A survey of cancer care institutions in Nepal to inform design of a pain management mobile application

BMC Palliative Care

Bijay Neupane¹  Usha Thapa¹  Krishna Sagar Sharma¹  Manita Dhakal¹  Rajesh Gongal²  Ganesh Koirala²  Abish Adhikari³  Bishnu Dutta Paudel⁴  Sandhya Chapagain Acharya⁴  Ramila Shilpakar⁴  Regina Kattel⁵  Sudip Shrestha⁵  Rebecca Dillingham⁶  Hexuan Zhang⁷  Kara Fitzgibbon⁷  Catherine E. Elmore⁸  Virginia LeBaron⁸  Rachel Bennett⁸  Martha Maurer⁹  Daniel Munday^1,10 

[1] B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal;Hospice Nepal, Kathmandu, Nepal;Kathmandu Cancer Center, Tathali, Bhaktapur, Nepal;National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal;Nepal Cancer Hospital & Research Center, Kathmandu, Nepal;University of Virginia Center for Global Health Equity, Charlottesville, VA, USA;University of Virginia Center for Survey Research, Charlottesville, VA, USA;University of Virginia School of Nursing, 225 Jeannette Lancaster Way, 22908, Charlottesville, VA, USA;University of Wisconsin School of Pharmacy, Sonderegger Research Center, Madison, WI, USA;Usher Institute, University of Edinburgh, Edinburgh, UK;

关键词: Palliative care;    Cancer;    Mobile health;    Pain;    Pain management guidelines;    Nepal;    Survey;   

DOI  :  10.1186/s12904-021-00824-0

来源: Springer

【 摘 要 】

BackgroundOne way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs.ObjectivesThis research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application (‘app’) to scale-up implementation of existing locally developed PMG.MethodsWe conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app.FindingsSurveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39).ConclusionsSmart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.

【 授权许可】

CC BY