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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.
Abstract:
Purpose The purpose of this new resource-stratified guideline is to provide expert guidance to clinicians and policymakers on implementing palliative care of patients with cancer and their caregivers in resource-constrained settings and is intended to complement the Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update of 2016. Methods ASCO convened a multidisciplinary, multinational panel of experts in medical oncology, family medicine, radiation oncology, hematology/oncology, palliative and/or hospice care, pain and/or symptom management, patient advocacy, public health, and health economics. Guideline development involved a systematic literature review, a modified ADAPTE process, and a formal consensus-based process with the Expert Panel and additional experts (consensus ratings group). Results The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including Expert Panel). Recommendations The recommendations help define the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings. Additional information is available at www.asco.org/resource-stratified-guidelines . It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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