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.

项目概要 癌症导致的死亡人数比艾滋病毒、疟疾和结核病的总和还多，超过 70% 的癌症死亡发生在 世界上最贫穷的国家都患有非传染性疾病。 据估计，到 2030 年，癌症等疾病 (NCD) 的发病率正在迅速增长。 中低收入国家的患病人数将增加一倍以上，每年将有 900 万人死于该疾病。 在患有晚期、无法治愈的癌症并需要优质疼痛管理的中低收入国家中，姑息治疗是一种健康。 护理专业已发展到全面满足患者和家庭的症状管理需求 应对危及生命的疾病，例如晚期癌症，姑息治疗的基本原则是高质量的疼痛。 然而，在许多中低收入国家，由于医疗保健提供者缺乏知识，情况变得复杂。 尼泊尔是一个低收入国家，难以获得吗啡等有效止痛药物。 日益增长的癌症负担和显着的姑息治疗需求 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，旨在满足日益增长的需求 国家姑息治疗在国内相关教育能力建设方面发挥了重要作用。 尼泊尔的姑息治疗，部分是根据世界卫生组织制定的疼痛管理指南 (PMG) 组织（世界卫生组织）的标准并立足于尼泊尔的长期和持续的努力。 NAPCare 表明已准备好进入姑息治疗发展的新阶段——推动姑息治疗的发展 研究事业的发展已被提议作为世界卫生组织公共卫生战略的第五个支柱。 姑息治疗，但在中低收入国家进行的姑息治疗研究很少，这些国家的姑息治疗 移动技术（“移动医疗”）提供了一种可扩展且可持续的方法来解决这些需求。 该提案与 NAPcare 的肿瘤姑息治疗领导者合作。 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移动医疗 改善尼泊尔姑息治疗和癌症疼痛管理的提供，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，推广到其他中低收入国家和低收入国家 资源设置。在 4 个不同的领域内使用基于社区的参与性研究 (CBPR) 的原则。 在尼泊尔的肿瘤护理环境中，我们的目标是： 1) 评估和描述环境障碍和促进因素 2) 为肿瘤学提供者设计并试点测试决策支持 mHealth“应用程序” 这将促进 PMG 的实施；以及 3) 整合定制的研究增强活动 (REA) 加强尼泊尔的研究能力，包括相关课程、强化指导和创作 与中低收入国家相关的研究资源的“虚拟图书馆”。

项目成果

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

• 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