Resident Perspectives on Palliative Care at an Urban Teaching Hospital

Background There has been an increasing need to address end of life (EOL) care and palliative care in an era when measures to extend life for terminal illnesses are often initiated without consideration of quality of life. Addressing the barriers for resident physicians to initiate EOL conversations with patients is an important step towards eliminating the disconnect between patient wishes and provider goals. Purpose To assess resident physician perspectives on initiating palliative care conversations with terminally ill patients at an urban teaching hospital. Methods This paper solicited the experiences of pediatric, general surgery, and internal medicine residents through an anonymous survey to assess exposure to palliative care during training, comfort with providing palliative care, and barriers to implementing effective palliative care. Results 45% of residents reported exposure to palliative care prior to medical training. Ninety-three percent of these residents reported being formally introduced to palliative care during medical training through formal lecture, although the majority reported also being exposed through either small group discussions or informal teaching sessions. Time constraints and lack of knowledge on how to initiate and continue conversations surrounding EOL care were the greatest barriers to effectively caring for patients with terminal illnesses. Residents concurred that either attending physicians or hospital-designated palliative care providers should initiate palliative care discussions, with care managed by an interdisciplinary palliative care team; this consensus demonstrates a potential assumption that another provider will initiate EOL discussions. Conclusions This study evaluated the current state of physician training in EOL care and provided support for the use of experience-based training as an important adjunct to traditional didactic lectures in physician education.

Extent of Home Based Care Program Support to Hospital Based Care for Children with Chronic and Terminal Illness in Meru County, Kenya

Introduction: Chronic and Terminal illnesses continue to increase and aggravate the burden of disease and the diminish space in our hospitals and communities, Worldwide, 57 million persons died in 2008, an estimated 40 million were in need of HBCP, 6.6 - 10.8 million Children died, 98% Chronic and Terminal illnesses (CI/TI) are found in low and middle-income Countries. Chronic and Terminal illnesses in Children are on the rise in Sub Saharan Africa. Kenya lags in implementation of Home Based Care to mitigate effects of CI/TI. WHO, 2017 and Ministry of Health-Kenya 2013 shows that Children are affected by these Illnesses. These illnesses have made families’ to suffer psychosocial and economic hardships. Evaluation of determinants of Home Based Care Program (EHBCP) services by assessing if effective and quality delivery of HBCP Supports Hospital Based Care is key. Aims: To determine the extent to which Home Based Care Program services Support to Hospital Based Care for Children aged 1-14 years diagnosed with selected Chronic and Terminal illnesses in Meru County Kenya. Study Design: A descriptive Cross Sectional Survey. Place and Duration of Study: Meru County, Kenya between June 2018 and Dec 2019. Methodology: Methodology: Descriptive Cross Sectional Survey of 245 Caregivers of Children diagnosed with Chronic and Terminal illness were selected by proportionate to size sampling and simple random sampling from Meru County Health Facilities. Results: Delivery of quality and effective Home Based Care Program was positively associated with age, return rate of over 100% was achieved with about 245 respondents being interviewed (132%),experience of Health Care Workers (HCWs) 4.8 [95% CI = 1.06 – 21.68, P = 0.041]. HCWs profession, gender and years of work were positively related to Hospital Based Care services 3.03 [95%CI = 1.64 – 5.59, P<0.001]. Use of minimum HBCP package was found to be useful in support of hospital care, as 50.4% reported that its support was of a good or great extent. The trend was observed in all aspects of the minimum HBCP package studied, with 52.4%, 54.4% and 46.4% having the opinion that use of the package by caregivers, in management and mitigation of complications supported hospital care by a good or great extent respectively. Conclusion: Need for an urgent adoption of holistic approach on health care system strengthening by putting up a well-integrated Home Based Care Program with quality Minimum HBCP essential package to support the mainstream health care system. In addition adopt better management practices, planning strategies, resource allocation and monitoring for effective HBCP programmes as per the current guidelines to bridge the gaps identified in planning, management practices to fill the disjointed policy implementation and resource inadequacies in implementation of HBCP services to support Hospital Based care for ultimate delivery of quality care among the Chronically and Terminally ill Children.

Assessment of Utilization of HBCP Services for Children Diagnosed with Chronic and Terminal Illnesses Aged between 1-14 Years in Meru County, Kenya

Introduction: Worldwide, 57 million people died in 2008 from Chronic Illnesses, an estimated 40 million were in need of HBCP services with 6.6 - 10.8 million Children and adolescents dying [1,2]. 98% of Children with Chronic and Terminal illnesses (CI/TI) are found in low and middle-income Countries. Chronic and Terminal illnesses in Children are on the rise in Sub Saharan Africa. Kenya has lagged in implementation of Home Based Care to mitigate effects of CI/TI [3]. According to WHO, 2017 and Ministry of Health-Kenya 2013, millions of Children are affected by these Illnesses such as Tuberculosis, Asthma, Congenital abnormalities, HIV/AIDS and Cancer among others [4,5]. These illnesses have made families’ to suffer emotional, psychosocial and economic hardships [6,7]. Evaluation of utilization of Home Based Care Program (EHBCP) services is significant in assessing effectiveness and quality delivery of HBCP [8,9]. Aims: To assess usage of minimum essential package required in provision of Home Based Care program services for Children aged between 1-14 years diagnosed with selected Chronic and Terminal illnesses in Meru County Kenya. Study Design: A descriptive Cross Sectional Survey. Place and Duration of Study: Conducted in Meru County Kenya Health facilities between June 2018 and Dec 2019. Methodology: Descriptive Cross Sectional Survey of 245 Health Care Providers and Caregivers of Children diagnosed with selected by proportionate to size sampling and simple random sampling from different health facilities across Meru County was utilized. Results: Utilization, delivery of quality and effective Home Based Care program was positively associated with age, experience of Health Care Workers (HCWs) 4.8 [95% CI = 1.06 – 21.68, P = 0.041]. HCWs profession, gender and years of work were positively related to utilization and delivery of HBCP services 3.03 [95%CI = 1.64 – 5.59, P<0.001]. Conclusion: Current study concludes that utilization of Minimum HBCP essential package by participants was not effective and the quality delivery of minimum HBCP essential services was inadequate, which agrees with Sips et al., 2014 study that poor service delivery leads to inadequate utilization, it concludes that restructuring HBCP services would meet individual needs for ill Children.

Talking to children about death dying and bereavement – Is it time for a change in the school curriculum?

Open and honest communication between families is integral to caring for patients with progressive terminal illnesses. Talking to children about death, dying and bereavement, however, has always been a taboo subject. The specialist palliative care team in Gateshead NHS Foundation Trust share how they succesfully collaborated with a local secondary school to encourage young people to talk about these subjects.

Analgesia in the palliative care of children

Due to the increasing incidence of terminal illnesses in children, there is great urgency within pediatric medicine to give these patients the best palliative care possible. The main focus of palliative care is to alleviate suffering resulting from the psychophysical condition of the child, which is mostly due to physical pain. The first phase of managing pain in palliative care is quantifying and qualifying pain levels, although this is sometimes difficult to do with pediatric patients. In addition to implementing strategies that alleviate or remove pain for patients, it is also crucial to give patients and their families a feeling of full control over pain. In practice, non-pharmacological and pharmacological methods of analgesia are present. Pharmacological methods include non-opioid and opioid analgesics, followed by co-analgesics as well as methods of regional anesthesia. In order to give these patients the best care possible, it is necessary that the approach be individual, multimodal, multidisciplinary, and considerate of every detail.