ECHO palliative care in Africa (ECHO-PACA): Improving access to quality palliative care.

Document Type

Conference Paper


Internal Medicine (East Africa)


Background: There is limited access to quality Palliative Care (PC) for advanced cancer patients being treated in Sub Saharan Africa due to limited PC knowledge among health care providers in the region. The goal of this innovative project was to improve access by offering cost-effective training to these providers using Project ECHO (Extension for Community Healthcare Outcomes), an established telementoring and support program.Our aim was to evaluate feasibility, attitudes, knowledge, and efficacy of participants of ECHO-PACA to deliver PC.

Methods: An interdisciplinary team at the UT MD Anderson Cancer Center, guided by PC providers in Sub Saharan Africa, developed a standardized curriculum based on PC needs in the region. Participants were then recruited and monthly telementoring sessions consisting of case presentations, discussions, and didactic lectures began in July 2016. Program participants included 14 clinics and teaching hospitals from Ghana, Kenya, Nigeria, South Africa, and Zambia, with sessions offering participants the ability to interact and learn new skills in PC. Participants were surveyed at the beginning, mid-point and end of the 16 month program to evaluate changes in self-perceived efficacy in pain assessment and management, Identification of signs/symptoms of imminent death, Identifying and addressing challenging communication issues related to end of life.

Results: Median participation per session was 30. Median duration of monthly meetings was 90 minutes. 33 of 40 initial participants (83%) completed the survey. There was significant improvement in appropriate use of non-opioid analgesics for persistent pain (p = .03), titrating opioids to optimize pain control (p = .03), Identification of signs/symptoms of imminent death (p = .05), and Identifying and addressing challenging communication issues related to end of life (p = .02).

Conclusions: ECHO-PACA was a feasible, cost effective, pragmatic approach to disseminate PC knowledge without the need for travel, which has the potential to increase access to quality PC through enhancing the skills of providers in resource challenged areas of Sub Saharan Africa. Further studies are needed to evaluate ECHO-PACA impact on patient outcomes.

Publication (Name of Journal)

ASCO Meeting Library