosis and Cancer in Africa- Hepatocellular Carcinoma Case-Control (HC4) study
Are patients receiving end of life care in The Gambia?
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Survival and Pain:Unnecessary suffering
Hepatocellular Carcinoma Case-Control Study (n=113)- Half the HCC patients dead by 3months- Median pain score for HCC patients: 4 (very severe pain)- No one had been prescribed oral morphine
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Barriers to End of Life Care…
1) Opioid regulations and accessibility
2) Availability of essential drugs
3) Knowledge of healthcare professionals
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Barrier One:Opioid Regulations
Palliative Care Resources
One palliative care institute
Gambian National Policies- Import/Export License, renewed annually- Signature from the Ministry of Health- Central Medical Store distributes drugs once a year
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Barrier Two:Essential Drug Availability
GENERAL HOSPITAL, BANJUL
MEDICAL RESEARCH COUNCIL
PALLIATIVE CARE NGO
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Barrier Two:Essential Drug Availability
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349 total healthcare workers269 total responsesOverall Response Rate 77%
Barrier Three:Knowledge of Healthcare Professionals
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Barrier Three:Knowledge of Healthcare Professionals
Palliative Care Quiz for Nursing (PCQN)
“Long-term use of opioids (morphine) can often induce addiction” 15 (6%) gave the correct answer “false”
Factors associated with lower scores:- Less clinical experience- Lower number of terminal patients ever cared for- Lack of palliative care education
EDUCATION & TRAINING
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Discussion: To achieve effective end of life care…
- Implementation of national policies that promote palliative care and pain treatment
- Improved supply and distribution system for essential medicines
- Education and training for healthcare workers, with emphasis on eradicating the negative perception towards opioid analgesics
What we achieved…1) Perspective on end of life care in
West Africa2) Identified major issues3) Raised awareness4) Provided pain relief
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Discussion: To achieve effective end of life care…
- Implementation of national policies that promote palliative care and pain treatment
- Improved supply and distribution system for essential medicines
- Education and training for healthcare workers, with emphasis on eradicating the negative perception towards opioid analgesics
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Further research…Palliative Care Workshop
Objective: Will palliative care education and training improve the knowledge of healthcare professionals and consequently reduce the suffering of terminal cancer patients?
Rationale: Palliative care training associated with better knowledge
…How will this be implemented?
①High feasibility②Sustainability③Raising awareness④ Identify further issues⑤Cost effective
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Further research…Palliative Care Workshop
Workshop on End of Life/Palliative Care- Principles of palliative care- Pain and symptom management- Multi-disciplinary team approach to care- Cultural and spiritual issues- Grief and bereavement- Support for family and caregivers
Pre- and post-workshop test of palliative care knowledge- PCKT- PCQN
Pre- and post-workshop evaluation of patient QOL- APCA African Palliative Outcome Scale
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Further research…Palliative Care Workshop
Day 1Organisation- Introduction
- Materials- Consent
Days 2-5QOL Data Collection
2 sitesField workers
Days 6-7Workshop
1 sitePre and post knowledge
test
Week One
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Further research…Palliative Care Workshop
Day 1Organisation- Introduction
- Materials- Consent
Days 2-5QOL Data Collection
2 sitesField workers
Days 6-7Workshop
1 sitePre and post knowledge
test
Day 1Organisation
- Re-cap- Materials
Days 2-6QOL Data Collection
2 sitesField workers
Day 7Finish studyWeek Two
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Acknowledgements
Dr. Maud Lemoine
Dr. Yusuke Shimakawa
Dr. Gibril Ndow
Dr. Saihou Sabally
Mr. Saydiba Tamba
Mr. Famara Bojang
Mr. Alagie SannehMr. Lamin Giana
Mr. Yusupha Bah
Prof Simon Taylor-Robinson
Prof Mark Thursz THANK YOU
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Breakdown of Costs
African Palliative Care Association (APCA) Palliative care training & workshops
Hands On Care – Dr Saihou Sabally Myself – palliative care training in Japan
Flights £500 Accommodation £500 Local Transportation £500 Field workers £750 Consumables £250
£2500 x 2 weeks= Total £5000