La formación en Cuidados Paliativos en las Universidades Europeas PALLIATIVE CARE MEDICAL EDUCATION IN EUROPEAN UNIVERSITIES


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José Miguel Carrasco, Eduardo Garralda, Kathrin Woitha y Carlos Centeno, del Programa de Investigación ATLANTES de la Universidad de Navarra, España, explican el trasfondo de un estudio internacional realizado en colaboración con otros miembros del Comité Directivo para la Educación Médica en Cuidados Paliativos de la Asociación Europea de Cuidados Paliativos y el grupo de trabajo sobre Desarrollo de Cuidados Paliativos en Europa de la misma Asociación.

Algunos de los autores del estudio: (de izquierda a derecha) Eduardo Garralda, José Miguel Carrasco, Carlos Centeno y Kathrin Woitha

Algunos de los autores del estudio: (de izquierda a derecha) Eduardo Garralda, José Miguel Carrasco, Carlos Centeno y Kathrin Woitha

Un estudio realizado con datos de 43 países de la Región Europea (según la definición de la Organización Mundial de la Salud) ha revelado que los estudiantes de Medicina tienen un acceso desigual a la formación en Cuidados Paliativos. El trabajo, liderado por investigadores del Programa ATLANTES del Instituto Cultura y Sociedad (ICS) de la Universidad de Navarra, se ha publicado en la revista Journal of Pain and Symptom Management.

Para evaluar el estatus de la enseñanza de la disciplina, los investigadores proponen un sistema de puntuación atendiendo a tres factores: la proporción de facultades de Medicina en las que se enseña Cuidados Paliativos; la proporción de facultades de Medicina que los ofrecen como materia obligatoria; y el número total de profesores de Cuidados Paliativos.

De acuerdo con la investigación, en 13 de los países analizados los Cuidados Paliativos se enseñan en todas las facultades de Medicina, pero solo en seis de ellos es una materia obligatoria. En 15 países, se enseña únicamente en algunas universidades y en 14 no se contempla ningún tipo de formación específica en la materia. Israel, Noruega, Reino Unido, Bélgica, Francia, Austria, Alemania e Irlanda parecen ser los lugares donde la enseñanza de los Cuidados Paliativos está más desarrollada.

Los autores concluyen que si bien los Cuidados Paliativos forman parte de un “número sustancial” de programas médicos de grado en las universidades europeas y que está emergiendo “una estructura de enseñanza cualificada”, queda patente la amplia diferencia entre los distintos países.

Hemos producido un breve video donde Carlos Centeno y otros miembros explicamos más sobre este estudio internacional y el porqué para todos nosotros la educación medica en Cuidados Paliativos es un reto al que se debe hacer frente. 

Descarga una copia gratuita del artículo completo
Este post hace referencia al artículo,Palliative Care Medical Education in European Universities: A Descriptive Study and Numerical Scoring System Proposal for Assessing Educational Development’ de JM Carrasco, TJ Lynch, E Garralda, K Woitha, F Elsner, M Filbet, JE Ellershaw, D Clark, y C Centeno, publicado en Journal of Pain and Symptom Management. Este artículo está disponible en ‘acceso libre’ y puede descargarse gratuitamente.

Enlaces y recursos

  • Ver el video – algunos miembros del equipo de investigación explican más sobre el estudio internacional de la situación de la enseñanza de Cuidados Paliativos en las universidades europeas.

Más sobre los miembros del equipo internacional de investigación… Este estudio fue producido en colaboración con otros miembros del Comité Directivo para la Educación Médica en Cuidados Paliativos en Europa: Frank Elsner, Departamento de Medicina Paliativa de la Universidad RWTH Aachen, (Alemania); Marilène Filbet, Instituto Marie Curie de Cuidados Paliativos y el Hospital académico universitario Lyon Sud HCL (Francia); y John E Ellershaw, Universidad de Liverpool (GB); y con miembros del Grupo de trabajo sobre el Desarrollo de Cuidados Paliativos en Europa: David Clark, Universidad de Glasgow University – campus Dumfries, (GB), y Thomas J Lynch, del Kimmer Cancer Center de la Universidad John Hopkins (EEUU).

 

 

Palliative care medical education in European universities

José Miguel Carrasco, Eduardo Garralda, Kathrin Woitha and Carlos Centeno from the ATLANTES Research Programme based at the University of Navarra, Spain, explain the background to an international research study made in collaboration with other members of the EAPC Steering Committee for Palliative Medicine Education and the EAPC Task Force on the Development of Palliative Care in Europe.

Some of the authors of this study: (left) Eduardo Garralda, José Miguel Carrasco, Carlos Centeno and Kathrin Woitha

Some of the authors of this study: (left) Eduardo Garralda, José Miguel Carrasco, Carlos Centeno and Kathrin Woitha

A study carried out in 43 countries of the World Health Organization (WHO) European Region has revealed that medical students have unequal access to palliative medicine undergraduate training. The study, led by researchers of the ATLANTES Research Programme, from the Institute for Culture and Society, University of Navarra, was recently published in the Journal of Pain and Symptom Management.

To assess the status of medical education, the investigators propose a numerical scoring system based on three factors: proportion of medical faculties teaching palliative medicine; the proportion of medical faculties teaching palliative medicine as a compulsory subject; and the total number of palliative medicine teachers.

According to the research, palliative care is taught in all medical faculties in 13 of the analysed countries, but it is mandatory in only six countries. In 15 countries, it is only taught in some universities and in 14 countries there is no specific training at all on the topic. Israel, Norway, United Kingdom, Belgium, France, Austria, Germany and Ireland seem to be the countries where palliative medicine education is most developed.

The authors conclude that though palliative medicine appears in a substantial number of undergraduate medical programmes in European universities, and a ‘qualified teaching structure’ is evolving; it is also clear that there are great differences among the diverse countries. For example, the number of medical faculties teaching palliative medicine, the extent to which it is mandatory, and the type of qualified professors in charge of palliative medicine education vary from country to country.

We’ve produced a short video where Carlos Centeno and other members of our team explain more about this international study and just why palliative medicine education is a ‘must-face challenge’ for all of us. 

Download a free copy of the full article
This post relates to a longer article,Palliative Care Medical Education in European Universities: A Descriptive Study and Numerical Scoring System Proposal for Assessing Educational Development’ by JM Carrasco, TJ Lynch, E Garralda, K Woitha, F Elsner, M Filbet, JE Ellershaw, D Clark, and C Centeno, published in the Journal of Pain and Symptom Management. This paper is available in Open Access and can be downloaded free of charge.

Links and resources

More about the members of the international research team …
This study was made in collaboration with other members of the EAPC Steering Committee for Palliative Medicine Education: Frank Elsner, Palliative Medicine Department of RWTH Aachen University, (Germany); Marilène Filbet, Marie Curie Institute for Palliative Care and the Academic University Hospital Lyon Sud HCL (France); and John E Ellershaw, Liverpool University (UK); and with members of the EAPC Task Force on the Development of Palliative Care in Europe: David Clark, Glasgow University – Dumfries campus, (UK), and Thomas J Lynch, the Kimmer Cancer Center of the John Hopkins University (US).

Acknowledgement 
With grateful thanks to Eduardo Garralda and Dr Maria Nabal for the translation of this post.

 

Posted in EAPC ACTIVITIES, EAPC Taskforces/special projects, EDUCATION & TRAINING, NATIONAL & INTERNATIONAL REPORTS, RESEARCH | Tagged | Leave a comment

Misuse of low-quality data for drawing conclusions on opioid dependence is a health abuse

Willem Scholten, PharmD MPA, Consultant – Medicines and Controlled Substances, Willem Scholten Consultancy, Lopik, the Netherlands; Jack E. Henningfield, PhD, Vice-President, Research and Health Policy, Pinney Associates, Bethesda, Maryland, and The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

Willem Scholten

Willem Scholten

Vowles et al. published a systematic review on “misuse, abuse and addiction” in the April 2015 issue of PAIN, the official journal of the International Association for the Study of Pain (IASP).1  In short, their main conclusions were that “between 21% and 28 %” of patients to whom opioid analgesics are prescribed misuse their opioids and “rates of addiction averaged between 8% and 12%”. They do not conclude on abuse rates.

Jack Heningfield

Jack E Henningfield

In a letter-to-the-editor, we argue that the outcomes are invalid because of the low quality and heterogeneity of the studies included. Vowles et al. included 38 studies and many of these had been rejected in a Cochrane study by Minozzi et al. on their determination that the studies were not adequate for the purposes of a meta-analysis.2,3  Moreover, definitions used by the authors are vague.

Amazingly, the authors’ definition of misuse is “opioid use contrary to the directed or prescribed pattern of use, regardless of the presence or absence of harm or adverse effects”. This is identical to what is generally called patient non-compliance, a common problem in patients to whom medicines are prescribed. Therefore, putting a figure on non-compliance among opioid analgesic patients only makes sense if comparing to non-compliance rates for all medicines, which is 25 %.4  Therefore, non-compliance (‘misuse’) in patients using opioid analgesics is not any different from non-compliance among the general population of patients who use medicines.

Also, the analysis of addiction rates is not a reliable outcome and contrary to what Vowles et al. suggest, according to the Cochrane study by Minozzi et al., there is not any reason to withhold opioid analgesics to pain patients in need.

Moreover, in a Special Commentary in the same issue of PAIN, Dr Jane Ballantine says that the authors “tackle the debatably impossible task of estimating the prevalence of opioid misuse, abuse, and addiction in chronic pain”, but simultaneously, she admits that: “it is hard to understand what addiction actually is when it arises during pain treatment with opioids.” Then she commends that “All patients exhibiting misuse, abuse, or addiction” should be included in “addiction-type programmes”.5

It is always good for a doctor to look critically on his or her own prescribing habits, to assess the pain as good as possible and then, to prescribe the correct amount of the best medicine at the right dosage. Sometimes this could even mean that another option than pharmacological treatment is preferred. However, basing oneself on unfounded and incredibly high figures of misuse and dependence is not in the interest of the patients and therefore, a health abuse.

References

  1. Vowles KE, Mindy L, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. PAIN, April 2015; Vol 15(4): 569-576.
  2. Scholten W, Henningfield JE. A meta-analysis based on diffuse definitions and low quality literature is not a good fundament for decisions on treatment of chronic pain patients. PAIN, August 2015; 156(8): 1576-1578.
  3. Minozzi S, Amato L, Davoli M. Development of dependence following treatment with opioid analgesics for pain relief: a systematic review. Addiction. 2013 Apr;108(4):688-98.
  4. DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–209.
  5. Ballantyne JC. Assessing the prevalence of opioid misuse, abuse, and addiction in chronic pain. PAIN, April 2015; Vol 15(4): 567-568.
Posted in ADVOCACY & POLICY, Opioid access | Tagged | Leave a comment

Coming of age: Improving palliative and end-of-life care for lesbian, gay, bisexual, and trans*people

Dr Richard Harding, the Cicely Saunders Institute for Palliative Care, King’s College London, concludes our short series that discusses how we can improve end of life experiences and care needs for people in minority communities.

Dr Richard Harding

Dr Richard Harding

Hospice and palliative care services have identified their need to better serve the community according to need – which has led to a focus on social exclusion. The history of hospice care for lesbian and gay people is an uncomfortable one – the lack of the hospice movement’s engagement with the HIV epidemic led to parallel hospice services dedicated to gay men, injecting drug users and immigrant African communities who were already experiencing unbearable stigma. A review that modelled the evidence on barriers to palliative care 1 identified the literature on sexuality and hospice and healthcare use. It identified studies that reported: gay/bisexual men expressed concern at the possibility of a hostile response to their identity by Church-affiliated providers of hospice care; patients’ sexuality predicted nurses’ willingness to care for AIDS patients; assistant nurse students were more likely than other nursing staff to wish to refrain from nursing gay men with HIV.

Our systematic review of palliative and end-of-life care for lesbian, gay, bisexual, and trans*people (LGBT) found epidemiological evidence that they may have greater needs but poorer access. The small amount of available evidence originated mainly from the USA.

The guiding principles of palliative and end-of-life care are good communication and person-centredness. It is hard to imagine a more central aspect of a person than their sexual identity and significant relationships. Facing the end of life and feeling unable to share these aspects of personhood, or not having a life partner respected, are experiences something few of us would want to face.

ACCESSCare (Advanced Cancer Care Equality Strategy for gender and Sexual minorities) is a study to improve palliative and end-of-life care for LGBT people funded by Marie Curie. Led from the Cicely Saunders Institute at King’s College London, its strategy aims to both increase the demand for appropriate care from LGBT people and their carers, and improve the supply of care from clinicians. It is an original collaboration between King’s and Health Equality Rights Organisation, who bring unique skills in LGBT community health, community leadership and engagement, and social media strategies.

ACCESScare is currently actively recruiting LGBT people facing the later stages of a progressive condition, their carers and bereaved carers. The data they give us will inform two outputs. Firstly, we will use it to inform small media and online resources to help LGBT access and use the care they need. Second, we will use the data and the new resources to develop training resources to be delivered within existing training courses for clinicians.

The response to ACCESScare has been overwhelmingly positive from LGBT community organisations, media and individuals. Likewise, from hospice and palliative care staff and services. This is testament to society’s maturation with respect to two historical taboos: sex and death.

References and resources
1. Harding R, Easterbrook P, Higginson I, Karus D, Raveis V, Marconi K. Access and equity in HIV/AIDS palliative care: a review of the evidence and responses. Palliative Medicine. 2005;19(3):251-8.
2. Harding R, Epiphaniou E, Chidgey-Clark J. Needs, experiences, and preferences of sexual minorities for end-of-life care and palliative care: a systematic review. J Palliat Med. 2012 May; 15 (5): 602-11. doi: 10. 1089/jpm.2011.0279. Epub 2012 Mar 8.

View more information about the ACCESScare study.

Read more on the EAPC Blog
You can read earlier posts in this series from Dr Robert Killeen from the USA and Dr Kathryn Almack from the UK.

Posted in ADVOCACY & POLICY, PATIENT & FAMILY CARE, PSYCHO-SOCIAL ISSUES, RESEARCH | Tagged , | Leave a comment

‘We treat everyone the same: Lesbian, gay, bisexual, and trans*people invisibility in end of life care’

A new series that discusses how we can improve end of life experiences and care needs for people in minority communities.

Dr Kathryn Almack, Principal Research Fellow, Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, University of Nottingham, UK, draws upon some of the findings from her research study.

Dr Kathryn Almack

Dr Kathryn Almack

I have recently completed a major research study exploring the end of life care experiences and needs in the lives of older LGBT people (lesbian, gay, bisexual, and trans*people) in the UK, funded by Marie Curie Research Programme. In part, this study was prompted by consultation for the English End of Life Care Strategy Equality Impact Assessment (2008), which revealed that in terms of quality of end of life care, LGBT people were most at risk of discrimination.

In our survey, 74% of respondents reported feeling ‘not very confident’ or ‘not very confident at all’ that mainstream health and social care services provide sensitive and appropriate end of life care services for LGBT people. We found that forms of discrimination are not always overt but can include more subtle and sometimes unintentional forms of discrimination that are less easy to challenge. One example is ‘heteronormativity'; a cultural bias that views heterosexuality as ‘normal’ and taken for granted in a way that LGBT relationships and identities are not. Examples of heteronormativity include the under-representation of LGBT relationships and people in service promotion leaflets, or assumptions made that someone is heterosexual unless otherwise stated. Heteronormativity can make someone feel invisible, erase a big part of someone’s identity, and impact on their ability to involve those closest to them in their care. Some examples we were told by interview respondents include a bisexual woman sat in the waiting room with her female partner; when the nurse called her in she said: “Your sister can come with you.” In contrast, if it was a man and woman sat together of similar age, it is more likely that the nurse might check (or assume) first that they are husband and wife not brother and sister. A gay man told us about being wheeled onto a ward by one of the porters who said to him: “Lots of nice (female) nurses on this ward!” Harmless ‘banter’ perhaps but it made the patient feel awkward and silent. Questions about children and grandchildren may appear friendly attempts at conversation, but for many older LGBT people, having children wasn’t a possibility or they might be estranged.

When I’ve discussed these kinds of examples with nursing students, I hear responses such as: “We treat everyone the same,” or “If someone doesn’t tell you they’re gay what can you do?” LGBT people are not always in a position of being able to immediately let professionals they encounter know of their sexual orientation or gender identity; some might not wish to disclose their sexual or gender identity or talk about their relationships. What staff can do is to practise not making assumptions and using subtle ways of being open. The onus must be on staff, not patients, to ensure fair and equal quality care for all patients. That should include addressing specific issues to ensure that LGBT patients, their families and carers can feel they are in a non-discriminatory environment, and can feel comfortable and safe being themselves.

Links and resources
A summary, end of award report and updates on The Last Outing research project can be found under completed projects on the Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care’s webpage.

Almack K, Moss B and Smith T. (2015) Research and policy about end of life care for LGBT people: identifying implications for social work services, in J Fish and K Karban (eds.), Social Work and Lesbian, Gay, Bisexual and Trans Health Inequalities: International Perspectives. Bristol: Policy Press, pp. 173-186.

Almack K, Seymour J and Bellamy G. (2010) Exploring the impact of sexual orientation on experiences and concerns about end of life care and on bereavement for lesbian, gay and bisexual elders. Sociology. 44 (5): 908-924.

Cartwright C, Hughes M and Lienert T. (2012). End of life care for gay, lesbian, bisexual and transgender people. Culture, Health and Sexuality, 14(5), 537-48.

Green L and Grant V. (2008) `Gagged Grief and Beleaguered Bereavements?’ An Analysis of Multidisciplinary Theory and Research Relating to Same Sex Partnership Bereavement. Sexualities, 11(3): 275-300.

Harding R, Epiphaniou E and Chidgey-Clark J. (2012). Needs, experiences, and preferences of sexual minorities for end-of-life care and palliative care: a systematic review. Journal of Palliative Medicine, 15 (5), 602-11.

Higgins A and Glacken M. (2009) Sculpting the distress: easing or exacerbating the grief experience of same-sex couples. International Journal of Palliative Nursing, 15(4): 170-176.

National End of Life Care Programme (2012) The route to success in end of life care – achieving quality for lesbian, gay, bisexual and transgender people.

Stein G and Almack K. (2012) Care Near the End of Life: The Concerns, Needs and Experiences of LGBT Elders. In R Ward, I Rivers and M Sutherland (editors) Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support. Jessica Kingsley Publishers: 114-134.

Ward R, Pugh S, Price E. (2010) Don’t look back? Improving health and social care service delivery for older LGB users. Equality and Human Rights Commission.

Whittle S, Turner L and Al-Alami M. (2007a) Engendered Penalties: Transgender and Transsexual People’s Experiences of Inequality and Discrimination. London: The Equalities Review.

Whittle S and Turner L. (2007b) Bereavement: A guide for transsexual, transgender people and their loved ones. Department of Health.

More on the EAPC Blog
Read an earlier post in this series by Dr Robert Killeen from the USA. Next week, Dr Richard Harding (Cicely Saunders Institute, King’s College London) joins the discussion.

Posted in ADVOCACY & POLICY, PATIENT & FAMILY CARE, PSYCHO-SOCIAL ISSUES | Tagged , | 1 Comment

Transgendered plight and medical acceptance

 

A new series starts this week on how we can improve end of life experiences and care needs for people in minority communities. Robert Killeen MD, who works in hospice and palliative medicine in the USA, introduces the series.

Dr Robert Killeen

Dr Robert Killeen

In recent years I reported on a transgendered lady whose plight exemplified the difficulties of the transgendered in society and medicine. The patient was an elderly female (male-to-female) with metastatic cancer that was unresponsive to chemotherapy. She was admitted to the hospice inpatient unit for symptomatic care. She subsequently improved and was well enough to leave the unit though not well enough to go back home. She was to be placed in a nursing home but she was too poor to afford a single room. Her dilemma began when she desired a female roommate. She was post-surgically and outwardly female. However, the nursing homes could not comply as they viewed her as a male. In the end she spent the remainder of her days within the hospice unit as her gender had caused her life to run aground. Trans people frequently find their exposure to the healthcare system, both in living and in dying, to be a daunting experience.

The transgendered community reside in a societal abyss where only the ‘passable’ come into the shadows and the few brave come into the light. Their first experience may come from a visit to their healthcare provider, where they feel they must achieve acceptance before they can hope to gain treatment. In a study by the University of Washington the results for the transgendered population were disheartening. Nearly a third of older transgendered adults surveyed reported their overall health as ‘poor’ yet almost half had reported receiving inferior health care. While 90% of the older transgendered had a primary care provider only 27% obtained routine checkups. Mental health issues have the foremost difficulties as trans people carry high rates of depression (48%), and even higher rates of suicide (71%). The fear of being ‘outed’ and judged by medical practice cause many to refrain from being seen for their maladies. This apprehension allows their treatable illnesses to become incurable problems.

In the previous century both race and sexuality were primary issues; in this century gender identity has come to the forefront. At present, the transgendered are coming forward slowly, carefully, and lonely. Societal acceptance, at times, seems unclear. For the medical field this shouldn’t even be in question. We are here to treat equally people of all stations, of all walks of life. Acceptance is a given, not an option.

References
Killeen R. Hospice and the Transgendered. GeriPal, www.geripal.org, June 12, 2013.

Fredriksen-Goldsen KI, Kim HJ, Emlet CA, et al. The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults. Seattle: Institute for Multigenerational Health. University of Washington. 2011.

Coming up…
Follow the EAPC Blog on Wednesday and next week when Dr Kathryn Almack  and Dr Richard Harding will be sharing some of their research findings and new studies.

Posted in ADVOCACY & POLICY, PSYCHO-SOCIAL ISSUES | Tagged , , | Leave a comment

Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study

Dr Mervyn Koh, Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, explains the background to a longer research article that has been selected as ‘Editor’s choice’ in the July edition of Palliative Medicine.

Dr Mervyn Koh

Dr Mervyn Koh

One in three of those practising palliative care is experiencing burnout and at risk of developing anxiety and depression.

That’s what we found in our study of 273 palliative care practitioners – doctors, nurses and social workers working in hospital palliative care services, hospice home care and inpatient hospices.

We who practise in this field often work long hours, feel ‘stretched’ from being under-staffed and are daily exposed to the emotional trauma of death, factors which predispose us to both burnout and psychological morbidity. Burnout can adversely affect us physically, mentally and may eventually even affect patient care. It can spill over to affect our personal lives as well.

We found that working long hours (> 60 hours per week) increased the odds of burnout by nine times and psychological morbidity by seven times. While we did expect the increased risk and odds of burnout, we were surprised by the large effect and differences we found.

Spirituality – those who described themselves as being more spiritual were at lower risk of burnout. We think that having a strong spiritual belief may be protective against burnout as it gives a sense of mission to the work that we do.

Those who were married also had lower rates of burnout compared to their single counterparts who were comparatively twice as prone to emotional exhaustion. Perhaps being married gives the support network that may help combat burnout.

We were also very interested in finding out whether working in different settings actually made a difference to the prevalence of burnout as the authors all came from various palliative care settings. We found that our colleagues working in home hospice care were significantly more at risk of psychological morbidity than those in inpatient hospice care and hospitals. A possible explanation for this finding could be that those doing home care were responsible for more patients, had to spend longer time travelling and had less acute care support.

The second part of our study focused on the usefulness of 14 coping mechanisms used by palliative care practitioners in preventing burnout and promoting longevity in the specialty. 1 Of the 14 factors we studied, we found that those who used eight of these factors were associated with less burnout compared to those who didn’t use them. These were physical wellbeing (or exercising), clinical variety (doing a mix of clinical work, teaching, research and admin), having hobbies, engaging in meditation and quiet reflection, being passionate about one’s work, having realistic expectations about what we can or cannot do, finding time to remember patients, and organisational activities, and all were protective against burnout.

We who do palliative care need to be aware of these factors that can lead to burnout and learn to take better care of ourselves. Those in positions of influence and leadership should also take greater responsibility to care for those working for them by organising activities to help prevent burnout.

So go for your run, take that long walk in the woods, sign up for that cooking class – know your limits – you can’t do everything. Spend time together remembering your patients, find time to go out for lunch with your team and at the end of the day, go home when it’s time – to those that matter most to you.

Only when we know how to take care of ourselves, can we be in a position to care for others.

References
1. Swetz KM, Harrington SE and Matsuyama RK. Strategies for avoiding burnout in hospice and palliative medicine: peer advice for physicians on achieving longevity and fulfilment. J Palliat Med 2009; 12(9): 773–777.

PM July coverDownload a free copy of the full article
This post relates to a longer article, ‘Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study’ by Mervyn Yong Hwang Koh et al published in Palliat Med July 2015 vol. 29: no. 7 633-642. Published online before print March 31, 2015, doi: 10.1177/0269216315575850.

EAPC members and registered users of the EAPC website can download a free copy of this article and other ‘Editor’s choice’ papers from the EAPC website.  (If you need to register or login to download this paper please follow the instructions in the top right-hand corner of EAPC home page and scroll down to the article). Click here to view other EAPC-originated papers.

Posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, RESEARCH | Tagged | Leave a comment

FIT for CARE: A compassionate sports community to support palliative care in three countries

Dr Juan-Pablo Leiva is founder of FIT for CARE, a not-for-profit association developed by athletes in support of palliative care. Dr Leiva also works as a palliative care consultant at CUDECA Hospice Foundation, a specialist palliative care provider in southern Spain. Here, he explains how functional physical training, or a ‘workout of the day’ may contribute to increased public awareness of palliative care.

Dr Juan-Pablo Leiva (second from left) and colleagues

Dr Juan-Pablo Leiva (second from left) and colleagues

In the past few decades we have become accustomed to the idea – and the practice ­– that the achievement of optimal health and wellbeing in every nation must be in a partnership with government, health services and every major sector of the community. Today, the call for ‘health-promoting palliative care’ or for the development of compassionate communities is a parallel call for just this type of engagement concerning dying, death, loss and care. It is a movement towards the recognition that end-of-life care is ‘everyone´s responsibility’.1  From this concept has emerged FIT for CARE, a non-profit association, developed by athletes who practise functional training as professionals and amateurs.

FIT for CARE supports palliative care for children, teenagers and adults around the world. Our mission is to provide financial donations to non-profit palliative care centres that support terminally ill patients in Spain, Costa Rica and El Salvador. We also educate athletes and the general public about palliative care and how to access it. Our vision is to facilitate access to palliative care for all who need it: children, teenagers and adults. Why do we do this? Our motivation comes from the recognition that quality palliative care is a human right and our desire to support patients from the community.

Most athletes who support us are from sports communities that are passionate about CrossFit® (a constantly varied, high intensity programme, using functional movements to improve fitness). A characteristic of this kind of sports community is its fraternity and support to others. This has made it easier for groups to join and work together in Spain and Europe. Before every FIT for CARE sports event athletes and the public hear a talk about palliative care, how the team works, and how patients can access the service. We started our activities in January 2015 and already have pledges of commitment from Sweden, UK and Belgium, and some encouraging interest from Canada and New Zealand.

Javier López Osuna, is the owner and coach at CrossFit Al-Ándalus. He and his crew worked hard welcoming athletes and the public for the final event of the ‘Malaga FIT for CARE Affiliate League’ (developed by CrossFit Fuengirola) held recently at his facilities, where FIT for CARE raised almost 1,500 Euros for palliative care. He says:

Javier López Osuna, owner and coach at CrossFit Al-Ándalus

Javier López Osuna, owner and coach at CrossFit Al-Ándalus

“Before being involved in FIT for CARE I had no idea what palliative care was. When I learnt what palliative care teams do for people I realized that it’s a priority service, because there will be a point in our lives when all of us could have that need, for ourselves or our loved ones.”

On 26 May, FIT for CARE held a press conference in collaboration with the CUDECA Hospice Foundation in Benalmadena, Spain, to sign an agreement pledging our commitment to support palliative care services in Costa Rica, “Fundación Albergue San Gabriel”, and “Hospital Divina Providencia” in El Salvador, and CUDECA Hospice Foundation.

To celebrate World Hospice and Palliative Care Day, we’re planning an international sports event on 11 October: ‘One Day/ One WOD/One World’ (a WOD means ‘workout of the day’). We’re asking CrossFit® communities around the world to support palliative care by joining FIT for Care in this special event.

Thus, through the Compassionate Communities Public Health approach, 2 and using sport as a medium through which to raise funds and public awareness, FIT for CARE is encouraging communities, in Spain and Central America, to support patients and their families and to promote the invaluable work of local palliative care teams.

References

  1. Kellehear A. Compassionate Communities: end-of-life care as everyone´s responsibility. QJM. 2013 Dec;106(12):1071-5
  2. An Overview of Compassionate Communities in England. Murray Hall Community Trust. National Council for Palliative Care Dying Matters Coalition. July 2013. Available to download. 

Links and resources

Posted in ADVOCACY & POLICY, NATIONAL & INTERNATIONAL REPORTS | Tagged , , | 4 Comments