Background: Despite a plethora of evidence available on the benefits of palliative care (PC), it is estimated that only about 14% of those living in low- to middle-income countries (LMIC) or developing countries have access to PC. Objective: To globally examine PC expert perspectives regarding PC infrastructure and resources within each country, drug and opioid availability to provide PC, and workforce and educational issues. Design: Descriptive, open-ended survey seeking first-hand qualitative perspectives. Setting/Subjects: PC experts from 21 developing countries representing 5 continents around the world. Measurements: Qualitative narratives and discussions with PC experts. Results: The summaries inform four key recommendations for future progress of PC in developing countries: (1) PC infrastructure should increase accessibility to both urban and rural areas; (2) increasing medication and nonpharmacologic approaches for symptoms is essential; (3) interdisciplinary education should continue to expand and include scholarships, PC certifications, and advanced education; and 4) future research with developing countries is desperately needed to advance care and progress. Conclusions: Considerable PC progress has been accomplished; however, significant gaps remain. This report can be used to discuss PC capacity building within a country. It could serve as an important document while negotiating with authorities and Ministries of Health about expanding PC infrastructure, especially in rural areas. Finally, PC champions can use this report to advocate for increased opioid availability to promote comfort; in particular, increased availability of oral opioids is essential, so that patients can die comfortably at home.

Patients with life-threatening illnesses who face death may suffer physically, psychosocially, and spiritually. The constant presence of illness and episodes of worsening illness is a persistent reminder of forthcoming death and can lead to feelings of fear. Existential issues may arise in addition to the physical suffering. Patients’ approaches to life, illness, and ideal quality of life were found to create a sphere of influence that shaped their palliative care experience. Especially at the end of life, patients’ preferences for help in living a meaningful life are connected to the aim of palliative care “to improve quality of life,” which includes the patients’ perspectives of what is considered meaningful and important. Patients’ perceptions of their care may be seen as an indicator of quality of care and is considered important for the development and improvement of palliative care.

When patients are diagnosed with cancer, they lose the mode of living they have been accustomed to and face difficulties in coping with the new complexed medical condition. In the case of advanced stages of cancer, patients lose the ability to take an active role in decisions related to priority in treatment modality, decision-making, and planning. In addition, these patients lose the ability of choice-to agree to a certain mode of treatment, who will treat them, and where. Thus, these kinds of decisions are between family members and the treating team. This can happen only when both the formal caregivers and to lesser degree the informal partners are exposed to ongoing educational activities and training by both local experienced palliative care experts and international initiated courses (both frontal and remote). This article provides recommendations needed for an effective strategy at national levels to develop appropriate ways, whereby governmental agencies and non-governmental organizations can promote the establishment of palliative care services at all levels from primary to tertiary in each individual country. The basis for the above will rely on the experience that was gained through the application of palliative care principles.

Untreated or undertreated pain in dementia patients causes ineffective care and much suffering because pain identification, measurement, and management is difficult due to the different forms of dementia, other neurodegenerative processes, and the progressive worsening of verbal communication. Pain management requires continuous assessment and adjustment of treatments. There is a need for improved research and health education in the pain management of the elderly with dementia, a need for using shorter and quicker assessment scales, and for dedicating more time to understand their dementia problems to reduce the inequality of care given to them.

Unaddressed pain poses a significant problem for individuals with dementia, resulting in substantial distress and unnecessary suffering.The main causes of pain in dementia patients are reviewed.Some of them overlap with those faced by other patients, while others are distinct due to the specific neuropathological transformations inherent to dementia.These changes often modify the way pain is perceived, anticipated, and physically responded to.Consequently, diverse pain experiences and altered anticipatory and motor reactions can arise.It is imperative to enhance research, training, and the comprehension of pain management among healthcare practitioners, specifically concerning patients with dementia.

Community and home based palliative care services are gaining more recognition especially now where primary health care is important for equitable access to healthcare services.Hospice Africa Uganda has exemplified the use of community and homebased care services to reach to the underprivileged populations and this approach is being adopted by a community initiative called, Lweza Community Health Program to promote primary health care.Through this approach, patients with serious illness including those with infectious diseases have been identified, initiated on treatment and are being followed up in the community.This approach has helped to bridge the divide between the rich and the poor but also helped to address other social-cultural factors which influence the health of individuals and communities.It is hoped that the community initiative will become a model for many communities in Africa to improve equitable access to healthcare services in communities.

In this book, we focused on different cultures, traditions and faiths. Many parts of the world have indigenous cultures and spiritual beliefs in addition to the primary religion. There are chapters on indigenous religions as well as indigenous traditional healers. People everywhere experience trouble, sorrow, need and sickness and they develop skills and knowledge in response to these adversaries. This book provides insightful models of these parameters and serves as a valuable resource for healthcare providers and policymakers by taking a global approach to cultural diversity in the world. By understanding this cultural diversity and the many faces of psychological, social and spiritual dimensions of health and healing, we can learn from one another.

Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large.

The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences. The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.

Context Manual and movement therapies (MMTs) play a central role in the integrative oncology setting, significantly improving patients' quality of life (QOL). Despite research supporting the effectiveness and safety of these modalities, most oncology health care providers (HCPs) lack any MMT training. Objectives In this study, we examine the impact of an MMT-based integrative oncology training program with the participation of an international and multidisciplinary group of oncology HCPs. The feasibility of implementing these skills in palliative cancer care is examined. Methods A three-day evidence-based hands-on teaching program was designed to train oncology HCPs working in supportive cancer care MMT modalities from traditional Chinese and anthroposophic medicine. Prequalitative and postqualitative assessments of the trainees' narratives were analyzed using ATLAS.Ti software (Scientific Software Development GmbH, Berlin, Germany) for systematic coding. Results The training program was attended by 30 participants from Israel (15), Germany (7), Italy (6), Turkey (1), and Cyprus (1). The group included 13 nurses, 10 physicians, 6 complementary/integrative HCPs, and 1 psycho-oncologist. The pretraining expectations that were met at post-training included gaining knowledge and practical QOL-oriented skills, which could be implemented in the palliative and supportive care setting. A significant change in the attitude of trainees to touch therapy was also identified, with respondents seeing MMTs promoting patient-centered palliative care, including nonverbal communication. Conclusion An MMT training program for oncology HCPs for QOL-related indications is both feasible and likely to be implemented in palliative and supportive cancer care. Nonspecific effects of MMTs were also recognized for their ability to facilitate patient-centered care.

Palliative Care (PC) is defined by the World Health Organization (WHO) as a support provided by multiple disciplines in order to improve the quality of life of both patients and their caregivers, throughout the disease course, from diagnosis to end-of-life. PC aims to prevent and treat symptoms and side effects of the disease and its treatment. PC is well developed in most high- -income countries; however in most low-income settings, where approximately 80% of patients with cancer requiring PC care for advanced disease live, PC services are still uncommon. Health indicators monitoring global PC development are policy, education, use of medicines, service provision and professional activity. Globally, PC development may be categorized as Group 1 (no known hospice-PC activity), Group 2 (capacity-building activity), Groups 3a Isolated PC provided, 3b Generalized PC provided, 4a hospice-PC services at a stage of integration into regular service provision, and 4b hospice-PC services at a stage of advanced integration into regular service provision. Spirituality is an essential element of patient-centered PC. The use of Complementary and Traditional Medicine (CTM) in Middle Eastern countries is widespread. There are wide discrepancies in cancer care and PC in many regions of the world. The Individualized Care Planning and Coordination (ICPC) Model is designed to facilitate the advance care planning with continuity of all the measures like symptom control or emotional, social and spiritual care of both the patient and the family during the disease steps like relapse or end of life.

To date, access to healthcare services is still limited for large portions of the population in most African Countries.Most cancer patients seek treatment only at advanced stages of the illness, when the cancerous lesions are already inoperable; thus, the only remaining treatment option is palliative care.Unfortunately, there are still many obstacles to obtaining early diagnosis and treatment, primarily due to cultural and traditional mannerisms, along with lowhealth literacy.Furthermore, this poor access to health care restricts too many patients, especially those who live below the poverty line, from receiving basic treatment protocols.Uganda is a pioneer in breaking the "glass ceiling" by advancing community palliative care services, in great part due to the support of the Ugandan Government and the remarkable initiative of British-born physicians who have devoted their lives to assisting, supporting and accompanying cancer patients residing outside of the big cities.This movement came to fruition by virtue of the high sense of volunteerism among Ugandan's professional personnel as well as non-professional workers in the community.

An abstract is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.

Introduction Palliative care (PC) is a holistic philosophy of care that can only be obtained through the awareness of public and healthcare professionals, PC training and good integration into the health system. Depending on health system structures, there are differences in PC models and organisations in various countries. This study is designed to evaluate the current status of PC services in Turkey, which is strongly supported by national health policies. Methods The data were collected through official correspondence with the Ministry of Health, Provincial Directorate of Health and hospital authorities. Numbers of patients who received inpatient PC, the number of hospital beds, diagnosis of disease, duration of hospitalisation, the first three symptoms as the cause of hospitalisation, opioid use, place of discharge and mortality rates were evaluated. Results A total of 48,953 patients received inpatient PC support in 199 PC centres with 2,429 beds over a 26-month period. The most frequent diagnosis for hospitalisation was cancer (35%), and the most common symptom was pain (25%). Opioids were used in 26.7% of patients. Conclusion Steps should be taken for PC training and providing continuity through organisations outside the hospital and home care.

Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care.

Incorrect family name of Layth Mula-Hussain.

As palliative care services across the globe struggle with creating a model of service that is financially viable and not dependent on donation-based funds Sabar Health has created a national based hospice and home care unit that serves all sectors of the populations in all geographic areas of Israel.This model is financially stable and replicable in other parts of the world.The business, service and medical model created by Sabar Health can serve as a blueprint for palliative care services worldwide.This article will review the process of creating Sabar Health and discuss how each of the challenges was overcome.