An Ethnographic Study of Barriers to Cancer Pain Management and Opioid Availability in India

LeBaron, Virginia; Beck, Susan L.; Maurer, Martha A.; Black, Fraser; Palat, Gayatri

doi:10.1634/theoncologist.2013-0435

Cited by 39 publications

(35 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1622] The challenges and opportunities discussed below are based on interviews and observations collected during 9 months of in-country immersion fieldwork by the first author.…”

Section: Methodsmentioning

confidence: 99%

Recommendations to support nurses and improve the delivery of oncology and palliative care in India

LeBaron

Palat

Sinha

et al. 2017

Indian J Palliat Care

Self Cite

View full text Add to dashboard Cite

Context:Nurses in India often practice in resource-constrained settings and care for cancer patients with high symptom burden yet receive little oncology or palliative care training.Aim:The aim of this study is to explore challenges encountered by nurses in India and offer recommendations to improve the delivery of oncology and palliative care.Methods:Qualitative ethnography.Setting:The study was conducted at a government cancer hospital in urban South India.Sample:Thirty-seven oncology/palliative care nurses and 22 others (physicians, social workers, pharmacists, patients/family members) who interact closely with nurses were included in the study.Data Collection:Data were collected over 9 months (September 2011– June 2012). Key data sources included over 400 hours of participant observation and 54 audio-recorded semi-structured interviews.Analysis:Systematic qualitative analysis of field notes and interview transcripts identified key themes and patterns.Results:Key concerns of nurses included safety related to chemotherapy administration, workload and clerical responsibilities, patients who died on the wards, monitoring family attendants, and lack of supplies. Many participants verbalized distress that they received no formal oncology training.Conclusions:Recommendations to support nurses in India include: prioritize safety, optimize role of the nurse and explore innovative models of care delivery, empower staff nurses, strengthen nurse leadership, offer relevant educational programs, enhance teamwork, improve cancer pain management, and engage in research and quality improvement projects. Strong institutional commitment and leadership are required to implement interventions to support nurses. Successful interventions must account for existing cultural and professional norms and first address safety needs of nurses. Positive aspects from existing models of care delivery can be adapted and integrated into general nursing practice.

show abstract

“…[1622] The challenges and opportunities discussed below are based on interviews and observations collected during 9 months of in-country immersion fieldwork by the first author.…”

Section: Methodsmentioning

confidence: 99%

Recommendations to support nurses and improve the delivery of oncology and palliative care in India

LeBaron

Palat

Sinha

et al. 2017

Indian J Palliat Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…This is not helped by barriers to provision of morphine and other opioids (Ansong et al, 2013;Lebaron et al, 2014).…”

Section: Challenges Faced By Healthcare Professionalsmentioning

confidence: 99%

Guidelines in lower‐middle income countries

2017

View full text Add to dashboard Cite

Summary Guidelines include recommendations intended to optimize patient care; used appropriately, they make healthcare consistent and efficient. In most lower‐middle income countries (LMICs), there is a paucity of well‐designed guidelines; as a result, healthcare workers depend on guidelines developed in Higher Income Countries (HICs). However, local guidelines are more likely to be implemented because they are applicable to the specific environment; and consider factors such as availability of resources, specialized skills and local culture. If guidelines developed in HICs are to be implemented in LMICs, developers need to incorporate local experts in their development. Involvement of local stakeholders may improve the rates of implementation by identifying and removing barriers to implementation in LMICs. Another option is to encourage local experts to adapt them for use in LMICs; these guidelines may recommend strategies different from those used in HICs, but will be aimed at achieving the best practicable standard of care. Infrastructural deficits in LMICs could be improved by learning from and building on the successful response to the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic through interactions between HICs and LMICs. Similarly, collaborations between postgraduate medical colleges in both HICs and LMICs may help specialist doctors training in LMICs develop skills required for guideline development and implementation.

show abstract

“…Untreated or inadequately treated pain is the major cause of depression and eventually leads to loss of productivity and functionality, as well as poor health-related QoL, of patients 107,108. There are several impediments that contribute to the undertreatment of pain in India, which include lack of awareness, regulatory restrictions on opioid use, physician attitudes, overuse of NSAIDs and insufficient resources for managing pain in primary care settings 42,109–111. It is essential to minimize these barriers to ensure optimal treatment of pain.…”

Section: Undertreatment Of Painmentioning

confidence: 99%

Evidence and consensus recommendations for the pharmacological management of pain in India

Dureja¹,

Iyer

Das

et al. 2017

JPR

View full text Add to dashboard Cite

Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events – particularly with opioids and surgical methods of analgesia – are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case–control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making.

show abstract

An Ethnographic Study of Barriers to Cancer Pain Management and Opioid Availability in India

Cited by 39 publications

References 24 publications

Recommendations to support nurses and improve the delivery of oncology and palliative care in India

Recommendations to support nurses and improve the delivery of oncology and palliative care in India

Guidelines in lower‐middle income countries

Evidence and consensus recommendations for the pharmacological management of pain in India

Contact Info

Product

Resources

About