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Project of Levan Bakanidze
Work Out of Diseases Management Standards for Symptoms Relief in Terminal Illness and beginning of their implementation
Project Description
Problem Statement: According to World Health Organization (WHO, 2000) data, 10,000,000 cases of cancer incidence and 6,000,000 -of mortality is registered per year in the world. By the year 2020, 20,000,000 persons will get the cancer and 10,000,000 will die because of this disease. Due to this, problem of cancer, finally will pass the borders of health care and acquire the significance of world's global social importance. This is the reason, that at the present time cancer control activity already represents the prioritize direction of social and medical fields.
According to American Cancer Society (ACS, 2000), the cancer problem include the political, health care, social defense, economic, ecological and physiological issues.
The annual amount of cancer cases in Georgia exceeds 30,000 and additionally more than 7,000 new cases of cancer incidence and 5,500 cases of cancer mortality are registered annually. These figures have the tendency for increase. Unfortunately, the most of the cancer cases in Georgia are coming to advanced stages, when the radical treatment methods have the limited capabilities. Besides, even in case of conduction of special cancer treatment, 30%-50% of patients with main site tumors after some time has to deal with disease recurrence, when only symptomatically treatment could be considered. This contingent of patients need special attention in terms of adequate relief of symptoms, concerned with their disease, considering the medical, personal and psychological issues.
It is estimated that the most common form of terminal disease in Georgia, resulting the death, is cancer, causing the suffering first of all to patient and also patient's family members. That's way the alleviation and some times the eradication of symptoms and secondary diseases related to cancer is very essential for both of them. Especially essential are problems concerned with pain (more than 60 countries have at the present time the national policy on pain relief in terminally ill patients, but such a policy doesn't exists in Georgia like the most developing countries) and other symptoms making great discomfort and suffering and influencing the quality of life of patient, the main reason of which is the fact that they didn't receive the effective symptomatic treatment. The adequate management of these symptoms needs knowledge and understanding of reasons causing them. These symptoms may be caused by main disease itself directly (bowel obstruction by tumour) or indirectly (decubital ulcers due to wasting process), conducted treatment (side effects of anti-cancer therapy) and co-existing diseases.
Despite the some data, concerning the management of terminally ill patients, it could be say, that the adequate guidelines (recommendations, manuals, brochures, books) about this problem are not available in Georgia and cancer service staff is without the good methodology and educational background. That is the reason, that work out of disease management standards in terminal illness is the top priority for cancer service. For realization of mentioned task, the international experience should be considered, particularly: in 1998 WHO has edited the book: "Symptoms relief in terminal illness", which has became internationally accepted, been translated on 60 languages. This book was based on WHO Expert's Committee Report - "Pain relief and symptomatic treatment of cancer patients" (WHO, Geneva, 1990, No 804), aimed the work out of recommendations on management of other symptoms than pain. Doctors and nurses could use these recommendations not only for cancer patients, but regarding to AIDS and other chronic debilitating illnesses.
Considering above-mentioned, the translation of this book on Georgian and gathering of other related information is very important in terms of creation of diseases management standards in terminal illness, but it also should be taken in to account that after the translation, materials should be adopted to Georgian conditions, considering the national features, useable terms and facilities, available medications, cancer service infrastructure and etc. Besides, bearing in mind the fact that most of the terminally ill patients are staying at their houses (no hospices exist in Georgia) at the end of their lives and their family members have to take care of them, the information in this book should be easily understandable for population. Also this book containing the standards could be used by hospices as a guideline in future.
National Cancer Center (NCC) represents the head oncological organization in country, where the vast majority of cancer patients are coming for management and besides it's out-patient doctors are visiting at house terminally ill patients. So, it is preferable to aprobate this standards here, with future dissemination of gained experience in other health service facilities, presenting them to officials from Health Care Ministry.
Project Aim:
The project aim is the work out of disease management standards in terminal illness and beginning of their implementation in health care service.
Project Goals:
1. Gathering from Internet information concerning the symptoms relief in terminal illness (other than above-mentioned WHO book);
2. Translating of gathered materials;
3. Conduction of work with leader national specialists (consultants) for adopting the gathered materials to Georgian conditions;
4. Work out of disease management standards in terminal illness;
5. Edition of standards- "Symptoms relief and care of terminally ill patients" (500 samples), which will represent the disease management standards in terminal illness ;
6. Presentation standards to NCC, regional Cancer Centers and other health care service staff and it's distribution;
7. Conduction of periodical meetings with health care professionals concerning the implementation of management standards (sharing of experience);
8. Periodical evaluation of received results on grant project board composed of project participants, and volunteer NACC and NCC leader members;
9. Placement of standards and other project related materials on NACC Web Site;
10. Presentation of book and gained experience to Health Care Ministry officials.
Project Timeline:
Project beginning: 01.07.01.
Project end: 01.12.01.
The project will be realized according to following time-line:
# |
Goal |
mon, yer |
| 1 |
Gathering from Internet information concerning the symptoms relief in terminal illness | 07, 2001 |
| 2 | Translating of gathered materials | 07-08, 2001 |
| 3 | Conduction of work with leader national specialists (consultants) for adopting the gathered materials to Georgian conditions and work out of disease management standards in terminal illness | 08, 2001 |
| 4 | Edition of standards- "Symptoms relief and care of terminally ill patients" (500 samples) | 09, 2001 |
| 5 | Presentation of standards to NCC and other health care service staff and it's distribution; Instruction of medical staff (in- and out-patient doctors, nurses) on use of standards | 10, 2001 |
| 6 | Conduction of periodical meetings with health care professionals concerning the implementation of management standards | 10-11, 2001 |
| 7 | Periodical evaluation of received results in grant project board | 10-12, 2001 |
| 8 | Placement of standards and other project related materials on NACC Web Site | 11, 2001 |
| 9 | Presentation of book and gained experience to Health Care Ministry officials | 12, 2001 |
Expected results of project realization:
1. Diseases Management standards for symptoms relief in terminal illness in Georgia will be worked out, considering the international experience and local characteristics;
2. This standards will be implemented in NCC and regional cancer centers, raising of awareness of medical staff on terminally ill patients right care and management;
3. Presentation of project received results to Health Care Ministry officials will promote the acceptance of created standards in rank of state policy, implementing the terminal illness symptoms management standards in whole country health care service;
4. Placing of standard recommendations on NACC Web site, also instruction of medical staff generally having contact with families of a such patients on above mentioned issues and distribution of edited book will improve the condition of patients in terminal illness;
5. The first manual on care and right management of terminal illness symptoms - "Symptoms relief and care of terminally ill patients" (500 samples) will be available on Georgian language (relief and management of 14 symptoms and their accompanying signs by medical and non-medical means), which will be useful not only for health professionals, but also for population;
6. Because of the common symptoms the book also could be used for management of other chronic debilitating diseases.
Project future development:
1. Implementation of standards and open discussions with health professionals will promote the further scientific and clinical development of terminal illness patients management ;
2. Publication and popularization of standards will be good methodological background for creation of hospice services in Georgia in future;
Evaluation of project efficiency:
Project efficiency will be evaluated due to:
1. Periodical meetings with health care specialists and received results will be periodically discused on grant project board composed of project participants, and volunteer NACC and NCC leader members;
2. Arising interest of Health Care Ministry officials, followed by acceptance of standards on national level,
3. Improvement of quality of life of terminally ill patients.
Project budget:
# |
Budget item |
NCC (US$) |
OSGF (US$) |
Total (US$) |
| I Salaries of project participants
|
| 1 |
Project director (110 US $ per month for 6 month) | - | 660 | 660 |
| 2 | Project coordinator (100 US $ per month for 6 month) | - | 600 | 600 |
| 3 | Accouter (25 US $ per month for 6 month) | - | 150 | 150 |
| * | Total of Item I | - | 1410 | 1410 |
| II Honorariums of project participants
|
| 1 | Consultants (2 persons) | - | 420 | 420 |
| 2 | Translators (2 person) | - | 300 | 300 |
| 3 | Computer operator | - | 110 | 110 |
| 4 | Web master | - | 100 | 100 |
| * | Total of Item II | - | 930 | 930 |
| III Editorial expenses
|
| 1 | Edition of book- "Symptoms relief and care of terminally ill patients" (1500 samples) | - | 2000 | 2000 |
| 2 | NCC technical cost-sharing: Expenses for presentation of book to NCC and other health care service staff and it's distribution; Instruction of medical staff (in- and out-patient doctors, nurses) on distribution of book in cancer patients family members; Conduction of periodical meetings with health care professionals concerning the implementation of management standards (sharing of experience); Presentation of book and gained experience to Health Care Ministry officials | Technical assistance | - | - |
| * | Total of Item III | Technical assistance | 2000 | 2000 | | IV Administrative expenses | | 1 | Transportations, Ofice supplies | - | 200 | 200
| | 2 | Postal expenses | - | 100 | 100 | | 3 | Unexpected expenses | - | 100 | 100 | | * | Total of Item IV | - | 400 | 400 |
| Total of all Items
|
| 1 | All Items | - | 4740 | 4740 |
| 2 | Bank service % | - | 45 | 45 |
| * | TOTAL | - | 4785 |
4785 |
Additional Information
Requested by OSGF on NACC project:
"Work Out of Disease Management Standards for Symptoms Relief in Terminal Illness and Beginning of Their Implementation" in
Public Health Grant Program Competition
According to OSGF grant projects evaluation commission recommendations; the following changes were made to presented project budget in order of its harmonization (see below):
1. In case of funding, the project related book- "Symptoms relief and care of terminally ill patients", which will contain the created Management Standards, would be edited by 1 500 samples instead of previously supposed 500;
2. Consequently, the salaries and honorariums of project participants are significantly decreased, particularly from 3640 US $ to 2 340 US $.
Budget Narrative
The total project budget requested from OSGF is still 4785 $ US for 6 month of project duration. NCC will ensure the technical assistance in: presentation of book to NCC and other health care service staff and it's distribution to regional cancer centers; Instruction of medical staff (in- and out-patient doctors, nurses) on distribution of book in cancer patients family members; Conduction of periodical meetings with health care professionals concerning the implementation of management standards (sharing of experience); Presentation of book and gained experience to Health Care Ministry officials. NCC and NACC leader member's participation in grant project evaluation board will be provided on volunteer basis.
The general idea of project is concerned with conduction of analytical activities and that is the reason, that the salaries and honorariums are the main condition for project effective realization. Requested salaries are proposed for project director, coordinator and accouter, who will be working on project realization permanently and intensively. Honorariums are designed for other project participants, who will be engaged in project time to time or just for selected period. Editorial expenses (2 000 US $) are minimal considering that the price of 1 book on standards will be 1,3 US $ (1 500 samples). The amount of samples is calculated considering the amount of those doctors in NCC, regional cancer centers and country outpatient clinics who are dealing with problems of terminal illness, also other non- cancer clinics staff having the experience with terminal patients (Intensive care, neurological, and etc). The books will be sent to the targeted clinics by mail. Their conclusions and suggestions will be considered during the progress of project realization, due to conduction of regular meetings and also discussions on project board. Besides, the special place would be available on NACC Web for conduction of consultations and discussions with health professionals (the special note will be linked with NACC e-mail).
Project also considers the NACC administrative expenses, which are very small in amount of 400 US $ and are desired for transportations, Xerox, cartridge, paper and other possible office supplies - 200 US $, postal expenses - 100 US $, unexpected expenses - 100 US $.
Project participants and their responsibilities
Project director - Prof. Revaz Vepkhvadze - will be the main decision maker during the project realization. He will be heading the project board, which would be gathered once in a month during the first three months and twice in a month during the rest of three months. Besides, he will be heading the periodical meetings with health professionals. Project director will work in close cooperation with project consultants on every issue of each 14 symptoms management standards. As it was mentioned in presented project National Cancer Center (NCC) represents the head oncological organization in country, where the vast majority of cancer patients are coming for management and besides it's out-patient doctors are visiting at house terminally ill patients. So, it is preferable to aprobate this standards here. Besides, fully acknowledging the significance of OSGF funding, the NCC cost sharing (see Budget Narrative) is also very essential. That is the reason that project author considered Prof. Vepkhvadze, who is the NCC president at the present time and NACC Honorary member as the best candidate for project director.
Project coordinator - Dr. Levan Bakanidze - according to project director's considerations will organize every event and measure of project. He will control the execution of each project participant responsibilities and linkages between them, gather all prepared project related materials and present them to the board, define and organize the meetings of board, health professionals, project consultants, inform the Health Care Ministry on project progression, send the edited book to targeted health clinics by mail and control their response via the personnel meetings, letter correspondence or e-mail. Project coordinator will have an active participation in management standards creation and would be the main contacting person with OSGF.
Accouter - Maia Tskvitoria.
Project consultants - Prof. Revaz Gagua and Dr. Vasil Tkeshelashvili - Being the very competent on project related issues, they will take their active participation in: determining what sources should be used for gathering the necessary materials, adopting the gathered materials to Georgian conditions with project director; final working out of management standards. They will be the board members and besides attend all the meetings related to project to consider the remarks and suggestions from health professionals.
Translators - Maia Jashiashvili and Irina Gagua - have the one of the important mission in project for bringing the international experience for project director, coordinator and consultants on Georgian language.
Computer operator - Manana Gogichaishvili - will create the software data on all project related materials and prepare the book in Page Maker system for publishing.
Web Master - Constantine Stalinsky - just recently finished the work on NACC Site creation he has already put the note on Web about the this NACC project and also the entire project. In case of funding he will be responsible to place the book and other related materials in future on NACC Web Information section, also will put the notes after each meetings conducted in the borders of project.
Placement of disease management standards of terminal illness and other related materials on Internet will be possible by NACC grant received from U.S. Department of State, Educational and Cultural Affairs due to which NACC Web Site is created.
Project Author: Levan Bakanidze
15.02.01.
Gudget modified in 26.05.01
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