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Table 1 A summary of obstacles and opportunities to address them

From: Addressing obstacles to the inclusion of palliative care in humanitarian health projects: a qualitative study of humanitarian health professionals’ and policy makers’ perceptions

Obstacle

Summary

Opportunities to address it

Ethos

Primacy of life saving efforts in humanitarian action deflects attention from objectives of alleviating suffering and promoting dignity

Increased reflection and engagement in humanitarian organizations

Emphasizing all three goals of humanitarian action

Accepting potential for integration of curative and palliative approaches

Raise awareness of the unaddressed health-related suffering

Priority Setting

In situations of crisis where resources are scarce and needs are high, it may be difficult to justify directing resources to palliative care

Emphasize that most palliative care interventions are not costly

Partner with local community and lay caregivers

Question when care being provided may be futile or unduly burdensome

Ensure suffering and dignity are addressed for all patients as a matter of equity

Prioritize those resources dedicated to palliative care to address needs of patients with most imminent and severe needs

Funding

Palliative care is unlikely to be effective for garnering funding from the public or large donors, a perception which may lead to not including it in programs

Challenge perceptions of humanitarians as ‘heroic life-savers’ as it problematically narrows the scope of humanitarian action

Test the assumptions that palliative care efforts would not be seen favorably by donors

Learn from successful examples within and beyond the humanitarian sector (e.g hospice movement)

Identify relevant accountability metrics for palliative care

Guidance and expertise

There are few organizational polices and clinical standards related to palliative care in humanitarian settings, and few organizations have developed expertise or implemented training in this area

Develop policies, standards and clinical guidelines, and training for palliative care in humanitarian aid organizations

Share resources among organizations

Identify health professionals with palliative care expertise who can act as resources for the organization, and real time supports for teams

Access to medications

It is very difficult to access pain medications, especially opioids, in many countries due to legal restrictions, logistical issues, and misperceptions.

Advocate for standard access to opioids and other pain and symptom medications, especially removal of legal barriers

Plan and integrate medications into medical supply chain and logistics

Address misperceptions regarding opioids

Cultural specificity

Humanitarian organizations and their staff coming from other settings will have difficulty accessing or understanding local cultural, spiritual and social dimensions of death and dying

All humanitarians should reflect on their own cultural values, and engage with humility and respect

Consult and collaborate with translators, local health professionals, and lay care providers to provide culturally and religiously sensitive palliative care

Equity

Providing palliative care to displaced persons may lead to concerns for equity if this care is not available to host communities

Work with local communities to better understand and address their concerns

Design programs in ways that explicitly address issues of equitable access to care

Draw attention to the equity concerns of not providing palliation to those who require it, whether from refugee or host communities.

Continuity of care

Even if humanitarians initiated palliative care, continuity would be difficult if this approach does not exist in the local health system

Thoroughly explore and support existing local palliative care provision

Contribute to capacity building where needed, including training local lay people and health providers

Security

In some settings, security concerns may arise if when health professionals propose palliative care for a patient it is perceived by others as not providing the best care possible.

Carefully and continuously assess security risks

Ensure that health professionals are trained to evaluate such issues

Explore ways as a team to still provide palliative care while not undermining team safety

Terminology

Some humanitarian and local health professionals and policymakers may resist the term ‘palliative care’ but be open to the clinical approach if not labeled in this way

Consider how terms are understood and interpreted by different groups

Seek to clarify meanings and adapt vocabulary used to the particular context