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

项目摘要 癌症导致的死亡人数超过艾滋病毒、疟疾和结核病的总和，70%以上的癌症死亡发生在 世界上最贫穷的国家。在低收入和中等收入国家，非传染性疾病 包括癌症在内的非传染性疾病（NCD）是一个迅速增长的问题。据估计，到2030年， 在中低收入国家将增加一倍以上，每年将有900万人死于这种疾病。大多数患者 在患有晚期、无法治愈的癌症并需要高质量疼痛管理的LMIC中。姑息治疗是一种健康 护理专业，已发展到全面解决患者和家属的症状管理需求 应对限制生命的疾病，如晚期癌症。姑息治疗的一个基本原则是质量疼痛 管理然而，在许多中低收入国家，由于医疗保健提供者缺乏知识， 以及难以获得有效的止痛药物，如吗啡。尼泊尔是一个低收入国家， 不断增长的癌症负担和显著的姑息治疗需求。2009年，尼泊尔姑息治疗协会 （NAPCare）由社区利益相关者和医疗保健提供者组成，以满足日益增长的需求， 国内的姑息治疗。《国家艾滋病方案》在以下方面的教育能力建设方面发挥了重要作用： 尼泊尔的姑息治疗，部分是通过根据世界卫生组织制定的疼痛管理指南（PMG）， 根据世界卫生组织（世卫组织）的标准，并以尼泊尔的情况为基础。长期和持续的努力 NAPCare表明准备开始下一阶段的姑息治疗发展-移动 研究企业前进。研究已被提议作为世卫组织公共卫生战略的第五个支柱 姑息治疗，但很少姑息治疗的研究已经进行了中低收入国家，姑息治疗， 需求最为迫切。移动的技术（“mHealth”）提供了一种可扩展和可持续的方法， 这一严重的健康差距。该提案将NAPCare的肿瘤姑息治疗领导者与 弗吉尼亚大学的肿瘤学/姑息治疗和全球健康研究人员利用mHealth， 改善尼泊尔的姑息治疗和癌症疼痛管理。我们的努力将建立一个模型 非传染性疾病实施研究和研究能力建设，推广到其他低收入国家和低收入国家， 资源设置。在4个不同的社区内使用基于社区的前瞻性研究（CBPR）的原则 我们的目标是：1）评估和描述环境障碍和促进因素， 影响对PMG的依从性; 2）为肿瘤学提供者设计和试点测试决策支持mHealth“应用程序” 这将促进PMG的实施;和3）整合量身定制的研究增强活动（REA）， 加强尼泊尔国内的研究能力，包括相关的课程工作、密集的辅导和创造 与低收入国家相关的研究资源的“虚拟图书馆”。

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.