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，超过70%的癌症死亡发生在 世界上最贫穷的国家。在整个低收入和中等收入国家(LMIC)，非传染性 包括癌症在内的疾病(NCD)是一个迅速增长的问题。据估计，到2030年，癌症发病率 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、无法治愈的癌症的LMICs中，需要高质量的疼痛治疗。姑息治疗是一种健康 护理专业，已发展为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 管理层。然而，在许多LMIC中，由于医疗保健提供者缺乏知识，这一点变得复杂 以及难以获得有效的止痛药，如吗啡。尼泊尔是一个低收入国家， 不断增长的癌症负担和重大的姑息治疗需求。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 国内的姑息治疗。NAPCare在建设与以下方面相关的教育能力方面发挥了重要作用 尼泊尔的姑息治疗，部分通过创建基于世界健康的疼痛管理指南(PMG) 世界卫生组织(WHO)的标准，并植根于尼泊尔。的纵向和持续的努力 NAPCare表明已准备好开始下一阶段的姑息治疗发展-将 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大支柱 对于姑息治疗，但在LMIC中进行的姑息治疗研究很少，在那里姑息治疗 需求是最紧迫的。移动技术(‘mHealth’)提供了一种可扩展和可持续的方法来解决 这一关键的健康差距。这项提案与NAPCare的肿瘤学姑息治疗领导人合作 弗吉尼亚大学肿瘤学/姑息治疗和全球卫生研究人员利用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典范 用于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。社区参与研究(CBPR)原则在四个不同领域的应用 我们的目标是：1)评估和描述背景障碍和促进者 影响对PMG的遵守；2)为肿瘤学提供者设计和试行决策支持mHealth‘app’ 这将促进PMG的实施；以及3)整合量身定制的研究增强活动(REA)，以 加强尼泊尔国内的研究能力，包括相关课程工作、强化指导和创新 与LMIC背景相关的研究资源的“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.