Browsing by Author "Pastrana, Tania"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Global assessment of palliative care need: serious health related suffering measurement methodology
    (2024) Xiaoxiao Kwete; Afsan Bhadelia; Arreola-Ornelas, Héctor; Méndez, Oscar; William E., Rosa; Connor, Stephen; Downing, Julia; Jamison, Dean; Watkins, David; Calderón, Renzo; Cleary, James; Friedman, Joseph R.; Lima, Liliana de; Ntizimira, Christian; Pastrana, Tania; Pérez-Cruz, Pedro Emilio; Spence, Dingle; Rajagopal, M. R.; Vargas Enciso, Valentina; Krakauer, Eric; Radbruch, Lukas; Marie Knaul, Felicia
    Context: Inequities and gaps in palliative care access are a serious impediment to health systems especially in low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care need and was originally developed by The Lancet Commission on Global Access to Palliative Care and Pain Relief. In 2015, the first iteration – SHS 1.0 – was estimated at over 61 million people worldwide experiencing at least 6 billion days of SHS annually as a result of life-limiting and life-threatening conditions. Objectives: In this paper, an updated methodology - SHS 2.0 - is presented building on the work of the Lancet Commission and detailing calculations, data requirements, limitations, and assumptions. Methods and Results: The updates to the original methodology focus on measuring the number of people who die with (decedents) or live with (non-decedents) SHS in a given year to assess the number of people in need of palliative care across health conditions and populations. Detail on the methodology for measuring the number of days of SHS that was pioneered by the Lancet Commission, is also shared, as this second measure is essential for determining the health system responses that are necessary to address palliative care need and must be a priority for future methodological work on SHS. Conclusions: The methodology encompasses opportunities for applying SHS to future policy making assessment of future research priorities particularly in light of the dearth of data from low- and middle-income countries, and sharing of directions for future work to develop SHS 3.0.
  • No Thumbnail Available
    Item
    How to Advance Palliative Care Research in South America? Findings From a Delphi Study
    (2023) Paiva, Carlos Eduardo; Bonilla-Sierra, Patricia; Tripodoro, Vilma Adriana; Rodriguez-Nunez, Alfredo; De Simone, Gustavo; Rodriguez, Liliana Haydee; Vidal, Edison Iglesias de Oliveira; Rios, Miriam Riveros; Crispim, Douglas Henrique; Perrez-Cruz, Pedro; Nascimento, Maria Salete de Angelis; Ospina, Paola Marcela Ruiz; de Lima, Liliana; Pastrana, Tania; Zimmerman, Camilla; Hui, David; Bruera, Eduardo; Paiva, Bianca Sakamoto Ribeiro
    Context. Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved.Objectives. To develop a set of recommendations to advance PC research in SA.Methods. Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of >= 75%. Results. 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public poli-cies, education and prognosis were defined as the most relevant.Conclusion. Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resour-ces and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region. J Pain Symptom Manage 2023;65:193-202. (c) 2022 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY -NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
  • No Thumbnail Available
    Item
    Opioid analgesics prescribing in Latin America: systematic review and meta-analysis
    (2025) Leiva Vásquez, Ofelia Paz; Dittborn, Mariana; Turrillas, Pamela; Chukwusa, Emeka; Nkhoma, Kennedy; Adejoke Obirenjeyi Oluyase; Padilla Pérez, Oslando; Pastrana, Tania
    Background Improving access to opioids in Latin America requires better understanding of prescription patterns in palliative care.Aim To describe opioid prescribing patterns, including types and doses in morphine equivalent daily dose (MEDD), among patients receiving palliative care, including patients with cancer and non-cancer conditions in Latin America.Design Systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sources We searched MEDLINE, EMBASE, PubMed, LILACS and SciELO from inception to January 2025. Quantitative studies reporting opioid prescriptions in adult patients receiving palliative care were included. Two reviewers independently screened, extracted data and assessed methodological quality using the Effective Public Health Practice Project tool. A narrative synthesis and descriptive statistics were conducted. Meta-analysis of MEDD was performed post hoc using random-effects models.Results Of 2855 records, 51 studies from seven countries met inclusion criteria. Most were observational (75%), with 8641 patients analysed. Cancer pain was the main indication (98%). Morphine (61%) and tramadol (15%) were the most frequently prescribed opioids. A meta-analysis of 48 studies (8433 patients) yielded a pooled mean MEDD of 98.06 mg (95% CI 77.07 to 119.05), with substantial heterogeneity (I²=100%). Most studies were rated as low to moderate quality.Conclusions This review provides a regional synthesis of opioid prescribing patterns for palliative care in Latin America. Although morphine is the most used opioid, data show limited dosing variability and a scarcity of high-quality studies. Strengthening research capacity is essential to inform clinical guidelines and policy for equitable and adequate pain management in palliative care across the region.
  • No Thumbnail Available
    Item
    Opioid prescribing for cancer pain in Latin America: systematic review
    (2024) Leiva, Ofelia; Chukwusa, Emeka; Nkhoma, Kennedy; Dittborn, Mariana; Turrillas, Pamela; Pastrana, Tania
    Objective To explore opioid prescribing patterns for cancer pain in Latin America (LA).Methods A systematic review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Relevant databases, including MEDLINE, EMBASE, PubMed, LILACS and Scielo, were searched from inception to June 2023. Empirical studies of opioid prescription patterns in adult palliative care patients with cancer pain were included. Methodological quality was assessed using the Effective Public Health Practice Project tool. Data were analysed using narrative synthesis. Descriptive statistical analyses were conducted using SPSS V.28 (IBM). Categorical variables were summarised using frequencies and percentages and continuous variables as means or medians.Results Seventeen studies from six countries were included. Ten were observational, while seven were experimental, including five randomised controlled trials (RCT) and two non-RCT. Most were low or moderate methodological quality. Out of 7809 patients, morphine (54%) and tramadol (18%) were the most prescribed opioids. The median of morphine equivalent daily dose was 26 mg (IQR 26-41).Conclusion Latin America shows lower opioid consumption rates compared with high-income countries for control pain management (CPM). More rigorous research on CPM in LA is needed. Additionally, a comprehensive review of opioid prescription patterns, including non-cancer diagnoses, is necessary.