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Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline
Hibah Osman1, Sudip Shrestha1, Sarah Temin1
1Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI.
This guideline offers expert advice for delivering palliative cancer care to patients and caregivers in resource-limited areas. It focuses on models of care, staffing, and essential support services like pain and psychosocial management.
Area of Science:
- Oncology
- Palliative Care
- Health Economics
- Public Health
Background:
- Existing guidelines may not adequately address the needs of cancer patients in resource-constrained settings.
- Palliative care integration into standard oncology care requires adaptation for diverse healthcare environments.
- There is a need for specific guidance on implementing palliative care in settings with limited resources.
Purpose of the Study:
- To provide resource-stratified guidance for implementing palliative care for cancer patients and their caregivers in resource-constrained settings.
- To complement the American Society of Clinical Oncology (ASCO) 2016 guideline on integrating palliative care into standard oncology care.
- To inform clinicians and policymakers on essential components of palliative care delivery in diverse resource settings.
Main Methods:
- Convened a multidisciplinary, multinational expert panel.
- Conducted a systematic literature review of 48 publications on palliative care in resource-constrained settings, including cost-effectiveness analyses.
- Utilized a modified ADAPTE process and a formal consensus-based process for guideline development.
Main Results:
- Limited direct evidence for many clinical questions, necessitating reliance on indirect evidence and expert consensus.
- Achieved ≥75% agreement among the Expert Panel and consensus ratings group on recommendations.
- Developed recommendations covering models of care, staffing, roles, training, psychosocial support, spiritual care, and opioid analgesics.
Conclusions:
- The guideline provides actionable recommendations for palliative care delivery tailored to different resource strata.
- It emphasizes the importance of psychosocial support, spiritual care, and appropriate pain management, even in resource-limited environments.
- ASCO recommends that healthcare providers and decision-makers utilize these recommendations based on the highest available resource stratum, complementing local guidelines.
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