Vol. 37 No.
3 March 2009 Schedule with Abstracts
Palliative Care Development in Africa at a
Glance
Faith Mwangi-Powell, PhD, African Palliative
Care Association, Kampala, Uganda
(Mwangi-Powell has disclosed no relevant finan-
cial relationships.)
Objectives
1. Gain understanding of the nature of palliative
care development across Africa.
2. Identify barriers and challenges that make pal-
liative care delivery across Africa difficult.
3. Discuss innovative experiences in palliative
care development.
Globally, approximately 56 million people die
each year. Moreover, 42 million currently live
with HIV/AIDS, and there are 15.3 million new
cancer cases per annum. An estimated 60% of
such people would benefit from palliative care.
However, scaling up palliative care services to
meet this need has numerous challenges that
have worldwide applicability, including limited
workforce capacity; lack of policy integration; un-
availability of effective pain-relieving medication;
lack of research evidence; low public awareness;
uncommitted governments; lack of funding; en-
trenched attitudes within the medical profession;
cultural taboos surrounding death and the dis-
closure of diagnosis; and absence of a consensus
that regards palliative care a basic human right. In
Africa, these challenges are compounded by the
high disease burden and poverty. These challenges
are compounded by the diverse operational cir-
cumstances in which palliative care development
takes place across Africa.
It is against this backdrop that my presentation
provides an overview of palliative care development
across Africa. Following a description of the existing
levels of palliative care need, it explores the different
service models that have been developed to address
that need. It will be shown that service provision,
whereby achievements and successes are replicated
and weaknesses identified, is essential to optimize
service delivery across the continent to those in
need.
Domains
Structure and Processes of Care; Cultural Aspects
of Care
Lisa’s Story: The Other Shoe
Tom Batiuk, Cartoonist, Medina, OH
(Batiuk has disclosed no relevant financial
485
relationships.)
Objectives
1. Give voice to the multidimensional experience
of cancer as portrayed in the comic strip, Lisa’s
Story: The Other Shoe.
2. Experience the unique insights afforded as
author and illustrator—and later, cancer
survivor—chronicles the struggle of cancer.
3. Describe the value of storytelling to communi-
cate and share a message.
Tom Batiuk, who pens the continuing story of
Funky Winkerbean and his pals in a comic strip
of the same name, was recognized as one of three
finalists in the cartooning category of the 2008
Pulitzer Prize awards competition for the series
of daily comic strips that chronicled the death
of long-time character Lisa Moore. Moore suc-
cumbed to breast cancer on October 4, 2007, after
a second bout with the disease.
In January 1999, Mr. Batiuk introduced the
initial Lisa story arc—a 6-month story line on
breast cancer, a subject never before broached
in the comics. The captivating story chronicled
the struggle faced by the strip’s main character
and those around her when she was diagnosed
with breast cancer—and in the end, beat it! The
comic-strip series garnered tremendous publicity
as well as praise from breast cancer organizations,
healthcare providers, educators, the cartooning
community, and, overwhelmingly, from readers all
across the country.
But on May 9, 2007, Lisa’s life was turned upside
down again as she found out that her cancer had
returned. The strip followed Lisa as she under-
went chemotherapy again; learned from doctors
that her prospects were not hopeful; decided to
stop chemo; wrestled with how to tell her young
daughter about her cancer situation; decided
to testify before Congress for more funding for
cancer research; and then how those around her
coped with her death.
“When I first started to weave reality-based
story lines into the Funky Winkerbean comic strip,
I realized that the format is capable of supporting
mature expression. My creative goal with the breast
cancer story was to look beyond the statistics or
specifics of treatment and show a more universal
experience among people who have cancer, as well
as their friends and loved ones,” said Mr. Batiuk.
“On a practical level, my continuing goal is to help
people understand the importance of regular
checkups. Early detection is critically important.
486 Schedule with Abstracts
I hoped that after reading the Funky Winkerbean
Lisa’s story arc, more people would be prompted
to get checked so that if cancer is discovered, it
is done early enough to make a difference.” As a
result of Batiuk’s commitment to helping people
facing their own real-life battles with cancer,
University Hospitals Ireland Cancer Center in
Cleveland has unveiled a fund called Lisa’s Legacy
Fund for Cancer Research and Education, named
in honor of Batiuk’s character and her subsequent
story which resonated with hundreds of thousands
of readers.
Batiuk has sent the Funky characters through
two time warps, first aging the high school char-
acters to their early twenties, then again sending
them into the future to their forties last fall. This
second time jump put the characters 10 years after
Lisa’s death.
Tom Batiuk’s Funky Winkerbean and Crankshaft
comic strips are carried in over 400 newspapers
throughout the United States. Lisa’s Story: The Oth-
er Shoe is a collection of the Funky Winkerbean strips
that dealt with his character, Lisa Moore, as she
battled with cancer. In 2006, Batiuk, who himself
has battled cancer, was honored by the American
Cancer Society and presented its Cancer Care Hall
of Fame Award for his sympathetic work in high-
lighting the experiences of those with cancer.
Domains
Psychological and Psychiatric Aspects of Care; So-
cial Aspects of Care
10:15–11:15 am
Concurrent Sessions
The 2009 National Consensus Project for
Quality Palliative Care (NCP) Guidelines
(400)
Constance Dahlin, APRN BC AHPCN, Massachu-
setts General Hospital Palliative Care Service,
Boston, MA
(Dahlin has disclosed no relevant financial rela-
tionships.)
Objectives
1. Review the background of the National Con-
sensus Project for Quality Palliative Care and
the clinical practice guidelines.
2. Review the 2009 revised version of the
Guidelines.
3. Discuss the future of palliative care and role of
Vol. 37 No.3 March 2009
the NCP Guidelines in ensuring the quality of
care.
This session explores the changes incorporated
into the second edition of the National Consen-
sus Project’s Clinical Practice Guidelines for Quality
Palliative Care as well as provides a more general
discussion of progress in palliative care practice
from the perspective of the NCP. In 2004, The
National Consensus Project for Quality Palliative
Care (NCP) released its Clinical Practice Guide-
lines, the first set of national clinical practice
care guidelines for palliative care in the United
States. The document, marked by its interdisci-
plinary approach, articulated eight domains es-
sential to quality palliative care. The Guidelines
saw wide distribution and adoption. In 2006,
the National Quality Forum (NQF) released its
Preferred Practices for palliative care, a document
based on the NCP’s Guidelines, which offered 38
preferred practices for ensuring the successful
administering of quality palliative care. In con-
junction with the AAHPM/HPNA 2009 meet-
ing, with renewed support from philanthropic
organizations such as the California Healthcare
Foundation, the Kornfeld Foundation, The May-
day Fund, and Milbank Foundation, as well as
from AAHPM, HPNA, and NHPCO, the NCP will
release an updated, expanded second edition of
the Guidelines. The session discusses the updated
review of evidence, the inclusion of didactic real-
world sample scenarios of guideline application,
and describes future implications in the evolving
field of palliative care.
Domain
Structure and Processes of Care
How Sweet It Is! Management of Diabetes at
End of Life (401)
Daniel Cogan, NP, Visiting Nurse Service of
New York Hospice Care, New York, NY; Margery
Kirsch, MS RN CDE, Visiting Nurse Service of
New York, New York, NY
(All speakers for this session have disclosed no
relevant financial relationships.)
Objectives
1. Discuss the epidemiology, pathophysiology,
and standard assessment and treatment guide-
lines for diabetes mellitus.
2. Describe “loose control” goals of care appropri-
ate for maximizing quality of life and minimiz-
ing diabetes-related symptoms in terminally ill