The Institute for Palliative Medicine: International Programs
To date, our faculty has touched, taught, and influenced palliative care capacity or program development in more than 45 countries around the world. Our experiences have underscored the vast need, the value of our outreach, and that decreasing unnecessary pain and suffering around the world is possible, Frank D. Ferris, MD, FAAHPM, FAACE, Director, International Programs
Mission: To discover, demonstrate and disseminate successful strategies to advance palliative care globally.
Vision: Transforming health care globally.
The Need: There is an urgent need for palliative care globally. While approximately 1 billion people have access to most of the World Health Organization's Essential Medicines, including opioids and at least some palliative care services (primarily in Australia/New Zealand, Europe and North America), more than 5.5 billion people do not…Read more about the need worldwide…close
With the increasing incidence of illness and the success of modern medicine, more people are living with advanced life-threatening illnesses for much longer. As a result, the need for pain relief and palliative care has become a major public health issue and an urgent imperative, worldwide.
Medical experts working with the World Health Organization (WHO) estimate that more than 60% of the 50 million deaths worldwide each year, especially the six million who die of cancer and the three million who die of AIDS, could benefit significantly from palliative care services if they receive them early enough in the illness experience, i.e., palliative care would prevent and relieve suffering, improve quality of life, ensure a safe and comfortable death, and help the bereaved rebuild their lives. Some patients would even live longer. The 600 million elderly worldwide (greater than 60 years of age) are particularly vulnerable as their risk of developing one or more life-threatening illnesses e.g., cancer, congestive heart failure, diabetes, dementia, etc. and becoming dependent increases as they age.
Today, in Europe, North America and Australia/New Zealand (areas that have developed healthcare systems), approximately 1 billion of the world's population have access to palliative care services and many of the opioid analgesics needed to control moderate to severe pain. However, in most of these countries there is still considerable need for extensive education for all healthcare workers, expanded and enhanced palliative services, and earlier/broader use of opioids and other palliative care medications and therapies.
In most developing and transition countries, where more than five of the 6.7 billion people in the world live, including more than 50% of the 600 million elderly, there is almost no pain control or palliative care. Yet, given 1) their disease demographics (80% of new cancer cases in developing countries present with late-stage disease, e.g., stage III (advanced) or IV (metastatic) cancer), and 2) their lack of resources to purchase/provide medical therapies even for patients who present with early stage disease, palliative care is the most appropriate focus of care for most patients with life-threatening illnesses in these countries (rather than just abandoning them to die).
Annually, 10 million people worldwide are diagnosed with cancer (50% of these are in developing countries) and 6 million die from cancer. By 2020, global cancer rates are expected to increase by 50% to 15 million new cases a year. At the same time, each year more than 5 million people are infected with HIV disease and more than 3 million people die of AIDS. Cancer and AIDS are excellent entry points for developing palliative care capacity as these diseases cause so much suffering for patients and families. Up to 60% of patients experience moderate to severe pain that requires opioid analgesics to control it, as well as exhibiting a wide range of other issues that cause considerable patient/family suffering. Needs for care are often intense and protracted. Family caregivers may lose their future; families go bankrupt buying medications and therapies, and providing care.
International Program Activities: Since 2001, the Institute for Palliative Medicine at San Diego Hospice (IPMSDH) has been developing international programs that build on our expertise in education, research and advocacy. Today, our international activities include:
- In-Country Professional Education, including sensitization presentations, classroom and bedside training courses…read more…close
To build in-country knowledge and skills, the IPMSDH International Programs offer a variety of in-country professional education programs customized to fit with participants' training needs, cultural values and the contexts within which they practice. IPMSDH also trains physicians and other clinicians who want to be palliative care consultants/master teachers/opinion leaders in their own country.
Sensitization workshops offered over 2-3 days build health professionals' awareness of the importance of palliative care and their knowledge of core palliative care competencies. A three-week Introductory Bedside-Training Course provides more in-depth instruction on the basic palliative care knowledge and skills needed to effectively care for patients. A 2-3 week Advanced Bedside-Training Course provides more in-depth learning. Both are based on the internationally recognized EPEC and EPEC-oncology curricula that were largely developed by IPMSDH faculty with input from hundreds of bioethics and palliative care experts.
- International Visitor Programs: Customized educational experiences at San Diego Hospice for doctors, nurses, pharmacists, social workers, spiritual and bereavement counselors who want to learn basic or advanced knowledge and skills related to palliative care…read more…close
The International Visitor Program provides palliative care training for physicians and other team members who want to understand and experience the clinical and organization aspects of palliative care and hospice as it is provided in the US by The Institute for palliative medicine at San Diego hospice across San Diego County. Visits can be arranged for up to 4 weeks.
Mark Boughey, MD, Melbourne|
Peter Hudson, RN, PhD, Melbourne
Peter Sherwen, MB.BS, Melbourne
Fabio Brecciaroli, MD, Brisbane
Peter Moore, MD, Sydney
Andrew Broadbent, MD, Sydney
Sue Isobel Salau, RN, Victoria
|Brazil||Fernanda Fukushima, MD, Botucatu|
Guilherme Barros, MD, Botucatu
Paula Rosa, MD, São Paulo
|Canada||Anne Langlois, MD|
Gary Rodin, MD, PhD, Toronto
Camilla Zimmermann, MD, Toronto
William O'Neill, Toronto
Deborah Emmerson, Toronto
Larry Librach, MD, Toronto
|Chile||Rodrigo Correa, MD, Santiago|
|Cyprus||Silvia Abou Samra Lazaridou, MD - Nicosia|
Giorgi Metivishvili, MD, Tbilisi|
Mariam Velijanashvili, MD, Tbilisi
Rema Gvamichava, MD, PhD, Tbilisi
Dimitri Kordzaya, MD, PhD, ScD, Tbilisi
Tamar Alibegashvili, MD, Tbilisi
Peter Arkosy, MD, PhD|
Andrea Gonda, MD, PhD
|India||Sanjay Pisharodi, MD|
Swati Vasava, MD
Seema Mishra, MD, New Delhi
Vivekanand Shanbhag, MD, Mumbai
Ui Yamada, MD, PhD, Tokyo|
Shigeki Yamaguchi, MD, Mibu, Tochigi
|Mexico||Sergio Conti, MD, Tijuana|
Leticia Gonzalez, MSW, San Miguel Allende
Elizabeth Lopez Avalos de Paul, San Miguel de Allende
Eric Rosenberg, MD, Tijuana
|Norway||Sebastian von Hofacker, MD, Bergen|
|Singapore||Angel Lee, MD|
Wai Yong Tham, MBBS; MMed
Yew Seng Tan, MD
|Slovenia||Branka Cerv, RN|
Maja Seruga, MD
|Spain||Rocio Campos Mendez, Extremadura|
Lourdes Guanter, Barcelona, Spain
Xavier Gomez-Batiste, MD, PhD, Barcelona
Susana Sanchez Calderon, Psychologist, Badajoz
|Taiwan||Anna Hsu, MD|
Che Yang, RN, Taipei
|Tanzania||Frank Manase, MD, Dar Es Salem|
|United Arab Emirates||Terry Sparling, MD, Abu Dhabi|
|Ukraine||Leonid Stadnjuk, Kiev|
Still to be put in the table in the right place (I will get that information for you shortly) Catherine Nakibuule
- International Visiting Scholars Program: The International Visiting Scholars program is modeled after IPMSDH's program to train US Medical Residents in palliative care…read more…close
It enables physicians who received their medical training outside North America to receive classroom and bedside training in the core knowledge and skills of palliative care at San Diego Hospice. It also provides an overview of our comprehensive palliative care program that serves a large geographic region with a population of 3.2 million people.
- International Palliative Medicine Fellowship Program (IPMF): Specialist training for doctors who want to be palliative medicine experts and focus their career on palliative care…read more…close
The International Palliative Medicine Fellowship Program, with the assistance of the San Diego County Medical Society, provides expert-level bedside training at IPMSDH and in-country for physicians who want to be consultants/master teachers/opinion leaders in their country. Over a 2-3 year training period, each fellow makes 5-6 visits to IPMSDH for an average of four weeks per visit. Based on the U.S. Palliative Medicine Fellowship training standards, a customized learning plan is developed for each fellow.
In the future, new Fellowship Programs for members of interdisciplinary teams will make specialty training programs available to nurses, pharmacists, social workers, spiritual and bereavement counselors.
Fellowship Program Members
- Mohamed Hablas
- Lilian Hidalgo
- Agnes Calsina
- Paul Mmbando, MBChB - Tanzania
- Eddie Mwebesa
- Do Trong Thuy
- Khanh Thanh Quach
- Ioseb Abesadze (graduate)
- Tamari Rukhadze (graduate)
- Hassan Abbas (graduate)
- Mohammad Bushnaq (graduate)
- Mohammad Shtiat (graduate)
- Sewer Al-Salmany (graduate)
- Gantyua Tserendorj (graduate)
- Odontuya Davaasuren (graduate)
- Urska Lunder (graduate)
- International Leadership Development Initiative (LDI): Leadership training for palliative care physicians who have an opportunity to advance palliative care in their setting and have demonstrated a drive for building personal leadership skills…Read more about LDI and the doctors who are participating…
- Apply for Cohort 2 of the LDI: Applications are now being accepted…Read more…
- LDI Video: Leadership Development Initiative Participants
Leadership Development Initiative
Watch Leadership Development Initiative participants and mentors speak about their LDI experience:
Here's the link to view it directly on YouTube:
- International Scholars-in-Residence Program: Customized programs for educators and researchers who want to spend an extended time at IPMSDH engaged in skill building and academic pursuits…read more…close
The International Scholars-in-Residence Program provides opportunities for clinicians, educators and research to spend an extended period of time of up to one year at the Institute for Palliative Medicine at San Diego Hospice engaged in academic enrichment. Programs are customized to the educational goals of the scholar. For more details, please contact member of the International Programs Faculty.
Scholars-in-Residence to date have included:
- Staffan Landström, MD, PhD, Stockholms Sjukhem Foundation, Karolinska, Stockholm, Sweden
- Bruce Arnold, PhD, University of Calgary, Calgary, Canada
In collaboration with other international facilitators, IPMSDH faculty meet with clinical and governmental opinion leaders in each host country to discuss health policies, palliative medicine availability, opioid importation, distribution and prescribing practices, professional education needs, funding issues and other factors affecting the development of a comprehensive palliative care program. Findings from a comprehensive situational assessment, along with estimates of annual opioid need, are used to develop a multi-year strategy for increasing access to palliative care.
- Technical Assistance with Program Implementation: Customized technical assistance to help policy-makers, regulators and national champions in healthcare systems implement comprehensive palliative care programs in their countries…read more…close
The IPMSDH International Programs offer technical assistance to help national champions and healthcare systems implement comprehensive palliative care programs. IPMSDH faculty assist with the development and implementation of strategic and business plans; quality standards, clinical practice and treatment guidelines and performance improvement strategies to establish expectations for palliative care delivery and specific criteria for evaluating and improving performance; data collection systems to support evaluation of implementation processes, service quality and clinical outcomes; and communications/marketing strategies to increase media and public awareness of the need for, and benefits of, palliative care for the country.
- Collaborative Evaluation and Research to identify policy, education, program implementation and quality improvement interventions that consistently produce positive outcomes across populations and clinical settings…read more…close
One of the International Programs' major goals is to identify policy, education, program implementation and quality improvement interventions that consistently produce positive outcomes across populations and clinical settings. To build this evidence base, all interventions include a rigorous evaluation of the structure, process and impact of the education and program implementation activities, and the experience of the participants, the host organization and the patients and families who are the recipients of the care. Examples include evaluation of knowledge, attitudes, and perceived competence; improvements in palliative care infrastructure, comprehensiveness of patient care, patient-reported pain scores, and the country's reported level of opioid consumption relative to estimated need.
- Knowledge and Information Dissemination: Strategies to 'bring our international experiences home' and share them with colleagues locally, throughout the USA, and internationally…read more…close
In keeping with the vision of "bringing the experience back home," the IPMSDH International Programs share insights on the provision of culturally appropriate and integrated palliative care gained abroad with palliative care professionals locally and throughout the United States. Promising and proven approaches to educational interventions and palliative care program development, along with other palliative care resources, are publicized through a variety of communication channels, including publications, conference presentations and an IPMSDH web portal.
- Advocacy for Worldwide Palliative Care: Collaboration with governments, organizations and international foundations to promote pain management and palliative care as a fundamental human right and essential healthcare service.
- Frank D. Ferris, MD, FAAHPM, FAACE, Director, International Programs
- Shannon Moore, MD, Assistant Director, International Programs
- Holly Yang, MD, Assistant Director, International Palliative Medicine Fellowship Program
- Debra Pledger-Fonte, Program Coordinator, International Programs
- Linda Lloyd, PhD, MPH, Director, Center for Research
- Stephanie Whitmore, BA, Coordinator, Research
- Fraser Black, BSc, MD, CCFP, FCFP International Associate Faculty
- David Cameron, MB ChB, M Prax Med, M Phil (Palliative Medicine), FCFP(SA) International Associate Faculty
- Ron Cameron-Lewis, BA, AGSM International Associate Faculty
- Liliana De Lima, MHA International Associate Faculty
- Liz Gwyther, MD, MB ChB, FCFP, MSc International Associate Faculty
- Carl Johan Furst, MD, PhD International Associate Faculty
- Eric Krakauer, MD, PhD International Associate Faculty
- Staffan Landström, MD, PhD International Associate Faculty
- Daniela Mosoiu, MD, PhD International Associate Faculty
- Katherine Irene Pettus, PhD, International Associate Faculty
- Lukas Radbruch, Professor International Associate Faculty
- Mary Wheeler, MSN, RN, ACHPN International Associate Faculty
- American Academy of Hospice and Palliative Medicine
- American Society of Clinical Oncology (ASCO), International Education
- Centre for Palliative Care in Melbourne, Australia
- The Diana, Princess of Wales Memorial Fund
- Global Access to Pain Relief Initiative (GAPRI), the International Union Against Cancer (UICC)
- Institut Català d'Oncologia, Barcelona, Spain
- International Association for Hospice and Palliative Care
- International Network for Cancer and Treatment Research (INCTR)
- International Palliative Care Initiative, Public Health Networks, Open Society Foundations, New York
- International Renaissance Foundation, Kiev, Ukraine
- Middle East Cancer Consortium
- Office of International Affairs, National Cancer Institute, Bethesda, MD
- Open Society Georgia Foundation, Tbilisi, Georgia
- Pain Policy Studies Group and the U.S. Cancer Pain Relief Initiative, Madison, WI
- World Health Organization (WHO)
- and other national and international palliative care advocacy groups
For Further Information:The International Programs
The Institute for Palliative Medicine at San Diego Hospice
4311 Third Avenue
San Diego, California 92103-1407
+1 (619) 278-6225
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