Browsing by Author "Merriman, Anne"

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    Palliative Care-Related Self-Report Problems among Cancer Patients in East Africa: A Two-Country Study
    (Supportive Care in Cancer, 2014) Harding, Richard; Powell, Richard A.; Namisango, Eve; Merriman, Anne; Gikaara, Nancy
    Palliative care-related problems have not been measured in Africa in line with the WHO definition. This study aimed to measure the three-day period intensity of multidimensional problems (physical, psychological, social, and spiritual) among advanced cancer patients in Kenya and Uganda.Adults with advanced malignant disease gave self-report data to the African Palliative Outcome Scale (POS).Among 210 respondents, more than half had an underlying HIV diagnosis (51.9 %). The worst ranked POS items were pain and information. In three multivariable ordinal logistic regression models with the 3 POS factors as dependent variables, for the first model (factor 1 physical and psychological well-being), as age increased, the well-being also improved (B = 0.022, p = 0.037), and as physical function score worsened, factor score also worsened (B = −0.685, p < 0.001). In the second model (factor 2 interpersonal well-being), a trend toward significance was found for gender, with being male predicting a higher (better) factor score (B = 0.502, p = 0.067). For the third model (factor 3 existential and spiritual), increasing age was predictive of higher (better) factor score (B = 0.023, p = 0.032), and worsening function was predictive of lower (worse) factor score (B = −0.543, p < 0.001). This novel data revealed pain and information to plan for the future to affect patients most severely, underlining the importance of analgesia and social support. HIV infection did not affect the level of need. Our data suggest increasing need as function declines; therefore, home-based models with adequate family support are essential.
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    Palliative Medicine, an Urgent Public Health Need in the Developing World
    (Journal of Public Health Policy, 2007) Jagwe, Jack; Merriman, Anne
    ‘‘Palliative Care: A Public Health Priority in Developing Countries’’ in this issue of the Journal demands the attention of all those addressing public health problems in the developing world. Since 2000, palliative care has been an essential clinical service, in the context of HIV/AIDS, in the health strategic plan of Uganda, but has any other country taken it up? Palliative care is coming under health policies for HIV/AIDS not cancer, because HIV underlies many of the top 10 causes of death in developing countries today. To most countries in the Developing world, palliative care is a new specialty. Dame Cicely Saunders, OBE, first researched and modernized hospice and palliative medicine, in 1967. In 1986, the World Health Organization (WHO) took an interest in the problem of relief from pain for persons facing life-threatening illnesses, addressing mainly cancer. In 1986, WHO published their best seller, ‘‘Cancer Pain Relief’’(1) and sent it to all Governments in the world.