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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