Palliative Care-Albania.

Sixty percent of cancer patients are diagnosed with advanced stages of disease and those diagnosed in early stages face challenges to receive adequate treatment. Palliative care has had significant developments in recent years in Albania because of a close partnership with the Ministry of Health, local nonprofit organizations, and the Open Society Foundation Albania. In 2011, a five-year action plan for palliative care as one of four parts of the National Cancer Control Plan was approved. At the end of 2014, the first palliative care law was approved by Parliament. Palliative care by-laws, documents, standards, clinical protocols, and guidelines for adults and children have been developed. Training and education are being provided to primary care professionals. Curricula on palliative care have been developed for the faculty of medicine, nursing high schools, and social work. About 80% of essential medications used in palliative care are available in Albania, 50% of these are paid for and have some access restrictions, and meanwhile the opiophobia still remains an enormous barrier. In the last three years, significant progress has been made in service provision. From only one public palliative care service in 2013, there are now eight palliative care services in eight of the 11 regional hospitals. By the end of 2016, it is expected that palliative care services will be available in all regional hospitals in the country.

Reducing the barriers to pain management in Albania: results from an educational seminar with family doctors.

Palliative care (PC) services are a very limited service in Albania and are provided mainly from the nonprofit sector (nongovernmental organizations [NGOs]) that cover about 30% of the demand. There are very few doctors and nurses qualified in PC and pain management. Training and education programs on opioid treatment do not exist and patients cannot access opioids easily. This study evaluated the attitudes of family doctors on pain assessment, management, and opioid usage before and after seminars on opioid pain management. The Barriers Questionnaire II (BQ-II) was used to evaluate attitudes towards pain management in 227 family doctors (general practitioners) working in the state primary health care system in both urban and rural areas. Data was collected before and after one-day seminars on opioids conducted in six cities located in all the major regions of the country. The response rate was 83.3%. Barriers were measured to be high in the participating physicians, with mean scores of 3 out of 5 or above for 10 of 27 items. The danger of addiction to pain medicines as well as the fear that many people with cancer would get addicted to pain medicine received the highest scores. At the end of the seminar barriers were significantly lower, with the total mean scores (with standard deviation) reduced from 2.4±0.6 to 1.6±0.7. High barriers to the use of opioids in family physicians in Albania were reduced significantly following a one-day training, demonstrating the effectiveness of the intervention. However, more research on the sustainability of the training effect is needed.