Factors related to good death in the Eastern Mediterranean Region: a systematic review

Background: Considerations for palliative care and quality of death has significantly increased over the past 10 years in the Eastern Mediterranean Region (EMR). Recent trends in ageing and increasing chronic disease burden have drawn attention to the need to pay attention to the concept of good death and related factors from the perspective of the local population. Aims: To assess the factors related to good death in the EMR. Methods: We searched PubMed, Embase, Scopus, Web of Science, and ProQuest on 22 October 2021 for English language articles, with no time limit, using keywords “quality of death”, “good death”, “quality of dying”, “good dying”, “Middle Eastern”, and countries in the Region. The quality of articles was evaluated using the Hawker criterion and based on the PRISMA guidelines. From the thematic analysis, the factors influencing good death were extracted. EndNote X8 software was used for data management. Results: The search yielded 55 articles, and 14 were included in the study, with a total of 3589 participants. Factors related to good death were classified into 2 main categories: patient preferences and end-of-life care. The former was divided into 4 groups: symptom management, psychological support, social support, and spiritual care. The second category included 2 subcategories: death control and patient autonomy, and end-of-life care. Conclusion: Although patients’ beliefs about good death are personal, unique, and different, perception about good death in the EMR depends on the extent to which patients’ preferences are met and end-of-life care is provided. More research on good death is recommended in the context of Islamic countries in EMR, and to empower patients and their families to better manage the dying process and create educational programmes.

Palliative care models and innovations in 4 Eastern Mediterranean Region countries: a case-based study

Background: There is a global agreement that palliative care should be universally accessible. However, in low- and middle-income countries and conflict zones, most people lack access to it. In the Eastern Mediterranean Region (EMR), no country has achieved integration of palliative care into its health care system, and only 4 countries have better-than-isolated palliative care provision. Aims: To promote and guide palliative care improvement in the EMR, with case studies showing the successes and challenges of palliative care implementation from 4 countries in the Region. Methods: We developed a structured, succinct, case-writing format and invited palliative care leaders in the EMR to use it to describe successes and challenges in palliative care implementation in their countries. Results: Within the EMR, in addition to many challenges and needs, there are examples of successful palliative care policy development, community-based service creation, and paediatric palliative care implementation. Conclusion: The experiences of the regional palliative care leaders documented in succinct, structured case studies, can help guide regional palliative care development in the EMR and other regions

The level of knowledge about palliative care in Iranian patients with cancer.

BACKGROUND: Patient awareness plays an important role in integrating palliative care into the patient care process. Lack of awareness can create a negative attitude towards palliative care and affect patients' decisions during the treatment process. The present study was conducted to determine the level of knowledge about palliative care in Iranian patients with cancer. METHODS: The descriptive study was conducted with a convenience sample of 103 cancer patients admitted to an oncology center in Yazd, Iran, A three-part questionnaire including demographic information, sources of palliative care information and the Palliative Care Knowledge Scale (PaCKS) was used to collect data. All statistical analyses were performed using software SPSS 21. RESULTS: The mean age of patients was 36.2 ± 13.5 years. Of the total, 38.8% of patients received information about palliative care through the media and 36.9% from the treatment team. On a scale of 0 to 13, the mean PaCKS score was 6.7 ± 3.7. A 'good' level of knowledge was reported by 29.1% of participants; however 84.5% stated that they should leave other doctors at the time of receiving palliative care, 71.8% considered palliative care for patients in the last six months of life, 84.5% considered palliative care for patients with cancer, and 70.9% stated that palliative care encourages people to discontinue treatments aimed at treating their disease. CONCLUSION: Our study found most cancer patients have a moderate to weak level of knowledge and considerable misinformation about palliative care, which highlights the importance of providing palliative care education. The development of training programs in this area could play an effective role in improving patients' knowledge of palliative care.

Perspectives of Afghan refugee mothers on the experience of caring for a child with cancer: a qualitative analysis

Background: Cancer in children causes many challenges for the family. When a refugee family experiences it, its impacts may be different and more specific considerations for care may be needed. Aims: This study aimed to explore the experiences of Afghan mothers living in the Islamic Republic of Iran who had a child with cancer. Methods: This was a qualitative study, conducted in 2017, of Afghan refugee women with children diagnosed with cancer and referred to a cancer referral hospital in Tehran; they were selected through purposive sampling. Face-to-face, semi-structured and in-depth interviews were conducted for data collection until data saturation was reached. Conventional content analysis was done. MAXQDA 10 was used for organizing the data. Results: Nine Afghan mothers were interviewed. They were aged 24–44 years and the children were aged 2–9 years. A primary theme called “passive acceptor” was found with five subthemes: chronic suffering, health issues, lack of skills, maladaptive coping and enthusiasm. The mothers were struggling to cope with the challenges of caring for a child with cancer both financially, physically and emotionally. Conclusion: In spite of many issues in common with similar groups in other countries, Afghan mothers appear to need to greater assistance when it comes to seeking help and understanding for the care for their child with cancer, possibly because of cultural barriers to self-empowerment. Tailored care plans are recommended for Afghan refugee mothers in the Islamic Republic of Iran.

Evaluating the Factor Structure of the Persian Version of Posttraumatic Growth Inventory in Cancer Patients

PURPOSE: This study aimed to assess the factor structure of the Persian version of posttraumatic growth inventory (P-PTGI). METHODS: Participants included 272 Iranian people of Azari ethnicity (111 women and 161 men), aged between 21 and 91 years (mean 52.65 years), who were diagnosed with cancer and were referred to the oncology department of the university hospital. The P-PTGI was assessed to determine the construct validity, using various indices of confirmatory factor analysis and standardized lambda coefficient, followed by further assessment of the discriminant and convergent validities by using the structural equation model. LISREL 8.8 for Windows and SPSS were used for data analysis. RESULTS: The calculated values of comparative fit index, incremental fit index, normed fit index, and non-normed fit index > .90 and the values of standardized root-mean-square residual < .08 indicate an acceptable fit for the original PTGI. Considering that the values of average variance extracted (.52–.74) were greater than the square of correlation coefficients between the five dimensions of P-PTGI, discriminant validity was approved. Convergent validity was confirmed through a high value of standardized lambda coefficient (.52–.92) between the items and their related factors. CONCLUSIONS: This study revealed that P-PTGI has an acceptable validity and reliability for posttraumatic growth assessment in Iranian cancer patients and its factor structure is similar to that of the original form developed by Tedeschi and Calhoun.

Pathological description and immunohistochemical demonstration of ovine abortion associated with Toxoplasma gondii in Iran / 대한수의학회지

The obligatory intracellular protozoan parasite Toxoplasma gondii is a major world wide cause of infectious ovine abortion. In some different diagnostic techniques that are being used to detect this pathogen in ovine fetuses, immunohistochemistry (IHC) is a very sensitive and expensive one. Histopathology is not truly a specific and sensitive test for Toxoplasma infection but it can be helpful to choose some suspected tissues for IHC. In this study 9.5% of 200 samples (aborted ovine fetuses internal organs such as brain, liver, heart, lung, kidney, spleen) (4.6~14.4% with 95% CI) were positive in IHC with a very good logical agreement among different diagnostic techniques (kappa = 0.73, 0.8) and with no significant difference among different fetal age groups (p > 0.05).