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barriers to End of life care in the gambia : H ow can we reduce unnecessary suffering?

barriers to End of life care in the gambia : H ow can we reduce unnecessary suffering?. Yuki Takao IGHI Student Challenges Competition 2013 – 27 th November Supervisor: Prof. Mark Thursz. Presentation Overview. Background My BSc project with PROLIFICA Objectives Results

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barriers to End of life care in the gambia : H ow can we reduce unnecessary suffering?

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  1. barriers to End of life care in the gambia:How can we reduce unnecessary suffering? Yuki Takao IGHI Student Challenges Competition 2013 – 27thNovember Supervisor: Prof. Mark Thursz

  2. Presentation Overview • Background • My BSc project with PROLIFICA • Objectives • Results • Future aims and further research

  3. Background:Palliative Care in the African Setting • 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) • 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)

  4. 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?

  5. 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

  6. Barriers to End of Life Care… 1) Opioid regulations and accessibility 2) Availability of essential drugs 3) Knowledge of healthcare professionals

  7. 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

  8. Barrier Two:Essential Drug Availability MEDICAL RESEARCH COUNCIL GENERAL HOSPITAL, BANJUL PALLIATIVE CARE NGO

  9. Barrier Two:Essential Drug Availability

  10. Barrier Three:Knowledge of Healthcare Professionals 349 total healthcare workers 269 total responses Overall Response Rate 77%

  11. 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

  12. Discussion:To achieve effective end of life care… What we achieved… Perspective on end of life care in West Africa Identified major issues Raised awareness Provided pain relief • 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

  13. 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

  14. Further research…Palliative Care Workshop Rationale: Palliative care training associated with better knowledge Objective: Will palliative care education and training improve the knowledge of healthcare professionals and consequently reduce the suffering of terminal cancer patients? High feasibility Sustainability Raising awareness Identify further issues Cost effective …How will this be implemented?

  15. 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

  16. Further research…Palliative Care Workshop Week One

  17. Further research…Palliative Care Workshop Week Two

  18. Acknowledgements Dr. Maud Lemoine Dr. Yusuke Shimakawa Dr. GibrilNdow Dr. SaihouSabally Mr. SaydibaTamba Mr. FamaraBojang Mr. AlagieSannehMr. LaminGiana Mr. YusuphaBah Prof Simon Taylor-Robinson Prof Mark Thursz THANK YOU

  19. Breakdown of Costs • African Palliative Care Association (APCA) • Palliative care training & workshops • Hands On Care – DrSaihouSabally • Myself – palliative care training in Japan • Flights £500 • Accommodation £500 • Local Transportation £500 • Field workers £750 • Consumables £250 £2500 x 2 weeks = Total £5000

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