Richard A Powell, International Palliative Care Researcher, Nairobi, Kenya, introduces a longer article that is published in the November/December edition of the European Journal of Palliative Care
With the publication of the next paper in the journal’s series on palliative care and research in Africa, a Kenyan proverb springs to mind: “You don’t teach a grown up monkey how to climb a tree.”
But one can persuade an adult primate to ascend a towering perennial, modifying their behaviour around the challenge by providing experiential learning scenarios.
Similarly, and locating that insight within a palliative care clinical setting, all of us can and should have established wisdoms and practices challenged to ensure they are valid, effective and beneficial. After all, what we do is not necessarily what we should be doing and, indeed, what works, and having the humility to recognise that fact is an admirable professional disposition. Indeed, ‘learning from new evidence’ and not accepting the status quo because it is the status quo is the unofficial mantra of, and premise that underpins, the work of the African Palliative Care Research Network in its attempts to advance research on the continent and inform service provision and policy formulation.
Researchers in eastern Africa have been at the vanguard of palliative care research, working in collaboration with local and international strategic partners. Various studies have resulted in numerous peer-reviewed publications – including in the Journal of Pain and Symptom Management – conference presentations and a raised profile globally. However, there are three key concerns that need addressing going forward.
First, methodologically there is a need, as a critical mass of trained researchers is nurtured and additional partnerships are formed, to move away from descriptive study designs, in which only associations between variables are explored, to interventionist designs in which causal relationships can be extrapolated and the potentially beneficial impact of services proven.
Second, the palliative care policy environment across many African countries remains generally adverse (1) and decision-makers require evidence of effectiveness before advocating for legislative and funding initiatives. Consequently, researchers should have one eye on developing meaningful policy briefs for an audience of decision-makers while the other focuses on publishing in peer-reviewed journals.
Third, ensuring that existing research-based successes are sustained is an ongoing challenge. While palliative care services on the continent have made significant advances in a number of countries on the continent, and despite the progress made, palliative care research has lagged behind when both should evolve simultaneously. Established partners are required to achieve this goal. Potential partnering organisations in developed regions of the world may perceive the field as requiring an excessive investment of time and energy, compared to rewards that can be more easily secured in partnering with research institutions in similarly advanced settings. Despite the challenges, however, Africa holds the possibility of one making a formative, potentially seminal, contribution to a nascent research field.
Significant research has been conducted to date in eastern Africa, as the latest edition of the European Journal of Palliative Care shows.There remains the exciting challenge of a great deal more that needs to be achieved, including making methodological advances, influencing national policy development, and effectively sustaining the research agenda.
1. Lynch T, Connor S, Clark D. Mapping levels of palliative care development: a global update. Journal of Pain and Symptom Management 2013; 45: 1094-1106.
To find out more…
The article to which this post relates, Palliative care research in eastern Africa by Eve Namisango, Richard A Powell, Helen Kariuki, Richard Harding, Emmanuel Luyirika and Faith Mwangi-Powell, is published in the November/December 2013 issue of the European Journal of Palliative Care (EJPC) (vol. 20, issue 6). If you already have a web-based subscription to the EJPC you will be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
Please note that the full article in the EJPC, and other EAPC-related articles, will soon be available to download free of charge from the EAPC website – keep checking the EAPC home page for latest information.
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