1. Al-Sadeel Society Palliative Care for Cancer Patients مؤسسة السّديل للعناية التلطيفية بمرضى السرطان

2. Challenges & Obstaclesfacing the oncology nurse in his/her attempts to manage painin Palestinian Authority Amal Dweib Khleif BSN, Palliative Care Nurse

3. 8,106 new cancer cases (2000-2005) in the west bank. 3,471 deaths. ↓ high mortality rate among cancer patients in Palestine. Pediatric cases (0-14 yrs): 519 cases (2000-2005) Palestinian cancer registry, 2005 Background

4. most cases diagnosed at the end stage (5,550 cases) representing 68% Means     terminally ill and at their end of life patients are not early detected no more in need for curative care indeed in need for palliative care to live comfortably and free of pain. Palestinian cancer registry, 2005 Background

5. AL-Sadeel Society Symptoms Assessment at Beit Jala Governmental Hospital- Bethlehem

6. 73% of patients have moderate to severe pain

8. Challenges & ObstaclesFacing the Oncology Nurse In Managing PainIn Palestinian Authority

9. The Nurse spends more time with the patient than any other health professional and is thus in an ideal position to constantly assess and evaluate the effectiveness of their pain treatments (McCaffrey and Beebe, 1994)

10. Nurses play a very active role in ensuring good pain control in patients suffering from unrelieved pain (Human Rights Watch, March 2009)

11. Through direct observations and interviews with nurses working in the field of oncology Oncology Nurses at the Palestinian Authority face many challenges and obstacles in their practicing of pain management for the cancer patient

13. Challenges are classified under Three main categories: Rules and regulations. Nurses related practices. Patients and their families beliefs.

14. Current Rules and Regulations Current rules and regulations in the PA regarding opioid use and consumption are complicated and consist of long routine process. Special forms for prescribing opioids with duplication of forms and the need for many signatures and approvals from the doctor and the administration are in use.

15. Amount of medication prescribed for the patient are restricted and not to exceed 30 tablets of MCR and 5 ampules of morphine. MIR is not available. No national policy for palliative care and pain management available at the current in the PA. Current Rules and Regulationscontinue…

16. Pain treatment and palliative care are not priorities for the government. Complex procurement and prescription regulations and the threat of harsh punishment for miss-handling morphine discourage pharmacies and hospitals from stocking and healthcare workers from prescribing it. Current Rules and Regulationscontinue…

17. Nurses Related Practices Nurses' role is limited to administering the ordered medications for the patient High work load, the limited time available for assessment of patient needs and pain Lack of training and education in pain management and palliative care

19. Nurses Related Practicescontinue… Nurses' attitude toward patient's perception of pain and the misbelief of the patient’s complaint of pain. Pain management is not in the priority of the nurse schedule. Pain is not taken as a fifth vital sign.

20. Nurses Related Practicescontinue… Accessibility to controlled drugs is restricted and complicated. Myths and misbeliefs of nurses regarding side effects of opioids.

22. Patients and their Families Beliefs Bearing pain is part of the human well being Consider morphine consumption as a social stigma. Fear from addiction. Combine the use of morphine with the end of life and death.

23. Beliefs that pain will go with the eradication of the disease. Patients and families usually look forward towards cure. Lack of trust between staff, patient and family. Patients and their Families Believes continue…

24. Conclusion Misinformation about oral morphine remains extremely common among healthcare workers. Knowledge about how to assess and treat pain is often absent or deeply inadequate. The combination of ignorance among healthcare workers with myths about opioids results in failure to treat patients, who are suffering from severe pain with opioid analgesics. (Human Rights Watch, March 2009)

25. Future Plans and Recommendations Public awareness about palliative care and quality of life. Demand decision makers to establish “palliative care policy”. Continuous Education and Training for all health professionals about palliative care and pain management. Conduct researches and studies concerning cancer patients and their families in Palestine.

26. Psychosocial and emotional support for the patient and the family using support groups and survivor volunteers. Cooperation with local and international organizations in the field of cancer and palliative care. Developing projects related to Palliative care services.

27. Thank You X-MASS 2009