Medicine and Health Sciences Commons^™

A Mixed Methodological Approach To Study The Feasibility Of An End-Of-Life Care Pathway, Noureen Azizullah Mistry

Theses & Dissertations

Background: The growing significance of end-of-life care in response to the increasing prevalence of chronic illnesses and aging populations has prompted recognition of the need for patient-centred care. Care pathways are employed worldwide to offer comprehensive end-of-life care to patients in various healthcare settings. In Pakistan, there is a recognised need to evaluate the feasibility of introducing an end-of-life care pathway.
Objectives: This study aimed to (a) determine the feasibility of using an end-of-life care pathway for hospital-based and home-based palliative care patients, and (b) explore the experiences and opinions of registered nurses piloting the pathway.
Methods: An explanatory sequential …

Exploring The Patients’ And Family Members’ Perspectives On Home-Based Palliative Care, Nadia Sultan Ali

Theses & Dissertations

Background: Home health care is considered as a partial substitute for institutional long-term care, because patients and families with known poor prognoses prefer to stay home with their loved ones and people mostly cannot bear the cost of care at the hospital. Therefore, the importance of home-based palliative care is raised via a shared and coordinated model for saving lives through care.
Purpose: To explore patients' and family members' perspectives and experiences of receiving home-based palliative care services.
Method: This was a qualitative exploratory study conducted in Karachi, targeting patients and family members receiving home-based palliative care services. The data …

Kenyan Palliative Care Providers’ And Leaders’ Perceptions Of Palliative Care Research Needs And Support To Facilitate Rigorous Research, K. Cartmell, E. Doherty, Nancy Gikaara, Z. Ali, S. Qanungo, E. S. Melikam, R. A. Powell

Internal Medicine, East Africa

Background: Palliative care (PC) can reduce symptom distress and improve quality of life for patients and their families experiencing life-threatening illness. While the need for PC in Kenya is high, PC service delivery and research is limited. Qualitative research is needed to explore potential areas for PC research and support needed to enable that research. This insight is critical for informing a national PC research agenda and mobilizing limited resources for conducting rigorous PC research in Kenya.

Objectives: To explore perceptions of priority areas for PC research and support needed to facilitate rigorous research from the perspective of Kenyan PC …

Augmented Package Of Palliative Care For Women With Cervical Cancer: Responding To Refractory Suffering, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all …

Perceptions, Knowledge And Attitudes Towards The Concept And Approach Of Palliative Care Amongst Caregivers: A Cross-Sectional Survey In Karachi, Pakistan, Sameera Shah, Faizan Qaisar, Iqbal Azam Syed, Khairunnisa Mansoor

Department of Family Medicine

Background: Limited comprehension of the concept of palliative care and misconceptions about it are barriers to meaningful utilisation of palliative care programs. As caregivers play an integral role for patients with terminal illness, it is necessary to assess their perceptions and attitudes towards the palliative care approach.
Method: A cross-sectional survey was conducted. Data was collected from the Aga Khan Hospital in-patient and out-patient departments and home-based palliative care services. All adult caregivers who met the inclusion criteria and consented, completed a questionnaire till the sample size was reached. Univariate and multivariate multivariable analysis was done and results were reported …

Randomized Control Trial Of Advanced Cancer Patients At A Private Hospital In Kenya And The Impact Of Dignity Therapy On Quality Of Life, John Weru, Miriam Gatehi, Alice Musibi

Internal Medicine, East Africa

Background: Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005.The aim of the study was to assess the effect of one session of dignity therapy on quality of life in advanced cancer patients.

Methods: This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. …

Effectiveness Of High-Fidelity Simulation In Nursing Education For End-Of-Life Care: A Quasi-Experimental Design, Salma Rattani, Zohra Kurji, Amina Aijaz Khowaja Ap, Jacqueline Maria Dias, Anila Naz Alisher

School of Nursing & Midwifery

Background: Providing end of life (EOL) care is a component of palliative care but dealing with dying patients and their family members is stressful for the healthcare providers. To prepare them for providing EOL care, the high-fidelity simulation could be used as a pedagogy in which real-life scenarios are used on the computerized manikins mimicking the real patients.
Aims: The aim of this study was to measure the effectiveness of high-fidelity simulation to teach EOL care in the palliative nursing course in the undergraduate nursing education program at the School of Nursing and Midwifery at Aga Khan University which is …

Case Study Describing Access To Palliative Care In Pakistan, Salma Amin Rattani

Theses & Dissertations

Around the world, cancer is a leading cause of death and the burden of cancer is expected to increase in low-and middle-income countries (LMICs), where 82% of the world’s population resides. In these countries, which include Pakistan, aspects of the culture and traditions, inaccessibility to diagnostic and treatment facilities impede access to palliative care. In many cases, people do not reach treatment facilities until they are at the stage when the person is at the end-of-life and is dying. This paints the picture of cancer as a deadly disease and as soon as it is diagnosed nothing can be done …

Using Cirupa To Help Foster Communication With Families About Brain Death In Sub‑Saharan Africa, Sayed Karar, Anthony Ochola, Fatima Juma, Feroza Daroowalla

Internal Medicine, East Africa

Brain death, with a functioning cardiovascular system, remains a difficult issue to grasp for most families. Furthermore, conversations about brain death remain challenging even for the most experienced physicians. We developed an acronym, CIRUPA, to further improve the goals of care conversations in patients diagnosed with brain death. To our knowledge, this is the first acronym within Sub‑Saharan Africa, which helps provide a structured method on how to foster conversations centered around brain death.

Palliative Surgical Gastrostomy Under Ultrasound‑Guided Bilateral Rectus Sheath Blocks In A Head And Neck Cancer Patient, Saima Rashid, Faisal Shamim,, Maha Khan, Robyna Khan

Department of Anaesthesia

No abstract provided.

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At A Tertiary Hospital In Kenya, Stephen Omondi, John Weru, Asim Jamal, Gerald Yonga

Internal Medicine, East Africa

Background: An advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on lifesustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of …

Home-Care Of The Dying, Riaz Qureshi

Department of Family Medicine

No abstract provided.