Development, acceptability and usability of culturally appropriate survivor narrative videos for breast cancer treatment in Botswana: a pilot study.

OBJECTIVES: Narrative communication has demonstrated effectiveness in promoting positive health behaviours, delivering support and coping with complex decision-making. Formal research evaluating this intervention for cancer treatment in Africa is lacking. We aimed to develop, and assess acceptability and usability of survivor video narrative interventions for breast cancer treatment in Botswana. DESIGN: A pilot study design. SETTING: Single-centre, tertiary hospital, sub-Saharan Africa. PARTICIPANTS: Eight women, ≥18 years old, with stages I-III breast cancer were enrolled for the video intervention. 106 women, ≥18 years old, with stages I-IV breast cancer viewed the narrative videos and 98 completed the acceptability and usability surveys. INTERVENTION: Survivor narrative videos were developed using the theory of planned behaviour and using a purposive sample of Batswana, Setswana-speaking, breast cancer survivors, who had completed systemic treatment and surgery with high rates of adherence to the prescribed treatment plan. PRIMARY OUTCOMES: We assessed acceptability and usability among prospectively enrolled patients presenting for routine breast cancer care at Princess Marina Hospital in Botswana, using a 13-item survey. RESULTS: Participants expressed high acceptability and usability of the videos, including 99% (97/98) who strongly agreed/agreed that the video presentations were easy to understand, 92% (90/98) who would recommend to other survivors and 94% (92/98) who wished there were more videos. Additionally, 89% (87/98) agreed or strongly agreed that the one-on-one instruction on how to use the tablet was helpful and 87% (85/98) that the video player was easy to use. CONCLUSION: Culturally appropriate survivor video narratives have high acceptability and usability among patients with breast cancer in Botswana. There is an opportunity to leverage this intervention in routine breast cancer care for treatment support. Future studies will test the implementation and effectiveness of narrative videos on a wider scale, including for patients being treated for other cancers.

Delphi Method to Develop a Palliative Care Tool for Children and Families in Sub-Saharan Africa.

CONTEXT: In sub-Saharan Africa, there is no standardized approach to pediatric palliative care assessment. Because of this, there is a critical demand for evidence-based assessment tools that identify the specialized needs of children and their families requiring palliative care in developing countries. OBJECTIVES: To develop a standardized approach to pediatric palliative care (PPC) assessment that includes an individualized plan of care for use in sub-Saharan Africa. METHODS: A Delphi method approach used five rounds to explore core elements that define the essential assessment attributes mandatory for providing excellence in PPC. Using the Delphi method, the consensus from 11 PPC experts was obtained during four Delphi rounds regarding the most important questions to include in a PPC assessment tool and plan of care. During the final Delphi round 5, the expert consensus was confirmed in a separate group of 36 childhood cancer/palliative care clinical providers. RESULTS: Five core elements were developed as the foundation for a PPC assessment. A symptom assessment tool was developed that includes 15 symptoms that PPC experts agreed occurred more than 65% of the time in their patients. CONCLUSION: The Delphi method was an effective tool to develop a consensus on a PPC assessment tool to use with children and their families in sub-Saharan Africa. This standardized approach will enable the collection of data to drive outcomes and research.

The Declaration on Palliative Care in a Pandemic: report of the African Ministers of Health Meeting and the 7th International African Palliative Care Conference, held from the 24th to 26th August 2022 in Kampala, Uganda and virtually.

The 7th International African Palliative Care Conference and the 4th African Ministers of Health Meeting were held in Kampala from the 24th to 26th August 2022. The theme of the conference - Palliative Care in a Pandemic - reflected the reality of palliative care provision on the continent, and the experience of patients and providers over the past 2 years. It was hosted by the African Palliative Care Association and the Worldwide Hospice Palliative Care Alliance with co-sponsors being the International Children's Palliative Care Network, the International Association of Hospice and Palliative Care, Global Partners in Care and Palliative care in Humanitarian Aid Situations and Emergencies. The conference was held in Kampala as a hybrid event, with a mix of in-person, pre-recorded and virtual presentations. The African Ministers of Health Meeting held on the 24th August was attended by delegates from 25 Ministries of Health, with 92 participants in-person and 122 attending virtually. Hosted by the Minister of State for Primary Health Care in Uganda, the participants at the meeting endorsed a Declaration on Palliative Care in a Pandemic. The main conference, held on the 25th and 26th August, was attended by 334 delegates from 40 countries, 199 (60%) of whom attended in-person. Key themes discussed throughout the conference included: contagious compassion; building a business case and evidence for palliative care in Africa; palliative care policy, funding and sustainability; the importance of collaboration and global partnerships; palliative care for all ages, children through to the elderly, and all conditions; the need to be innovative and creative, embracing technology; and a feeling of hopefulness in the future of palliative care in the region as we go forward together. The impact of the pandemic has been significant on everyone. Despite this, and the limitations imposed by the pandemic, the African palliative care community has come through it stronger, is committed to continuing the development of palliative care across the region, working together and is hopeful for the future.

Strengthening palliative care delivery in developing countries: a training workshop model in Botswana.

BACKGROUND: The persistent global unmet need for palliative care continues to be felt acutely in Sub-Saharan Africa, where the volume is growing and access to palliative services remains underdeveloped. Recognizing the increasing urgency of bolstering palliative care infrastructure, several countries, such as Botswana, have established national policies and strategies to enhance care delivery. Given that education and training are essential components in pursuing this goal, we present a model for a training workshop that was successful in increasing the palliative care knowledge base and skill set in a group of nurses. METHODS: A 2-day palliative care workshop was conducted for 15 nurses in Gaborone, Botswana in October 2014. Ten nurses completed pre- and post-workshop tests consisting of 21 questions spanning palliative care topics and delivery skills. RESULTS: The survey category with the highest pre-test score of 70% was principles of palliative care. Ninety percent of participants demonstrated statistically significant improvement in post-test scores in comparison to pre-test results. The greatest increase in scores were observed in the categories of communication, end-of-life care and syringe driver use for administration of analgesic medications. The lowest post-test score category was spirituality, though it consisted of one survey question. CONCLUSIONS: Here we provide quantitative data that supports the success of the training workshop model presented. Improvement in palliative care knowledge and treatment skills, as evidenced by the increased scores from pre- to post-test results, suggests the efficacy of this 2-day training program in advancing palliative care education of nurses. Given the unmet need for healthcare workers trained in palliative care, this model could serve as a valuable tool for expanding and strengthening the delivery of care in settings where patients have limited access to palliative care services.

Palliative care in Botswana: current state and challenges to further development.

BACKGROUND: A rising tide of cancers and other chronic diseases, alongside the ongoing HIV/AIDS epidemic, has created an increasing demand for palliative care in Africa. Yet, few African nations have established effective palliative care programs. In Botswana, the escalating HIV/AIDS crisis revealed an unmet need for holistic care, prompting efforts to expand palliative care education and policy, and target curricular and health system integration in the years that followed. Despite numerous successes, Botswana continues to face barriers to palliative care development. In this paper, we examine the country's current state of palliative care and the challenges it must still overcome. METHODS: Data was collected from June to July of 2015, and includes interviews of physicians, nurses and hospice staff. RESULTS: Palliative care delivery in Botswana is primarily concentrated in the south, where the country's first palliative care clinic and three hospices are located. While 157 health care workers, students and lecturers received palliative care training from 2013 to 2014, 100% of participants felt that education remains a significant obstacle for palliative care expansion. Sixty-four percent commented on the need for increased palliative care understanding and awareness, while 91% noted the difficulty of achieving adequate access to pain medication. CONCLUSIONS: Several targets were identified that have persistently hampered efforts to advance palliative care in Botswana, including: infrastructural challenges such as access to pain medications, the strained size of the palliative care workforce, and a need for increased palliative care education and understanding. However, recent achievements in national strategy and policy offer promising avenues for moving past these historical barriers. With implementation of action plans already underway, Botswana may ultimately provide a model for successful palliative care implementation in continuing to strengthen palliative care services throughout the country.

Multidisciplinary Gynecologic Oncology Clinic in Botswana: A Model for Multidisciplinary Oncology Care in Low- and Middle-Income Settings.

PURPOSE: Cervical cancer is a major cause of mortality in low- and middle-income countries (LMICs) and the most common cancer diagnosed in women in Botswana. Most women present with locally advanced disease, requiring chemotherapy and radiation. Care co-ordination requires input from a multidisciplinary team (MDT) to deliver appropriate, timely treatment. However, there are limited published examples of MDT implementation in LMICs. METHODS: In May 2015, a weekly MDT clinic for gynecologic cancer care was initiated at Botswana's national referral facility. The MDT clinic served as a forum for discussion and coordination of patients with gynecologic cancer and consisted of a gynecologist, pathologist, medical oncologist, radiation oncologist, palliative care specialist, and nurse coordinator. RESULTS: Between May 2015 and December 2015, 135 patients were seen in the MDT clinic. The mean age of the patients was 49 years. Most (60%) of the patients were HIV positive. The most common diagnosis was cervical cancer (60%), followed by high-grade cervical intraepithelial neoplastic lesions (12%) and vulvar cancer (11%). Only data up to September 2015 were assessed for treatment delays. It was found that only 38% of patients needed more than one visit for care coordination before treatment initiation. Among patients with cervical cancer, the median delay from date of biopsy to start of radiation treatment was 39 days (interquartile range, 34 to 57 days) for patients treated after MDT initiation, compared with 108 days (interquartile range, 71 to 147 days) for patients treated before MDT initiation (P < .001). CONCLUSION: Implementation of MDT clinics in LMICs is feasible and can help reduce delays in treatment initiation, as demonstrated by a gynecologic MDT clinic in Botswana. Streamlining care through MDT clinics can enhance care coordination and improve clinical outcomes. This model can apply to cancer care in other LMICs.

Cervical Cancer in Botswana: Current State and Future Steps for Screening and Treatment Programs.

Botswana has a high burden of cervical cancer due to a limited screening program and high HIV prevalence. About 60% of the cervical cancer patients are HIV positive; most present with advanced cervical disease. Through initiatives by the Botswana Ministry of Health and various strategic partnerships, strides have been made in treatment of pre-invasive and invasive cancer. The See and Treat program for cervical cancer is expanding throughout the country. Starting in 2015, school-going girls will be vaccinated against HPV. In regards to treatment of invasive cancer, a multidisciplinary clinic has been initiated at the main oncology hospital to streamline care. However, challenges remain such as delays in treatment, lack of trained human personnel, limited follow-up care, and little patient education. Despite improvements in the care of pre-invasive and invasive cervical cancer patients, for declines in cervical cancer-related morbidity and mortality to be achieved, Botswana needs to continue to invest in decreasing the burden of disease and improving patient outcomes of patients with cervical cancer.