Conference Material > Poster
Doherty M, Richardson K, Lynch-Godrei A, Azad TB, Ferdous L, et al.
MSF Paediatric Days 2022. 2021 November 30; DOI:10.57740/k0d5-c989
Conference Material > Abstract
Nair MM, Kumar P, Mahajan R, Harshana A, Richardson K, et al.
MSF Scientific Days International 2020: Research. 2020 May 20
INTRODUCTION
Effective palliative care requires a multidisciplinary and holistic approach based on the provision of comprehensive care with treatment of pain and physical symptoms, management of psychosocial needs, as well as other non-medical needs. Few studies exist about palliative care in India, particularly in the context of people living with HIV/AIDS. MSF supports an advanced HIV inpatient ward in Bihar, where mortality rates are high. We aimed to explore the lived experiences of palliative care among patients, and their families, with advanced HIV, to understand conceptions of illness, death, and end-of-life care in Bihar, India.
METHODS
We carried out an exploratory, qualitative study using 21 semi-structured in-depth interviews and 1 focus group discussion. Participants included patients living with HIV/AIDS (PLHA), caregivers, relatives of deceased patients who had been treated in a government hospital, and key informants from community-based organizations in Patna, Bihar. Interview data were transcribed verbatim, translated from Hindi or other local languages into English by research assistants, and analysed using NVIVO (QSR International, Victoria, Australia). Two researchers then carried out inductive, thematic analysis of the data. Emergent codes and categories were identified and compared to subsequent areas of inquiry.
ETHICS
This study was approved by the ethics committee of the All India Institute of Medical Sciences, Patna, India, and the MSF Ethics Review Board.
RESULTS
Latent thematic analysis revealed poor understanding of palliative care among advanced HIV patients and their caregivers; the term “palliative care” was not known to PLHA. PLHA and relatives expected active treatment, despite poor prognosis, and believed that dying patients should be provided a separate, private inpatient area. However, patients were able to identify the importance of psychosocial counselling, the desire for a separate dedicated space for terminal patients with social and recreational activities to prevent isolation, and a preference for home-based palliative care wherever possible. Our data showed that relatives of patients played a substantial role in influencing doctors and nurses to avoid divulging the nature of the disease and prognosis directly to patients. There was variation in preferences for open disclosure of prognosis amongst critically ill PLHA and relatives of deceased patients.
CONCLUSION
There is a need to improve palliative care provision for advanced HIV patients in Bihar, who do not typically have access to such services. PLHA should have a separate dedicated area, with adequate psychosocial counselling for patients and families, and regular recreational activities to prevent social isolation.
CONFLICTS OF INTEREST
None declared.
Effective palliative care requires a multidisciplinary and holistic approach based on the provision of comprehensive care with treatment of pain and physical symptoms, management of psychosocial needs, as well as other non-medical needs. Few studies exist about palliative care in India, particularly in the context of people living with HIV/AIDS. MSF supports an advanced HIV inpatient ward in Bihar, where mortality rates are high. We aimed to explore the lived experiences of palliative care among patients, and their families, with advanced HIV, to understand conceptions of illness, death, and end-of-life care in Bihar, India.
METHODS
We carried out an exploratory, qualitative study using 21 semi-structured in-depth interviews and 1 focus group discussion. Participants included patients living with HIV/AIDS (PLHA), caregivers, relatives of deceased patients who had been treated in a government hospital, and key informants from community-based organizations in Patna, Bihar. Interview data were transcribed verbatim, translated from Hindi or other local languages into English by research assistants, and analysed using NVIVO (QSR International, Victoria, Australia). Two researchers then carried out inductive, thematic analysis of the data. Emergent codes and categories were identified and compared to subsequent areas of inquiry.
ETHICS
This study was approved by the ethics committee of the All India Institute of Medical Sciences, Patna, India, and the MSF Ethics Review Board.
RESULTS
Latent thematic analysis revealed poor understanding of palliative care among advanced HIV patients and their caregivers; the term “palliative care” was not known to PLHA. PLHA and relatives expected active treatment, despite poor prognosis, and believed that dying patients should be provided a separate, private inpatient area. However, patients were able to identify the importance of psychosocial counselling, the desire for a separate dedicated space for terminal patients with social and recreational activities to prevent isolation, and a preference for home-based palliative care wherever possible. Our data showed that relatives of patients played a substantial role in influencing doctors and nurses to avoid divulging the nature of the disease and prognosis directly to patients. There was variation in preferences for open disclosure of prognosis amongst critically ill PLHA and relatives of deceased patients.
CONCLUSION
There is a need to improve palliative care provision for advanced HIV patients in Bihar, who do not typically have access to such services. PLHA should have a separate dedicated area, with adequate psychosocial counselling for patients and families, and regular recreational activities to prevent social isolation.
CONFLICTS OF INTEREST
None declared.
Conference Material > Abstract
Omar MF, Kashifa Z, Ghalib MK, Deslandes D, Morton N
MSF Scientific Days UK 2019: Innovation. 2019 May 10
INTRODUCTION
Palliative care improves the quality of life of patients, and their families, facing problems associated with life-threatening illness, through the prevention and relief of suffering. Most children needing palliative care at the end of life are neonates residing in low- and middle-income countries; around 68% have perinatal conditions, and nearly 10% have congenital anomalies. MSF operates maternity services within Dasht-e-Barchi hospital, Kabul, Afghanistan, where over one thousand deliveries take place each month. The intermediate-level neonatal unit receives babies with extremely low birth weight, extreme prematurity, congenital anomalies and other conditions such as severe birth asphyxia. For many of these babies, intensive curative therapy is deemed not in the baby's best interests and providing appropriate comfort care is required. We describe our efforts to implement palliative care in this setting.
METHODS
Steps taken towards implementation of palliative care within the neonatal unit initially involved discussions with key stakeholders, including the project clinical staff, the Ministry of Health and community leaders, to identify needs and local barriers. Following this, sensitization and training of staff was carried out to improve understanding of palliative care. Finally, we developed a palliative care framework, involving tools for clinical management, as well as guidance for decision-making and communication, and the implementation of a palliative care committee.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
Discussions with key stakeholders, including individuals based within the Ministry of Health, community leaders, and clinical staff, helped identify contextual barriers to implementing palliative care, including religious beliefs and the lack of an existing medical and legal framework. Some staff initially described resistance, partly due to their lack of experience or training in palliative care, and the absence of formal policies around palliative care in Afghanistan. We carried out training for nursing and medical staff, focusing on core concepts and technical skills. We developed a communication framework, to help deliver clear and consistent information to caregivers, addressing the need for understanding improvements in quantity and quality of the baby’s life. To further enhance communication and collaboration, a palliative care committee was established, including nursing, medical and managerial staff. This committee meets regularly to discuss palliative care issues, as well as also holding ad-hoc meetings to support clinical decision-making and caregiver counselling.
CONCLUSIONS
The implementation of neonatal palliative care requires involvement of key stakeholders to overcome potential barriers and to develop a clear framework. The palliative care committee we developed provides a support system to help facilitate consistent decision-making, and a collaborative multi-disciplinary approach for clinical care. While there are ongoing challenges in such a context, our experience shows that it is possible to implement context-specific and family-centered palliative care.
CONFLICTS OF INTEREST
None declared.
Palliative care improves the quality of life of patients, and their families, facing problems associated with life-threatening illness, through the prevention and relief of suffering. Most children needing palliative care at the end of life are neonates residing in low- and middle-income countries; around 68% have perinatal conditions, and nearly 10% have congenital anomalies. MSF operates maternity services within Dasht-e-Barchi hospital, Kabul, Afghanistan, where over one thousand deliveries take place each month. The intermediate-level neonatal unit receives babies with extremely low birth weight, extreme prematurity, congenital anomalies and other conditions such as severe birth asphyxia. For many of these babies, intensive curative therapy is deemed not in the baby's best interests and providing appropriate comfort care is required. We describe our efforts to implement palliative care in this setting.
METHODS
Steps taken towards implementation of palliative care within the neonatal unit initially involved discussions with key stakeholders, including the project clinical staff, the Ministry of Health and community leaders, to identify needs and local barriers. Following this, sensitization and training of staff was carried out to improve understanding of palliative care. Finally, we developed a palliative care framework, involving tools for clinical management, as well as guidance for decision-making and communication, and the implementation of a palliative care committee.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
Discussions with key stakeholders, including individuals based within the Ministry of Health, community leaders, and clinical staff, helped identify contextual barriers to implementing palliative care, including religious beliefs and the lack of an existing medical and legal framework. Some staff initially described resistance, partly due to their lack of experience or training in palliative care, and the absence of formal policies around palliative care in Afghanistan. We carried out training for nursing and medical staff, focusing on core concepts and technical skills. We developed a communication framework, to help deliver clear and consistent information to caregivers, addressing the need for understanding improvements in quantity and quality of the baby’s life. To further enhance communication and collaboration, a palliative care committee was established, including nursing, medical and managerial staff. This committee meets regularly to discuss palliative care issues, as well as also holding ad-hoc meetings to support clinical decision-making and caregiver counselling.
CONCLUSIONS
The implementation of neonatal palliative care requires involvement of key stakeholders to overcome potential barriers and to develop a clear framework. The palliative care committee we developed provides a support system to help facilitate consistent decision-making, and a collaborative multi-disciplinary approach for clinical care. While there are ongoing challenges in such a context, our experience shows that it is possible to implement context-specific and family-centered palliative care.
CONFLICTS OF INTEREST
None declared.
Conference Material > Abstract
Yantzi R, Hadiuzzaman M, Gupta PS, Lamrous A, Pringle J, et al.
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/6gzd-jz18
INTRODUCTION
855,000 Rohingya refugees live in overcrowded camps in Cox’s Bazar, Bangladesh where MSF operates Goyalmara Hospital, the only dedicated pediatric and neonatal hospital serving the camps. Palliative care services have been prioritized due to the medical complexity of patients. While palliative care is increasingly recognized as an important component of humanitarian interventions, little is known about the experience
of and impact on staff delivering end-of-life care.
METHODS
This focused ethnography was conducted between March--August 2021 at Goyalmara Hospital. Data collection involved participant-observation, individual interviews with national (17) and international staff (five), focus group discussions with national staff (five), and analysis of protocols and other documents. A coding scheme was developed using transcript narrative summaries to identify key concepts and constant comparison techniques between and within data sources. Data were coded using NVivo 11.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the ERB of Bangladesh University of Health Sciences.
RESULTS
Moral experiences of staff were influenced by perceived duty of ensuring every effort was made on behalf of patients; ambiguity around the concepts of palliative and end-of-life care, and the perception of palliative care as withdrawal of treatment when “we have nothing to do”. Staff reported coping with frequent deaths by reassuring themselves that they had done their best, yet expressed frustration that MSF could not or would not refer patients for higher-level treatment that they believed was available, and over the lack of transparency of such policies. A perception that further referral for Bangladeshi children was possible in contrast to Rohingya led to a troubling acceptance by staff of discriminatory care pathways. The absence of home-based palliative care, communication barriers, and inconsistent access to morphine, contributed to a sense of powerlessness. Palliative care decision-making was led by expatriate doctors. Although nurses felt more engaged compared with previous roles, several doctors felt uncomfortable with decisions and unable to contradict expatriates. Revolving expatriates with different decision-making approaches undermined national staff confidence. Protocols were seen by all to promote consistency and were utilised by national staff to justify decisions when there was disagreement with expatriates. Non-medical staff were observed to play an important role in sharing difficult news with families but they reported feeling unprepared for this responsibility.
CONCLUSION
Ensuring clarity and transparency of referral policies and ceiling of-care criteria is needed to support staff coping mechanisms and to ensure that palliative care is not perceived as a substitute for life-saving care. Non-medical staff require adequate training and support if they are involved with communicating end-of-life decisions to families.
CONFLICTS OF INTEREST
None declared.
855,000 Rohingya refugees live in overcrowded camps in Cox’s Bazar, Bangladesh where MSF operates Goyalmara Hospital, the only dedicated pediatric and neonatal hospital serving the camps. Palliative care services have been prioritized due to the medical complexity of patients. While palliative care is increasingly recognized as an important component of humanitarian interventions, little is known about the experience
of and impact on staff delivering end-of-life care.
METHODS
This focused ethnography was conducted between March--August 2021 at Goyalmara Hospital. Data collection involved participant-observation, individual interviews with national (17) and international staff (five), focus group discussions with national staff (five), and analysis of protocols and other documents. A coding scheme was developed using transcript narrative summaries to identify key concepts and constant comparison techniques between and within data sources. Data were coded using NVivo 11.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the ERB of Bangladesh University of Health Sciences.
RESULTS
Moral experiences of staff were influenced by perceived duty of ensuring every effort was made on behalf of patients; ambiguity around the concepts of palliative and end-of-life care, and the perception of palliative care as withdrawal of treatment when “we have nothing to do”. Staff reported coping with frequent deaths by reassuring themselves that they had done their best, yet expressed frustration that MSF could not or would not refer patients for higher-level treatment that they believed was available, and over the lack of transparency of such policies. A perception that further referral for Bangladeshi children was possible in contrast to Rohingya led to a troubling acceptance by staff of discriminatory care pathways. The absence of home-based palliative care, communication barriers, and inconsistent access to morphine, contributed to a sense of powerlessness. Palliative care decision-making was led by expatriate doctors. Although nurses felt more engaged compared with previous roles, several doctors felt uncomfortable with decisions and unable to contradict expatriates. Revolving expatriates with different decision-making approaches undermined national staff confidence. Protocols were seen by all to promote consistency and were utilised by national staff to justify decisions when there was disagreement with expatriates. Non-medical staff were observed to play an important role in sharing difficult news with families but they reported feeling unprepared for this responsibility.
CONCLUSION
Ensuring clarity and transparency of referral policies and ceiling of-care criteria is needed to support staff coping mechanisms and to ensure that palliative care is not perceived as a substitute for life-saving care. Non-medical staff require adequate training and support if they are involved with communicating end-of-life decisions to families.
CONFLICTS OF INTEREST
None declared.
Journal Article > ResearchFull Text
BMJ Open. 2020 October 5; Volume 10 (Issue 10); e036179.; DOI:10.1136/bmjopen-2019-036179
Nair MM, Kumar P, Mahajan R, Harshana A, Richardson K, et al.
BMJ Open. 2020 October 5; Volume 10 (Issue 10); e036179.; DOI:10.1136/bmjopen-2019-036179
OBJECTIVES
This study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand the broader palliative care context in Bihar.
DESIGN
This was an exploratory, qualitative study which used thematic analysis of semistructured, in-depth interviews as well as a focus group discussion.
SETTINGS
All interviews took place in a secondary care hospital in Patna, Bihar which provides holistic care to critically unwell PLHA.
PARTICIPANTS
We purposively selected 29 participants: 10 critically unwell PLHA, 5 caregivers of hospitalised patients, 7 relatives of deceased patients who were treated in the secondary care hospital and 7 key informants from community-based organisations.
RESULTS
Critically ill PLHA emphasised the need for psychosocial counselling and opportunities for social interaction in the ward, as well as a preference for components of home-based palliative care, even though they were unfamiliar with actual terms such as 'palliative care' and 'end-of-life care'. Critically unwell PLHA generally expressed preference for separate, private inpatient areas for end-of-life care. Relatives of deceased patients stated that witnessing patients' deaths caused trauma for other PLHA. Caregivers and relatives of deceased patients felt there was inadequate time and space for grieving in the hospital. While both critically ill PLHA and relatives wished that poor prognosis be transparently disclosed to family members, many felt it should not be disclosed to the dying patients themselves.
CONCLUSIONS
Despite expected high inpatient fatality rates, PLHA in Bihar lack access to palliative care services. PLHA receiving end-of-life care in hospitals should have a separate dedicated area, with adequate psychosocial counselling and activities to prevent social isolation. Healthcare providers should make concerted efforts to inquire, understand and adapt their messaging on prognosis and end-of-life care based on patients' preferences.
This study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand the broader palliative care context in Bihar.
DESIGN
This was an exploratory, qualitative study which used thematic analysis of semistructured, in-depth interviews as well as a focus group discussion.
SETTINGS
All interviews took place in a secondary care hospital in Patna, Bihar which provides holistic care to critically unwell PLHA.
PARTICIPANTS
We purposively selected 29 participants: 10 critically unwell PLHA, 5 caregivers of hospitalised patients, 7 relatives of deceased patients who were treated in the secondary care hospital and 7 key informants from community-based organisations.
RESULTS
Critically ill PLHA emphasised the need for psychosocial counselling and opportunities for social interaction in the ward, as well as a preference for components of home-based palliative care, even though they were unfamiliar with actual terms such as 'palliative care' and 'end-of-life care'. Critically unwell PLHA generally expressed preference for separate, private inpatient areas for end-of-life care. Relatives of deceased patients stated that witnessing patients' deaths caused trauma for other PLHA. Caregivers and relatives of deceased patients felt there was inadequate time and space for grieving in the hospital. While both critically ill PLHA and relatives wished that poor prognosis be transparently disclosed to family members, many felt it should not be disclosed to the dying patients themselves.
CONCLUSIONS
Despite expected high inpatient fatality rates, PLHA in Bihar lack access to palliative care services. PLHA receiving end-of-life care in hospitals should have a separate dedicated area, with adequate psychosocial counselling and activities to prevent social isolation. Healthcare providers should make concerted efforts to inquire, understand and adapt their messaging on prognosis and end-of-life care based on patients' preferences.
Conference Material > Abstract
Yantzi R, Hadiuzzaman M, Gupta PS, Lamrous A, Richardson K, et al.
MSF Paediatric Days 2022. 2022 November 26; DOI:10.57740/2rds-ya16
BACKGROUND AND AIMS
MSF Goyalmara Hospital in Cox’s Bazar, Bangladesh, offers the highest level of paediatric and neonatal care serving the Rohingya refugee camps. Efforts are underway to integrate palliative care due to high mortality and medical complexity of patients, yet little is known about the experience of staff delivering palliative and end-of-life care.
METHODS
This focused ethnography was conducted between March and August 2021 at Goyalmara Hospital. Data collection involved participant observation, individual interviews with locally-hired (17) and international staff (5), focus group discussions with locally-hired staff (5), and analysis of protocols and other documents. A coding scheme was developed, and data coded using NVivo 11.
RESULTS
Staff perceived gaining the trust of caregivers (parents, grandparents) to be an essential step to providing palliative care and a source of professional fulfillment. Misunderstanding and mistrust were morally distressing to staff, and they experienced intense guilt when they believed that misunderstandings contributed to children’s deaths. Efforts to ensure caregiver understanding were complicated by language and cultural differences between staff and caregivers. Staff felt an obligation to suppress their emotional responses to death and dying, even though they acknowledged that this risked caregivers perceiving them as uncaring. Tensions emerged as some staff passed moral judgement on caregivers who they felt were making the ‘wrong decision’, or who brought a child to hospital too late to save their life. Likewise, staff perceived that caregivers did not always believe the staff were acting in their child’s best interests. Other staff were able to empathise with the impacts of grief and systematic exclusion on caregivers’ reactions and decision-making.
CONCLUSIONS
Positive therapeutic relationships with caregivers may alleviate an important source of moral distress among staff. Access to translation services, communication and grief resilience training, and appreciating psychological impacts of systematic healthcare exclusion on communities may mitigate this distress.
MSF Goyalmara Hospital in Cox’s Bazar, Bangladesh, offers the highest level of paediatric and neonatal care serving the Rohingya refugee camps. Efforts are underway to integrate palliative care due to high mortality and medical complexity of patients, yet little is known about the experience of staff delivering palliative and end-of-life care.
METHODS
This focused ethnography was conducted between March and August 2021 at Goyalmara Hospital. Data collection involved participant observation, individual interviews with locally-hired (17) and international staff (5), focus group discussions with locally-hired staff (5), and analysis of protocols and other documents. A coding scheme was developed, and data coded using NVivo 11.
RESULTS
Staff perceived gaining the trust of caregivers (parents, grandparents) to be an essential step to providing palliative care and a source of professional fulfillment. Misunderstanding and mistrust were morally distressing to staff, and they experienced intense guilt when they believed that misunderstandings contributed to children’s deaths. Efforts to ensure caregiver understanding were complicated by language and cultural differences between staff and caregivers. Staff felt an obligation to suppress their emotional responses to death and dying, even though they acknowledged that this risked caregivers perceiving them as uncaring. Tensions emerged as some staff passed moral judgement on caregivers who they felt were making the ‘wrong decision’, or who brought a child to hospital too late to save their life. Likewise, staff perceived that caregivers did not always believe the staff were acting in their child’s best interests. Other staff were able to empathise with the impacts of grief and systematic exclusion on caregivers’ reactions and decision-making.
CONCLUSIONS
Positive therapeutic relationships with caregivers may alleviate an important source of moral distress among staff. Access to translation services, communication and grief resilience training, and appreciating psychological impacts of systematic healthcare exclusion on communities may mitigate this distress.
Conference Material > Video (talk)
Yantzi R
MSF Scientific Days International 2022. 2022 June 7; DOI:10.57740/dbd4-1v49
Journal Article > ResearchFull Text
JCO Global Oncology. 2023 August 3 (Issue 9); e2300057.; DOI:10.1200/GO.23.00057
McNeil MJ, Godfrey A, Loggetto P, de Oliveira Junior A, Job G, et al.
JCO Global Oncology. 2023 August 3 (Issue 9); e2300057.; DOI:10.1200/GO.23.00057
PURPOSE
Early integration of pediatric palliative care (PPC) for children with cancer is critical to improving the quality of life of both the patient and family. Understanding physician perceptions of palliative care and perceived barriers to early integration is necessary to develop PPC in Brazil.
METHODS
The Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in Brazil. The survey was open from January 2022 to June 2022 and distributed to physicians of all specialties from participating institutions who treat children with cancer. Statistical analysis was complemented by qualitative analysis of open-ended responses.
RESULTS
A total of 272 respondents participated. Most respondents reported access to PPC experts for consultation (77.2%) and 34.5% indicated previous palliative care training. Physician knowledge of PPC was generally aligned with WHO guidance (median alignment, 93.0%; range, 80.5%-98.2%). However, about half (53.3%) felt comfortable addressing physical needs of patients receiving PPC, 35.3% addressing emotional needs, 25.8% addressing spiritual needs, and 33.5% addressing grief and bereavement needs. Most respondents (65.4%) felt palliative care should be involved from diagnosis, but only 10.3% stated that this occurred in their setting. The most important barriers identified were physician discomfort (89.0%), limited physician knowledge (88.6%), and lack of home-based services (83.8%).
CONCLUSION
Despite a strong understanding of the role of palliative care, physicians in Brazil reported low confidence delivering PPC to children with cancer. Additionally, physicians generally believed that PPC should be integrated earlier in the disease trajectory of children with cancer. This work will direct educational and capacity building initiatives to ensure greater access to high-quality PPC for children with cancer in Brazil to address patient and family suffering.
Early integration of pediatric palliative care (PPC) for children with cancer is critical to improving the quality of life of both the patient and family. Understanding physician perceptions of palliative care and perceived barriers to early integration is necessary to develop PPC in Brazil.
METHODS
The Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in Brazil. The survey was open from January 2022 to June 2022 and distributed to physicians of all specialties from participating institutions who treat children with cancer. Statistical analysis was complemented by qualitative analysis of open-ended responses.
RESULTS
A total of 272 respondents participated. Most respondents reported access to PPC experts for consultation (77.2%) and 34.5% indicated previous palliative care training. Physician knowledge of PPC was generally aligned with WHO guidance (median alignment, 93.0%; range, 80.5%-98.2%). However, about half (53.3%) felt comfortable addressing physical needs of patients receiving PPC, 35.3% addressing emotional needs, 25.8% addressing spiritual needs, and 33.5% addressing grief and bereavement needs. Most respondents (65.4%) felt palliative care should be involved from diagnosis, but only 10.3% stated that this occurred in their setting. The most important barriers identified were physician discomfort (89.0%), limited physician knowledge (88.6%), and lack of home-based services (83.8%).
CONCLUSION
Despite a strong understanding of the role of palliative care, physicians in Brazil reported low confidence delivering PPC to children with cancer. Additionally, physicians generally believed that PPC should be integrated earlier in the disease trajectory of children with cancer. This work will direct educational and capacity building initiatives to ensure greater access to high-quality PPC for children with cancer in Brazil to address patient and family suffering.
Conference Material > Poster
Blatman Z, Doherty M, Richardson K, Yantzi R, Rayala S
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/TbIQJgT
Conference Material > Video (talk)
Yantzi R
MSF Paediatric Days 2022. 2022 December 1; DOI:10.57740/a8w9-1x79
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