Exploring mHealth to Improve the Delivery of Palliative Care and Cancer Pain Management in Nepal: An Interdisciplinary Community Based Approach

探索移动医疗以改善尼泊尔姑息治疗和癌症疼痛管理的实施：基于社区的跨学科方法

• 批准号: 9766421
• 负责人: Rebecca A. Dillingham
• 金额: $ 16.76万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766421
• 关键词: Address; Adherence; Advanced Malignant Neoplasm; Blindness; Cancer Burden; Cancer Control Research; Cancer Pain Management; Cancer Patient; Caring; Cellular Phone; Cessation of life; Clinical; Collaborations; Communities; Complex; Country; Data; Data Collection; Development; Diagnosis; Digital Libraries; Disease; Ensure; Family; Foundations; Future; Government; Grant; Guideline Adherence; Guidelines; HIV; Health; Health Personnel; Health Priorities; Health Services Accessibility; Healthcare; Healthcare Systems; Incidence; Infrastructure; Intervention; Knowledge; Life; Malaria; Malignant Neoplasms; Measures; Medicine; Mentors; Mentorship; Mobile Health Application; Modeling; Morphine; Nepal; Pain; Pain management; Pain quality; Palliative Care; Paralysed; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Positioning Attribute; Process; Provider; Public Health; Readiness; Reproducibility; Research; Research Personnel; Resolution; Resources; Retinoblastoma; Site; Structure; Symptoms; Technology; Testing; Tuberculosis; Universities; Virginia; Virtual Library; Work; World Health; World Health Organization; base; cancer care; care systems; community based participatory research; coping; design; efficacy testing; evidence based guidelines; experience; global health; human capital; implementation research; improved; innovation; low and middle-income countries; low income country; mHealth; medical specialties; mobile computing; oncology; pain relief; palliative; peer; spinal cord compression; support tools; symptom management; tumor

Project Summary Cancer kills more people than HIV, malaria and tuberculosis combined, and over 70% of cancer deaths occur in the world's poorest countries. Throughout low and middle-income countries (LMICs), non-communicable diseases (NCD), including cancer, are a rapidly growing concern. It is estimated that by 2030 cancer incidence will more than double in LMICs, and 9 million people will die each year from the disease. The majority of patients in LMICs present with late-stage, incurable cancer and need quality pain management. Palliative care is a health care specialty that has evolved to holistically address the symptom management needs of patients and families coping with life-limiting illness, such as advanced cancer. A foundational principle of palliative care is quality pain management. However, in many LMICs this is complicated by a lack of knowledge among healthcare providers and difficulty obtaining effective pain relief medications, such as morphine. Nepal is a low-income country with a growing cancer burden and significant palliative care needs. In 2009, the Nepalese Association of Palliative Care (NAPCare) was formed by community stakeholders and healthcare providers to address the growing need for palliative care within the country. NAPCare has been instrumental in building educational capacity related to palliative care in Nepal, in part by creating Pain Management Guidelines (PMG) based on World Health Organization (WHO) standards and grounded in the Nepalese context. The longitudinal and sustained efforts of NAPCare demonstrate a readiness to embark on the next level of palliative care development – moving the research enterprise forward. Research has been proposed as a fifth pillar in the WHO Public Health Strategy for Palliative Care, but very little palliative care research has been conducted in LMICs, where palliative care needs are most pressing. Mobile technology (`mHealth') offers a scalable and sustainable approach to address this critical health gap. This proposal partners oncology palliative care leaders of NAPCare with oncology/palliative care and global health researchers at the University of Virginia to leverage mHealth to improve the delivery of palliative care and cancer pain management in Nepal. Our efforts will establish a model for NCD implementation research and research capacity building that generalizes to other LMICs and low- resource settings. Using principles of Community Based Participatory Research (CBPR) within 4 diverse oncology care settings in Nepal we aim to: 1) Assess and describe contextual barriers and facilitators that influence adherence to the PMG; 2) Design and pilot test a decision support mHealth `app' for oncology providers that will promote PMG implementation; and 3) Integrate tailored Research Enhancement Activities (REA) to strengthen research capacity within Nepal, including relevant course work, intensive mentoring, and creation of a `Virtual Library' of research resources relevant to the LMIC context.

项目总结

项目成果

Co-constructing collaboration: An evidence-based approach to advance and evaluate equitable global public health research partnerships.

共同构建协作：一种基于证据的方法，用于促进和评估公平的全球公共卫生研究伙伴关系。

• DOI: 10.1371/journal.pgph.0002481
• 发表时间: 2023
• 期刊: PLOS global public health
• 作者: Amos, Vanessa;LeBaron, Virginia;Chuong, Tuyet;Elmore, Catherine E;Hamal, Pawan Kumar;Paudel, Bishnu D;Steen, Amber;Chapagain, Sandhya
• 通讯作者: Chapagain, Sandhya

Building a 'Virtual Library': continuing a global collaboration to strengthen research capacity within Nepal and other low- and middle-income countries.

• DOI: 10.1080/16549716.2022.2112415
• 发表时间: 2022-12-31
• 期刊: Global health action
• 影响因子: 2.6
• 作者: Elmore CE;Acharya SC;Dulal S;Enneking-Norton F;Hamal PK;Kattel R;Maurer MA;Paudel D;Paudel BD;Shilpakar R;Shrestha DS;Thapa U;Wilson DT;LeBaron V
• 通讯作者: LeBaron V

A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal.

• DOI: 10.3389/fpain.2022.910995
• 发表时间: 2022
• 期刊: Frontiers in pain research (Lausanne, Switzerland)

A survey of cancer care institutions in Nepal to inform design of a pain management mobile application.

• DOI: 10.1186/s12904-021-00824-0
• 发表时间: 2021-11-05
• 期刊: BMC palliative care
• 影响因子: 3.1
• 作者: LeBaron V;Adhikari A;Bennett R;Chapagain Acharya S;Dhakal M;Elmore CE;Fitzgibbon K;Gongal R;Kattel R;Koirala G;Maurer M;Munday D;Neupane B;Sagar Sharma K;Shilpakar R;Shrestha S;Thapa U;Zhang H;Dillingham R;Dutta Paudel B
• 通讯作者: Dutta Paudel B