THE DEVELOPMENT OF PALLIATIVE CARE SERVICES IN TRINIDAD & TOBAGO
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1 THE DEVELOPMENT OF PALLIATIVE CARE SERVICES IN TRINIDAD & TOBAGO Dr. Karen Cox M.B.,B.S., M.R.C.G.P. M.Sc. Palliative medicine
2 Objectives Definition of Palliative Care and its remit The Global and Local Need for Palliative Care To discuss the mandate to provide Palliative Care Review of existing Palliative care service development: infrastructure, education, access to medication Review the Challenges to service provision WHO Public Health Strategy Model The Way Forward
3 WHO DEFINITION Latin Pallium=cloak The active total care of patients whose disease is not responsive to curative treatments Control of pain of other symptoms, psychological, social and spiritual problems is paramount. The goal is achievement of the best quality of life for patients and their families. Cancer Pain Relief and Palliative Care. Technical Report Series 804. Geneva: World Health Organization, 1990.
4 THE CAURA PALLIATIVE CARE UNIT, TRINIDAD
5 WHO NEEDS PALLIATIVE CARE? Anyone with a life-limiting illness Includes advanced cancer but also end stage heart failure, liver failure, renal failure, respiratory failure, dementia, advanced neurological diseases, AIDS.
6 WHEN SHOULD IT START?
7 WHAT SHOULD IT LOOK LIKE? A COMPREHENSIVE SERVICE COMMUNITY A MULTI-DISCIPLINARY TEAM Nurses Social Worker Pharmacist Doctors Chaplain HOSPICE HOSPITAL Physiotherapist Occup. Theraoist
8 GLOBAL ESTIMATES OF NEED 60% those dying could benefit from Palliative care 1 66% of newly diagnosed cancer patients/year will be incurable 2 Of those with cancer 60% will need pain control 2 1. Stjernsward J, Clark D. Palliative medicine-a global perspective. In: Doyle D et al, eds. Oxford textbook of palliative medicine, 3 rd ed. Oxford: Oxford University Press, 2004: Stjernsward J, Foley KM, Ferris FD. (2007) The Public Health Strategy for Palliative Care, Journal of Pain and Symptom Management, Vol 33 (5).
9 TRINIDAD & TOBAGO S STATISTICS Cancer is the third leading cause of death new cancer cases/year 2 One of the highest cancer mortality rates in the region 3 60% deaths due to Non Communicable Diseases Ageing Index has more than doubled in thirty years 4 ( ) 1.Ministry of Health, Trinidad and Tobago Hospital Utilisation Reports. 2.Dr Elizabeth Quamina Cancer Registry, Cancer in Trinidad and Tobago , The National Cancer Registry of Trinidad & Tobago 3. Pan American Health Organization, WHO., Cancer Mortality is declining in some countries of the Americas. 4. Central Statistical Office, Trinidad and Tobago 2011 population and housing census demographic report.
10 67 TH WHA GENEVA MAY 2014 WHA RESOLUTION Strengthening of palliative care as a component of comprehensive care throughout the life course Recognized Palliative Care: As fundamental to improving the QOL of individuals As an ethical responsibility of health systems
11 PAIN RELIEF: PRIVILEGE OR RIGHT? Pain management as a fundamental human right 1 Access to pain treatment as a human right 2 1. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth. Analg. 2007;105: Human Rights Watch. Please do not make us suffer anymore: Access to pain treatment as a human right
12 Journal of Pain and Symptom Management , DOI: ( /j.jpainsymman )
13 REGIONAL PALLIATIVE CARE SERVICES ERHA home-based oncology/palliative care service ( ??) Re-started 2017 SWRHA hospital based Palliative Care Clinic (2011) NWRHA 2 hospices (NGO-run, 1983 & 2009) TRHA home-based palliative care service (2014) NCRHA Palliative Care Unit, Out-patient Service & Hospital Consult service (2014)
14 NGO s LEADING THE WAY LIVING WATER COMMUNITY TRINIDAD & TOBAGO CANCER SOCIETY THE PALLIATIVE CARE SOCIETY OF TRINIDAD & TOBAGO
15 HOSPICES Two NGO-run hospices 12 beds each LIVING WATER HOSPICE est VITAS HOUSE HOSPICE est. 2009
16 NCRHA CAURA PALLIATIVE CARE UNIT Est beds NGO/ Health Authority partnership
17 PUBLIC SECTOR SERVICES - TRINIDAD OUT-PATIENT SERVICE San Fernando Teaching Hospital Single GP led Started 2011 COMMUNITY PALLIATIVE CARE SERVICE Nurse-led Started March 2017
18 PUBLIC SECTOR SERVICES - TOBAGO COMMUNITY PALLIATIVE CARE Nurse-led Started September 2014
19 EDUCATIONAL INITIATIVES Annual Conferences since 2011 Regional Workshops UWI M.Sc. in Palliative Care* Limited palliative care exposure for medical students
20 MEDICATION ACCESS & AVAILABILITY THE SEVEN ESSENTIAL OPIOIDS FOR PALLIATIVE CARE (IAHPC) Drug Codeine seven Morphine immediate release Morphine slow release Morphine injectable Methadone Oxycodone Fentanyl (transdermal) Available Codeine linctus 15mg/5mL Codeine/Acetaminophen 8/500 & 30/500 Oral solution 10mg/5mL 30mg & 60mg 15mg/mL NO NO NO
21 Sources: International Narcotics Control Board; World Health Organization population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, MORPHINE CONSUMPTION FOR THE AMERICAS mg/capita
22 CHALLENGES LACK OF A COMPREHENSIVE NATIONAL VISION AND COMMITMENT LACK OF POLICIES & PROTOCOLS LACK OF PUBLIC EDUCATION LACK OF PALLIATIVE CARE EXPERTISE AND LOCAL TRAINING OPPORTUNITIES ABSENCE OF REGIONAL INFRASTRUCTURE FOR PALLIATIVE CARE e.g. CLINICAL POSTS RETAINING SPECIALIST STAFF LIMITED REPERTOIRE OF MEDICATION FREQUENT STOCK-OUTS OF ESSENTIAL DRUGS
23 WHO PUBLIC HEALTH MODEL Making Palliative Care one of the key components of comprehensive cancer care 1990 POLICY Palliative care part of the national health plan, policies and regulations DRUG AVAILABILITY EDUCATION IMPLEMENTATION Stjernsward J, Foley KM, Ferris FD. (2007) The Public Health Strategy for Palliative Care, Journal of Pain and Symptom Management, Vol 33 (5).
24 Developmental Steps Engage opinion leaders National situational analysis and needs assessment Develop an action plan Establish a steering committee Develop the components of the MODEL
25 THE WAY FORWARD POLICY DRUGS EDUCATION IMPLEMENTATION National Policy on Pain Relief & Palliative Care Clinical protocols Essential Medicines Policy Recognition of PC as a specialty Creation of lead Palliative Care clinical posts at least 2 per RHA Policy on infrastructure needed for PC delivery per RHA Review drug estimates Review INCB quota Review distribution system Ensure community availability General public & media Integrate Palliative Care into undergrad medical & nursing curricula Train specialists Incentives for specialist training e.g. sponsorship of fellowships Local/Regional certification or training in PC Form linkages with community groups & leaders Train staff Multi-sectoral collaboration Strategic plan for the country s PC development
26 CARIBBEAN PALLIATIVE CARE ASSOCIATION CARIPALCA
27 The basic right of every individual The duty of every nurse and doctor to provide it
28 Thank you
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