Head Palliative Care Unit, Khartoum Oncology Hospital, King's College London, Cairo, Egypt.
Kings College London, Cicely Saunders Institute, Ministry of Health, Addis Ababa, Ethiopia.
BMC Palliat Care. 2024 Nov 15;23(1):264. doi: 10.1186/s12904-024-01590-5.
Palliative care in the Eastern Mediterranean Region (EMR) faces challenges despite the high number of patients in need. To provide accessible, affordable, and timely services, it is crucial to adopt a suitable care model. World health organization (WHO) recommends integrating palliative care with primary health care (PHC). Given the unique conditions of EMR countries, there is a need to design a model tailored to these contexts.
This study is a multi-method research project conducted through several sub-studies, including a literature review, policy analysis, expert opinion (Delphi Method), dimension-specific analysis, model development, and its validation and refinement (Delphi Method). Drawing from the WHO model, six dimensions: policy, drug availability, education, community integration, service delivery, and research were considered to developing the model and implementation requirements. Within each dimension, evidence-based solutions tailored to the region's context were explored.
A successful palliative care model requires, in the policy dimension, oversight by the Ministry of Health (MOH). Having a focal-person or working group within the MOH is crucial for policy-making, formulation, and approval of clinical guidelines, as well as addressing care challenges. It is essential to provide access to morphine and other essential medications, along with facilitating the administration and consumption of morphine at home. Conducting empowerment courses for care providers, can address various challenges. Community involvement through volunteers, charities, and non-governmental organizations (NGOs) is also important. To ensure service provision, monitoring and evaluating systems are crucial, along with striving for service continuity through an appropriate payment system. Lastly, research is necessary for needs assessment, evidence-based practice, and designing evaluation indicators. The proposed model relies on community health workers, especially nurses, as multitasking professionals available for community palliative care. In the presented model, special attention has been given to networking, collaboration, and the use of digital health technologies to support nurses.
The model proposed for integrating palliative care into PHC should serve as a framework that enhances access to available and affordable services for countries in the region. While this model was developed based on the overall conditions of the region, each country can tailor it to its unique strengths and opportunities.
尽管中东地区（EMR）有大量需要治疗的患者，但姑息治疗仍面临挑战。为了提供可及、负担得起和及时的服务，采用合适的护理模式至关重要。世界卫生组织（WHO）建议将姑息治疗与初级卫生保健（PHC）相结合。鉴于 EMR 国家的独特情况，需要设计适合这些情况的模型。
本研究是一个多方法研究项目，通过多项子研究进行，包括文献综述、政策分析、专家意见（德尔菲法）、特定维度分析、模型开发以及模型验证和完善（德尔菲法）。该研究以世界卫生组织模型为基础，考虑了六个维度：政策、药物供应、教育、社区整合、服务提供以及研究，以制定模型和实施要求。在每个维度中，都探讨了针对该地区情况的循证解决方案。
成功的姑息治疗模式需要在政策维度上由卫生部（MOH）进行监督。在 MOH 内部设立一个负责人或工作组对于政策制定、临床指南的制定、批准以及解决护理挑战至关重要。提供吗啡和其他基本药物的获取途径，以及促进在家中管理和使用吗啡也很重要。为护理人员提供赋权课程可以解决各种挑战。通过志愿者、慈善机构和非政府组织（NGO）让社区参与进来也很重要。为了确保服务的提供，监测和评估系统至关重要，同时还需要通过适当的支付系统来努力实现服务的连续性。最后，需要开展研究以进行需求评估、循证实践以及设计评估指标。所提出的模型依赖于社区卫生工作者，尤其是护士，作为可用于社区姑息治疗的多任务专业人员。在提出的模型中，特别关注了网络、协作以及使用数字健康技术来支持护士。
为将姑息治疗纳入 PHC 而提出的模型应作为一个框架，为该地区的国家提供更多获得可及和负担得起的服务的机会。虽然该模型是基于该地区的总体情况制定的，但每个国家都可以根据其独特的优势和机会对其进行调整。
