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Considerations for Fostering Palliative Care Awareness in Developing Contexts: Strategies From Locally Initiated Projects in India

  • Author Footnotes
    # Dr. Singh and Dr. Giannitrapani are co-first authors.
    Nainwant Singh
    Correspondence
    Address correspondence to: Nainwant Singh, MD, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (Building 324, 152-MPD), 94025, Menlo Park, CA, USA.
    Footnotes
    # Dr. Singh and Dr. Giannitrapani are co-first authors.
    Affiliations
    Division of Primary Care and Population Health (N.S., K.F.G., T.H., K.A.L.), Stanford University School of Medicine, Palo Alto, California, USA

    VA HS R&D Center for Innovation to Implementation (Ci2i) (N.S. K.F.G., R.G., K.A.L.), Menlo Park, California, USA
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  • Author Footnotes
    # Dr. Singh and Dr. Giannitrapani are co-first authors.
    Karleen F. Giannitrapani
    Footnotes
    # Dr. Singh and Dr. Giannitrapani are co-first authors.
    Affiliations
    Division of Primary Care and Population Health (N.S., K.F.G., T.H., K.A.L.), Stanford University School of Medicine, Palo Alto, California, USA

    VA HS R&D Center for Innovation to Implementation (Ci2i) (N.S. K.F.G., R.G., K.A.L.), Menlo Park, California, USA
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  • Aanchal Satija
    Affiliations
    Department of Onco-Anaesthesia and Palliative Medicine (A.S., A.G., S.B.), Dr. B. R. Ambedkar, IRCH, AIIMS, New Delhi, India
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  • Archana Ganesh
    Affiliations
    Department of Onco-Anaesthesia and Palliative Medicine (A.S., A.G., S.B.), Dr. B. R. Ambedkar, IRCH, AIIMS, New Delhi, India
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  • Raziel Gamboa
    Affiliations
    VA HS R&D Center for Innovation to Implementation (Ci2i) (N.S. K.F.G., R.G., K.A.L.), Menlo Park, California, USA
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  • Soraya Fereydooni
    Affiliations
    Yale University School of Medicine (S.F.), New Haven, Connecticut, USA
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  • Tayler Hennings
    Affiliations
    Division of Primary Care and Population Health (N.S., K.F.G., T.H., K.A.L.), Stanford University School of Medicine, Palo Alto, California, USA
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  • Shivani Chandrashekaran
    Affiliations
    Duke University School of Medicine (S.C.), Durham, North Carolina, USA
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  • Odette Spruijt
    Affiliations
    Peter MacCallum Cancer Center (O.S.), University of Melbourne, Melbourne, VIC, Australia
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  • Author Footnotes
    ## Dr. Bhatnagar and Dr. Lorenz are co-senior authors.
    Sushma Bhatnagar
    Footnotes
    ## Dr. Bhatnagar and Dr. Lorenz are co-senior authors.
    Affiliations
    Department of Onco-Anaesthesia and Palliative Medicine (A.S., A.G., S.B.), Dr. B. R. Ambedkar, IRCH, AIIMS, New Delhi, India
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  • Author Footnotes
    ## Dr. Bhatnagar and Dr. Lorenz are co-senior authors.
    Karl A. Lorenz
    Footnotes
    ## Dr. Bhatnagar and Dr. Lorenz are co-senior authors.
    Affiliations
    Division of Primary Care and Population Health (N.S., K.F.G., T.H., K.A.L.), Stanford University School of Medicine, Palo Alto, California, USA

    VA HS R&D Center for Innovation to Implementation (Ci2i) (N.S. K.F.G., R.G., K.A.L.), Menlo Park, California, USA
    Search for articles by this author
  • Author Footnotes
    # Dr. Singh and Dr. Giannitrapani are co-first authors.
    ## Dr. Bhatnagar and Dr. Lorenz are co-senior authors.

      Abstract

      Context

      Lack of palliative care (PC) awareness is a barrier to its utilization in developing contexts.

      Objectives

      To identify and understand strategies that changed awareness of the concepts and value of palliative care in a multi-site quality improvement project in India.

      Methods

      The Palliative Care - Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) evaluation team conducted 44 semi-structured interviews with clinician and organization stakeholders at seven geographically dispersed sites. We used inductive and deductive approaches in this secondary analysis to identify emerging themes.

      Results

      We identified the following strategies to improve awareness of concepts and value of palliative care. Strategy 1: Educate medical trainees, staff, and the community about palliative care and its concepts. Sub-strategies: Participate in community events. Integrate PC concepts into early medical education. Standardize training for practitioners. Strategy 2: Design and disseminate India-specific research to reinforce awareness of the value of palliative care. Sub-strategies: Publish and use India-specific palliative care research. Strategy 3: Facilitate communication between providers and departments to improve awareness of palliative care services and its concepts. Sub-strategies: Create referral frameworks and network with providers referring to palliative care to change awareness of available services and palliative care concepts.

      Conclusion

      To increase palliative care utilization, program development can include community and provider-focused efforts on awareness of the concepts and value of palliative care. These three strategies held salience across sites representing diverse Indian geographic and cultural settings; as such, they may be applicable to other contexts.

      Key Words

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