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Strategic Planning by the Palliative Care Steering Committee of the Middle East Cancer Consortium

Moore, Shannon Y. MD, MPH; Pirrello, Rosene D. RPh; Christianson, Sonya K. MD; Ferris, Frank D. MD, FAAHPM

Journal of Pediatric Hematology/Oncology: April 2011 - Volume 33 - Issue - p S39–S46
doi: 10.1097/MPH.0b013e3182121d91
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High quality comprehensive palliative care is a critical need for millions of patients and families, but remains only a dream in many parts of the world. The failure to do a strategic planning process is one obstacle to advancing education and pain prevention and relief. The Middle Eastern Cancer Consortium Steering Committee attendees completed an initial strategic planning process and identified “developmental steps” to advance palliative care. Underscoring the multi-disciplinary nature of comprehensive palliative care, discipline-specific planning was done (adult and pediatric cancer and medicine, pharmacy, nursing) in a separate process from country-specific planning. Delineating the layers of intersection and differences between disciplines and countries was very powerful. Finding the common strengths and weaknesses in the status quo creates the potential for a more powerful regional response to the palliative care needs. Implementing and refining these preliminary strategic plans will augment and align the efforts to advance palliative care education and pain management in the Middle East. The dream to prevent and relieve suffering for millions of patients with advanced disease will become reality with a powerful strategic planning process well implemented.

Institute for Palliative Medicine at San Diego Hospice, San Diego, CA

Reprints: Shannon Y. Moore, MD, MPH, Institute for Palliative Medicine at San Diego Hospice, 4311 Third Ave, San Diego, CA 92103 (e-mail: SMoore@SDHospice.org).

Received January 11, 2011

Accepted January 24, 2011

The Palliative Care Steering Committee of the Middle East Cancer Consortium (MECC) strives to decrease the suffering and improve the lives of patients and families in the Middle East living with cancer and other life-threatening illnesses. As patients in the region frequently present late into the health care system with advanced disease and multiple issues that cause them suffering, palliative care becomes a significant priority for comprehensive cancer care in the Middle East.

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BACKGROUND

In May 2009, clinicians with an interest in palliative care from each of the MECC countries, including Cyprus, Egypt, Israel, Jordan, the Palestine Authority and Turkey, and colleagues from Lebanon and Saudi Arabia, met in Larnaca, Cyprus to begin the collective strategic planning process as the MECC Palliative Care Steering Committee (MPCSC). Their overall goal: “to develop and implement a shared strategy to build palliative care capacity in MECC and other Middle Eastern countries.”

At that initial meeting in May 2009, the participants: (1) agreed in principle to work with the short definition of palliative care as “therapies to prevent and relieve suffering and help patients and families achieve their full potential in the face of adversity,” and adopted the longer 2002 World Health Organization definition of palliative care1,2; (2) reviewed the situation in each of the participating countries; (3) discussed the needs of patients and families and adopted in principle the Model of Needs developed by the Canadian Hospice Palliative Care Association3; (4) agreed to use the World Health Organization Public Health Strategy for integrating palliative care into existing health care systems4; and (5) envisioned developing “One Voice to guide the implementation of palliative care services to respond to the multiple needs of patients and families living with cancer and other life-threatening illnesses across the Middle East.”

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METHODS

To continue this strategic planning process, the MPCSC met again in January 2010 in Larnaca, Cyprus. This time, planning focused on strategies to improve pain management in the Middle East. The strategic planning process was facilitated by the authors.

Having already defined “what do we do” broadly as “improving palliative care across the Middle East,” and “why do we do this” as “to respond to the multiple needs of patients and families with cancer and other life-threatening illnesses,” participants completed a 2-part strategic planning process for 2 separate activities: (1) 8 country-specific groups defined the situation and next steps to change pain management policy and analgesic availability within their respective countries, and (2) 4 discipline-specific groups, including physicians, nurses, pharmacists, and pediatrician, defined the situation and next steps to increase education and improve pain management within their disciplines in the Middle East.

As background for each activity, the participants shared the current situation in their respective countries relative to pain management policy, analgesic (including opioid) availability, and current activities to advance education and pain management. Then, in each group, participants expanded their situation analyses by (a) defining key customers and stakeholders (Customer: Any person or organization who will directly benefit by the new services. Customers have needs and expectations that must be considered. It is important that what is offered to the “customer” is actually desired and will be seen as valuable) to answer the question “for whom we do it” and (b) performed an initial strengths, weaknesses, opportunities, and threats analysis to define the environment in which the new activities will be situated, including the strengths and weaknesses of the people/organization(s) that will develop the activities, and the opportunities and threats within the environment [external to the organization(s)] (Strengths: Internal attributes that will facilitate the development of the palliative care service. Weaknesses: Internal attributes that will make the development of the palliative care service more difficult. Opportunities: External conditions or forces that will influence the development of the palliative care service. Threats: External conditions, which may make the development of the palliative care service more difficult).

Finally, to further define “what do we do” and “how will we know we are succeeding,” each group specified initial developmental steps to be enacted during the next 1 to 2 years for each of the 2 activities.

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RESULTS

The results of the 8 country-specific groups to change pain management policy and analgesic availability are summarized in Table 1. The results of the 4 discipline-specific groups to increase education and improve pain management are summarized in Table 2.

TABLE 1

TABLE 1

TABLE 2

TABLE 2

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DISCUSSION

The participants' enthusiasm and dedication to palliative care, and the goal of creating “One Voice to guide the implementation of palliative care services in the Middle East” was clear. Experience with strategic planning was new to many of them. However, they grasped the concepts easily and each group actively engaged in an effective group planning process. Strong collegiality and mutual support emerged from this process. Their efforts were synergistic, and each group generated significant next steps for advancing palliative care in the Middle East.

To follow-up on this process, the facilitators and MECC leaders plan to “walk with” the participants as they implement the next steps of their strategic plans. Continued communication will be fostered by the development of a “web-based discussion group” for all participants, telephone consultation, and planned site visits to MECC countries. Further educational support will be provided through access to specific print resources and key internet web sites. The International Palliative Care Resource Center (www.IPCRC.net) will be a source of palliative care content and participants will have the opportunity to contribute country-specific resources and disseminate reports of their activities through IPCRC.net.

To continue the strategic planning process of the MPCSC and foster a shared approach to pain assessment and management and effective approaches to education, the Steering Committee will be meeting again in December 2010.

Without an effective strategic planning process, individuals and groups striving to implement palliative care services are rarely successful at developing population-based coverage. Through the initiative and resources provided by the MECC, a palliative care steering committee has taken the first steps to improve the availability of palliative care knowledge, skills, and services in the Middle East. The results of these efforts will be realized over the next 5 to 10 years as resources become available to implement these plans.

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REFERENCES

1. WHO Definition of Palliative Care, see http://www.who.int/cancer/palliative/definition/en/. Accessed on January 5, 2011.
2. Sepúlveda C, Marlin A, Yoshida T, et al. Palliative care: the World Health Organization's global perspective J Pain Symptom Manage.. 2002;24:91–96
3. Ferris F, Balfour H, Bowen K, et al. A model to guide patient and family care:: based on nationally accepted principles and norms of practice J Pain Symptom Manage.. 2002;24:106–123
4. Stjernsward J, Foley KM, Ferris FD. The public health strategy for palliative care J Pain Symptom Manage.. 2007;33:486–493
Keywords:

strategic planning; palliative care; comprehensive cancer care; Middle East

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