Palliative Care in Brazil

Palliative Care Handbook - Manual de Cuidados Paliativos INCTR Brasil

The official launch of Manual de Cuidados Paliativos INCTR Brasil took place during the Multidisciplinary Symposium and the Palliative Care Session, XII Brazilian Congress of Pediatric Oncology - SOBOPE, held in Curitiba, Brazil on October 1st. Many copies of the handbook were sold during the congress. The handbook will be advertised during palliative care symposiums, congresses and meetings. Individuals on INCTR Brazil's mailing list, including participants of the 41st Congress of SIOP who expressed an interest in the Portuguese version of the INCTR Palliative Care Handbook will be informed that it is now available. One thousand copies of the Portuguese version of the handbook have been printed. The price of the handbook is approximately 13 euros.

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 16-17, 2010 to develop 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 poor performance compared to many other nations (see Economist Intelligence Unit Report, 2010).

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), 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.

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Cafe Format Discussions on palliative care in Brazil

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. The final afternoon addressed the compelling case for a national program- "levelling the bar" to reduce inappropriate variation to establish commonly achievable "best" practices" and "raising the bar" to achieve more effective and efficient systems 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 plenary.

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), 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.

The meeting was organized by Dr Claudia Naylor (INCA); sponsored by Fundacao Do Cancer (Rio,Brazil) and INCTR-PAX and was supported by INCA (Institute Nacional de Cancer), SUS (Systema Unico de Saude) and Ministry of Health (Fed. Govt. of Brazil).

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