International Palliative Care

Question 1

List factors that affect palliative care in delivery in low income settings/countries

Answer 1

• Poverty
• lack of public health care
• Role of families in traditional societies
• disease spectrum
• funding for treatment limited to certain illnesses and not others

Question 2

Public health approach to palliative care

Answer 2

• appropriate policies
• adequate drug availability and medication policy
• Education for healthcare providers and public
• Implementation of palliative care services in all levels of society

Question 3

How to improve palliative care advocacy?

Answer 3

• articles
• real life stories
• newspapers, TV, internet
• public awareness campaigns
• involving public figures
• teaching PC in schools and college
• training pc workers

Question 4

Grassroots implementation of a palliative care program

Answer 4

• Needs assessment
• Strategy
  
  • what is available and what is not?
  • what local models can be used?
  • existing organization that can be used?
• Education
  
  • trained doctor and nurse
  • volunteers
  • empowering families
  • public
• Drug availability
  
  • procure strong opioids?
  • funding?
  • policy
• Implementation
  
  • practical action plan with short, medium long term goals
  • outcome measurement?
  • regular review

Question 5

Ethnicity

Answer 5

• social grouping of people on basis of history or territorial identity
• shared cultural patterns over generations
• may include language or shared ancestry
• not just geography

Question 6

Race

Answer 6

• Relies upon perceived biological differences between people and populations
• based on superficial physical characteristics (facial features, hair colour, skin)

Question 7

Culture

Answer 7

• Patterns of behaviour acquired and transmitted by symbols, language and rituals
• recipe for living in the world
• constantly adapting

Question 8

Factors that contribute to lower use of palliative care resources by ethnic minorities

Answer 8

• Attitudes to palliative care
• ethno-centralism of palliative care
• Awareness (lack of)
• social deprivation (low SES)
• Dissatisfaction with health care
• Mistrust
• Gatekeepers not referring

Question 9

How does culture influence pain?

Answer 9

• culture and beliefs can greatly impact perception and response to pain
• communication of pain
• eg. stoicism, loud expression,e tc

Question 10

WHO Essential medicines in Palliative Care

Answer 10

• Amitriptyline
• Bisacodyl
• Carbamazepine
• Citalopram
• Codeine
• Dexamethasone
• Diazepam
• Diclofenac
• Diphenhydramine
• Fentanyl
• Gabapentin
• Haloperidol
• Hyoscine Buylbromide
• Ibuprofen
• Loperamide
• Lorazepam
• Megestrol acetate
• Methadone
• Metoclopramide
• Midazolam
• Mineral oil enema
• Mirtazapine
• Morphine
• Octreotide
• Oral rehydration salts
• Oxycodone
• Paracetamol
• Prednisone
• Senna
• Tramadol
• Trazodone
• Zolpidem