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Background: Advanced cancer is associated with a significant symptom burden, and timely identification of palliative care (PC) needs, and provision of appropriate PC can improve treatment outcomes, reduce healthcare cost, and enhance patient and family satisfaction with care. Several tools have been used to identify PC needs in different clinical settings and patient groups.Objective: The primary objective was to determine the prevalence and associated characteristics of PC needs among cancer patients admitted to the surgical emergency center (SEC) of a large academic hospital in South Africa (SA). The association between PC needs and early death were explored as a secondary outcome.Design: This was a cross-sectional observational study that included all patients with known malignancy admitted through the SEC for acute surgical emergencies. The validated Supportive and Palliative Care Indicators Tool (SPICT™) was applied to patients' files on admission to the SEC. In addition, attending physicians were asked to estimate the 1 year survival probability of these patients by answering The Surprise Question (SQ).Setting: A tertiary level, public, academic hospital in Cape Town, SA.Results: One hundred and twelve admissions were included with a median age of 58 years. Fifty-two admissions (46.4%) were for metastatic patients and 60.7% were known with palliative treatment intent. The prevalence of SPICT- and SQ-defined PC needs was 46.4% and 54.7% respectively. Pain was the most prevalent presenting symptom and bowel obstruction the most prevalent presenting diagnosis. SPICT-positivity was a significant predictor of death before discharge and death within 6 months of first admission. Proportional agreement in predicting for PC needs of greater than 70% was shown between the two tools.Conclusion: Patients with PC needs comprise a significant proportion of SEC cancer admissions. This study shows the clear need for investment in staff and infrastructure to provide integrated palliative and end-of-life care as part of surgical services. The SPICTTM and SQ were shown to predict for early death in this cohort. Further validation of PC needs assessment tools is needed to guide the cost-effective implementation of PC services in low resource settings. [ABSTRACT FROM AUTHOR]

Background: Basic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality. Aim: This joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor. Setting: Palliative Medicine programme leads and teachers from eight medical schools in South Africa. Methods: A survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers. Results: Responses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the preclinical and clinical components of the curriculum. Conclusion: Through mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC). [ABSTRACT FROM AUTHOR]

Background: The South African National Policy Framework and Strategy on Palliative Care (NPFSPC) recommends that when integrating palliative care (PC) into the health system, a PC indicators tool should be used to guide clinicians to recognise a patient who should receive PC. The policy document recommends 'a simple screening tool developed for use in South Africa that would assist healthcare professionals (HCPs) to recognise patients who may have unmet palliative care needs'. Aim: This research study sought to develop South African consensus on indicators for PC to assist clinicians to recognise a patient in need of PC. Setting: The South African healthcare setting. Methods: A Delphi study was considered suitable as a methodology to develop consensus. The methodology was based on the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies to ensure rigour and transparency in conducting and reporting. Six different Delphi rounds were used to develop consensus. Each round allowed participants to anonymously rate statements with predefined rating scales. Results: Cognisant of the disparities in healthcare provision and access to equitable healthcare in South Africa, the expert advisory group recommended, especially for South Africa, that 'this tool is for deteriorating patients with an advanced life-limiting illness where all available and appropriate management for underlying illnesses and reversible complications has been offered'. The expert advisory group felt that disease-specific indicators should be described before the general indicators in the South African indicators tool, so all users of the tool orientate themselves to the disease categories first. This study included three new domains to address the South African context: trauma, infectious diseases and haematological diseases. General indicators for PC aligned with the original Supportive and Palliative Care Indicators Tool (SPICT) tool. Conclusion: The Supportive and Palliative Care Indicators Tool for South Africa (SPICTTM-SA) is a simple screening tool for South Africa that may assist HCPs to recognise patients who may have unmet PC needs. [ABSTRACT FROM AUTHOR]