Herce Michael E, Elmore Shekinah N, Kalanga Noel, Keck James W, Wroe Emily B, Phiri Atupere, Mayfield Alishya, Chingoli Felix, Beste Jason A, Tengatenga Listern, Bazile Junior, Krakauer Eric L, Rigodon Jonas
Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America; Abwenzi Pa Za Umoyo, Neno, Malawi; Partners in Health, Boston, Massachusetts, United States of America.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2014 Oct 14;9(10):e110457. doi: 10.1371/journal.pone.0110457. eCollection 2014.
Palliative care is rarely accessible in rural sub-Saharan Africa. Partners In Health and the Malawi government established the Neno Palliative Care Program (NPCP) to provide palliative care in rural Neno district. We conducted a situation analysis to evaluate early NPCP outcomes and better understand palliative care needs, knowledge, and preferences.
Employing rapid evaluation methodology, we collected data from 3 sources: 1) chart review of all adult patients from the NPCP's first 9 months; 2) structured interviews with patients and caregivers; 3) semi-structured interviews with key stakeholders.
The NPCP enrolled 63 patients in its first 9 months. Frequent diagnoses were cancer (n = 50, 79%) and HIV/AIDS (n = 37 of 61, 61%). Nearly all (n = 31, 84%) patients with HIV/AIDS were on antiretroviral therapy. Providers registered 112 patient encounters, including 22 (20%) home visits. Most (n = 43, 68%) patients had documented pain at baseline, of whom 23 (53%) were treated with morphine. A majority (n = 35, 56%) had ≥1 follow-up encounter. Mean African Palliative Outcome Scale pain score decreased non-significantly between baseline and follow-up (3.0 vs. 2.7, p = 0.5) for patients with baseline pain and complete pain assessment documentation. Providers referred 48 (76%) patients for psychosocial services, including community health worker support, socioeconomic assistance, or both. We interviewed 36 patients referred to the NPCP after the chart review period. Most had cancer (n = 19, 53%) or HIV/AIDS (n = 10, 28%). Patients frequently reported needing income (n = 24, 67%) or food (n = 22, 61%). Stakeholders cited a need to make integrated palliative care widely available.
We identified a high prevalence of pain and psychosocial needs among patients with serious chronic illnesses in rural Malawi. Early NPCP results suggest that comprehensive palliative care can be provided in rural Africa by integrating disease-modifying treatment and palliative care, linking hospital, clinic, and home-based services, and providing psychosocial support that includes socioeconomic assistance.
在撒哈拉以南非洲农村地区，姑息治疗服务极为匮乏。健康伙伴组织与马拉维政府共同设立了内诺姑息治疗项目（NPCP），旨在为内诺农村地区提供姑息治疗服务。我们开展了一项情况分析，以评估NPCP早期成效，并更深入了解姑息治疗的需求、知识及偏好。
采用快速评估方法，我们从3个来源收集数据：1）对NPCP前9个月所有成年患者的病历进行审查；2）对患者及照护者进行结构化访谈；3）对关键利益相关者进行半结构化访谈。
NPCP在前9个月共登记了63名患者。常见诊断为癌症（n = 50，79%）和艾滋病毒/艾滋病（61名患者中的37名，61%）。几乎所有（n = 31，84%）艾滋病毒/艾滋病患者都在接受抗逆转录病毒治疗。医护人员记录了112次患者诊疗情况，其中包括22次（20%）家访。大多数（n = 43，68%）患者在基线时有疼痛记录，其中23名（53%）接受了吗啡治疗。多数（n = 35，56%）患者有≥1次随访诊疗。对于有基线疼痛且有完整疼痛评估记录的患者，非洲姑息治疗结果量表疼痛评分在基线和随访之间无显著下降（3.0对2.7，p = 0.5）。医护人员为48名（76%）患者转诊至心理社会服务机构，包括社区卫生工作者支持、社会经济援助或两者皆有。在病历审查期之后，我们对36名转诊至NPCP的患者进行了访谈。大多数患者患有癌症（n = 19，53%）或艾滋病毒/艾滋病（n = 10，28%）。患者经常报告需要收入（n = 24，67%）或食物（n = 22，61%）。利益相关者指出需要广泛提供综合姑息治疗服务。
我们发现马拉维农村地区患有严重慢性病的患者中，疼痛和心理社会需求普遍存在。NPCP早期结果表明，通过整合疾病改善治疗与姑息治疗、连接医院、诊所和居家服务，并提供包括社会经济援助在内的心理社会支持，可在非洲农村地区提供全面姑息治疗服务。
