Anastasia Vishnevetsky, MDc
Nominated From: University of Washington
Research Site: Peru
Research Area: Health Systems; Neurology; Palliative Care
Primary Mentor: Dr. Claire Creutzfeldt
Palliative care practice and needs in Intensive Care Units (ICUs) in Lima, Peru: Epidemiology, provider attitudes, and patient needs
We aim to close an important gap in global health and palliative care by exploring the current state of palliative care training and practice as well as the attitude toward palliative care in neurological and general ICUs in Lima, Peru. This project will lay the groundwork for future implementation of a palliative care program at the Institute of Neurological Sciences in Lima and provide useful research for the broader initiative to start a national Peruvian palliative care program.Broadly, this project aims to characterize the current state of palliative care and end of life decisionmaking in Neurological Intensive Care Units (ICUs) and other ICUs in Peru and direct future palliative care interventions and quality improvement.
1. Characterize the patient population in the ICU of the Hospital de Neurosciencias Lima, Peru and the Unidad de Cuidados Críticos del Hospital Edgardo Rebagiati Martins.
2. Explore the current Palliative Care training, practice and understanding among Peruvian medical providers/physicians. We will approach this aim through (a) a survey that can be sent broadly to Peruvian critical care providers and (b) through one-on-one interviews with providers. The survey will ask providers to rate and quantify their exposure to core palliative care topics in their professional training and explore their attitudes and understanding of palliative care.
3. Characterize the attitudes towards palliative care and end of life care and identify the needs among the families of critically ill ICU patients in Lima.
Within the field of palliative care, neurologic patients pose a unique challenge due to the unpredictability of prognosis, and the fact that many neurologic patients are mentally incapacitated and may not be able to communicate their end-of-life care desires. Additionally, many neurologic conditions include gradual, unsteady, and unpredictable accumulation of deficits, so counseling and supporting patients through this emotional experience poses unique challenges as well. In the United States, the American Stroke Association recently issued a statement specifically focused on palliative care in the context of stroke, and this has been identified as an area for future research in previous studies in Peru as well: A study on functional outcomes in stroke suggested that little is known about end-of-life decision-making and the use of Do Not Resuscitate (DNR) or Withdraw of Life Support (WOLS) in Peru and how this might affect outcomes data. Peru contains 9.2 doctors per 10,000 people, but just one specialty palliative care service per 9,323,000 people, placing it at the lowest rate of provision of palliative care services in Latin America after Brazil. Since 2007, a law has prioritized palliative care services for oncologic patients, however little legislation or direction has been given regarding other patients with palliative care needs.