Icahn School of Medicine at Mount Sinai, New York, New York, USA.
ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Navarra, Spain; IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Navarra, Spain.
J Pain Symptom Manage. 2018 May;55(5):1313-1320.e2. doi: 10.1016/j.jpainsymman.2018.01.009. Epub 2018 Feb 2.
Factors contributing to and impeding palliative care (PC) development in Africa can provide insights into current strategies for advancing PC.
To identify key factors affecting PC development in African countries from in-country PC experts' perspectives.
About 16 PC experts from seven African countries undertook semistructured interviews on PC development in their respective countries. An interpretive description approach was adopted, with data analyzed using constant comparison.
Emerged themes included drivers, strengths, challenges, and aspirations for PC development in Africa. Drivers included advocates and pioneering organizations, HIV/AIDS, culture of caregiving, and the World Health Assembly PC resolution. Strengths included community health workers, the special role of nurses, diversity of services, and short training courses. Challenges included lack of PC education; lack of standardization in implementation; limited availability of and/or accessibility to morphine; poverty and disease burden; and lack of funding for PC. Aspirations included integration of PC, specialization in PC, nurse prescribing, and strong partnerships with Ministries of Health. Factors already highlighted in the literature were only briefly discussed.
The key factors underpinning PC development in the seven countries contributed to the beginnings of PC in Africa, fueled by advocates who built on existing strengths to maximize opportunities. However, the current approach is at high risk in terms of its sustainability, and strategies for maximizing existing resources and growing infrastructure support are needed moving forward.
促成和阻碍非洲姑息治疗（PC）发展的因素可以为当前推进 PC 的策略提供一些启示。
从非洲国家国内 PC 专家的角度，确定影响非洲国家 PC 发展的关键因素。
来自七个非洲国家的约 16 名 PC 专家就其各自国家的 PC 发展情况进行了半结构化访谈。采用解释性描述方法，使用恒比法进行数据分析。
出现的主题包括促进非洲 PC 发展的驱动力、优势、挑战和愿望。驱动力包括倡导者和开创性组织、艾滋病毒/艾滋病、关爱文化以及世界卫生大会 PC 决议。优势包括社区卫生工作者、护士的特殊作用、服务多样性以及短期培训课程。挑战包括缺乏 PC 教育、实施缺乏标准化、吗啡供应有限且获取困难、贫困和疾病负担以及 PC 资金不足。愿望包括 PC 的整合、PC 的专业化、护士处方以及与卫生部的强有力伙伴关系。文献中已经强调的因素只是简要讨论了一下。
这七个国家支撑 PC 发展的关键因素促成了非洲 PC 的起步，倡导者利用现有优势，抓住机会，推动了 PC 的发展。然而，目前的方法在可持续性方面存在高风险，需要采取策略来最大限度地利用现有资源并支持基础设施的发展。
