Laabar Tara Devi, Saunders Christobel, Auret Kirsten, Johnson Claire E
Department of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia.
Department of Nursing and Midwifery, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.
Indian J Palliat Care. 2023 Jan-Mar;29(1):15-27. doi: 10.25259/IJPC_92_2022. Epub 2022 Sep 21.
The demand for palliative care (PC) is ever-increasing globally. The emergence of COVID-19 pandemic has further accelerated the need for PC. In the lower-income countries (LICs), where PC need is highest, PC, the most humane, appropriate and realistic approach to care for patients and families affected by life-limiting illness, is minimal or non-existent. Recognising the disparity between high, middle and LICs, the World Health Organization (WHO) has recommended public health strategies for PC within the socioeconomic, cultural and spiritual contexts of individual countries. This review aimed to: (i) identify PC models in the LICs utilising public health strategies and (ii) characterise how social, cultural and spiritual components were integrated into these models. This is an integrative literature review. Thirty-seven articles were included from a search of four electronic databases - Medline, Embase, Global Health and CINAHL. Literature, both empirical and theoretical literature, published in English from January 2000 to May 2021 that mentioned PC models/services/programmes integrating public health strategies in the LICs were included in the study. A number of LICs utilised public health strategies to deliver PC. One-third of the selected articles highlighted the importance of integrating sociocultural and spiritual components into PC. Two main themes - and and five subthemes - (i) suitable policies; (ii) availability and accessibility of essential drugs; (iii) PC education for health professionals, policymakers and the public; (iv) implementation of PC at all levels of healthcare and (v) sociocultural and spiritual components, were derived. Despite embracing the public health approach, many LICs encountered several challenges in integrating all four strategies successfully.
全球对姑息治疗（PC）的需求在不断增加。新冠疫情的出现进一步加速了对姑息治疗的需求。在姑息治疗需求最高的低收入国家（LICs），姑息治疗作为照顾受危及生命疾病影响的患者及其家庭的最人道、合适和现实的方法，却极少存在或根本不存在。认识到高收入、中等收入和低收入国家之间的差距，世界卫生组织（WHO）建议在各个国家的社会经济、文化和精神背景下制定姑息治疗的公共卫生策略。本综述旨在：（i）确定低收入国家利用公共卫生策略的姑息治疗模式；（ii）描述社会、文化和精神成分如何融入这些模式。这是一项综合文献综述。通过检索四个电子数据库——Medline、Embase、Global Health和CINAHL，纳入了37篇文章。研究纳入了2000年1月至2021年5月以英文发表的、提及在低收入国家整合公共卫生策略的姑息治疗模式/服务/项目的实证和理论文献。一些低收入国家利用公共卫生策略来提供姑息治疗。三分之一的入选文章强调了将社会文化和精神成分融入姑息治疗的重要性。得出了两个主要主题以及五个子主题——（i）合适的政策；（ii）基本药物的可获得性和可及性；（iii）对卫生专业人员、政策制定者和公众的姑息治疗教育；（iv）在各级医疗保健中实施姑息治疗；（v）社会文化和精神成分。尽管采用了公共卫生方法，但许多低收入国家在成功整合所有四项策略方面遇到了若干挑战。
