National Palliative Care Program Planning in Brazil

National Palliative Care Program Planning in Brazil: Nov 16-17, 2010 : Rio de Janeiro

Ninety-five participants from all regions of Brazil, representing all disciplines providing palliative care services, met in Rio, Nov 16-1, 2010 to a national palliative care strategy. Notwithstanding substantial expertise, innovation and commitment within institutional and/or local programs, participants identified the variation in levels of service, patient outcomes and care-giver support as well as the difficulties of access to evaluation, care and opioids as major factors contributing to Brazil's relatively poorer performance compared to many other nations (Economist Intelligence Unit Report, 2010).

flickr:5393243144 Dr. simon Sutcliffe, INCTR Canada President

Following an opening welcome from INCA (Dr Luis Antonio Santini) and INCTR (Dr Simon Sutcliffe), brief presentations were made on Global Palliative Care (Dr Stuart Brown: INCTR-PAX), Canadian Palliative Care (Dr Fraser Black: INCTR-PAX), Brazilian Palliative Care (Dr Claudia Naylor: INCA), Family and Community Palliative Care in Northern B.C. (Dr Biz Bastian: INCTR-Canada), Opioid Availability and Dispensing in Brazil (Ms Maria Barbosa: Brazil), Caring for the Care-Giver (Doug Ennals: INCTR-PAX) the Global Cancer Control Challenge (Dr Simon Sutcliffe ; INCTR-Canada), Dr. Carlos Gill (INCTR-Brazil), and Renata Lucia Guisti Bruno and Dr. Angelica reported on progress in Palliative Care at the Santa Marcelina Hospital system.

Nine palliative care programs from across Brazil were presented, each reflecting the approaches by inter-disciplinary teams to provide institutional, community and home-based palliative services for patients, families and care-givers. Presenters high-lighted challenges of access to care, drugs, human resources, transportation, educational levels, awareness and socio-economic constraints, whilst reflecting the opportunities for improvement, the evident benefits of the care provided and the commitment of the teams to achieve their best level of service within prevailing contexts and resources.
A Discussion Cafe format allowed participants to work in small groups on pre-selected areas (Opioid Availability: Palliative Care Services: Pediatric Palliative Care: Palliative Care Education: Evaluation Tools: Rural and Urban Palliative Care: Psychosocial Care and Bereavement), encouraging networking, relationship-building, identification and exchange of ideas and common purpose to achieve solutions. Large group discussion encouraged further exchange, "strengths and weaknesses" and identification of priorities for action.

flickr:5393137618 Deep in discussion in small group sessions.

The final afternoon addressed the compelling case for a national program— "leveling the bar" to reduce inappropriate variation to establish commonly achievable "best" practice and "raising the bar" to achieve a more effective and efficient system to enhance palliative care outcomes. The national plan must be seen to "add value", and not compete with, or detract from good work already on-going through institutional and state-funded services. Issues of GOVERNANCE of a national palliative care program (the concept of a commonly developed and operated plan by "shareholders" within the palliative care system as opposed to a plan owned and managed by a single stakeholder), the role and nature of LEADERSHIP of multi-stakeholder programs, and the distinction of "advocacy" from program and system change through a collaborative endeavor involving all stakeholders (public, patient, provider and politics) were discussed in full plenary mode.

There was a strong sense that "the time was right" and that a "tipping point" had been reached for national program development. In the closing comments by Dr Luis Antonio Santini (Director, INCA), he complemented the participants on their 2 days of work, recognized their commitment to responsible change through collaborative and strategic endeavor, and offered the support of INCA to assist the process of strategic plan development and "navigation” within the context of cancer control and health service planning.
Meeting organized by Dr Claudia Naylor (INCA); sponsored by Fundacao Do Cancer (Rio,Brazil) and INCTR-PAX: supported by INCA (Institute Nacional de Cancer), SUS (Systema Unico de Saude) and Ministry of Health (Fed. Govt. of Brazil).

Claudia Naylor (INCA) Stuart Brown (INCTR-PAX); Fraser Black (INCTR-PAX); Simon Sutcliffe (INCTR-Canada); Doug Ennals (INCTR-PAX); Biz Bastian (INCTR-Canada).

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