Critical Analytical Insights of Palliative Care Process Modelling in a Regional Cancer Care

Palliative care services are rapidly evolving in cancer care organisations. In palliative care processes, administratives are involved without acknowledging that they may hinder rather than facilitate the path of palliative care in respect to cancer patients. Comprehending a palliative care organisation, without looking at current running processes is groundless. Therefore, a critical understanding of palliative care processes is necessary for improving respective cancer care systems. In this research palliative care Business Process Models (BPMs) have been developed to empower palliative care domain experts not only attaining a critical understanding of the currently running palliative care operations, but also in informing further required improvements with associated implications on cancer patients. Amongst the key outcomes of developing and analysing palliative BPMs in a cancer care organisation revealed identifying gaps, limitations, challenges, and opportunities to reflectively improve palliative care processes in cancer care centres. Finally, this research suggests further re-engineering of palliative care processes as reference models that may be instantiated in specific socio-cultural, person-centered, and other contextual settings aimed at improved qualitative palliative care for cancer patients

Stress, resilience, and moral distress among health care providers in oncology during the COVID-19 pandemic

BackgroundThe coronavirus pandemic has potential implications for stress levels and resilience among oncology healthcare professionals (HCPs). This study aims to assess perceived stress, resilience, and moral distress levels among oncology HCPs in Jordan during the pandemic and identify associated risk factors.MethodsAn online cross-sectional survey was conducted among oncology HCPs in Jordan using three validated tools: Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RSIC), and Moral Distress Thermometer (MDT). Seven items were used to assess sources of stress.ResultsA total of 965 participants enrolled with a 74% response rate. The participants’ ages ranged from 20 to 74 (mean = 32.74, SD = 5.197), with 79.1% males, 45.1% were physicians, 32.6% were public hospital workers, 57.1% were married, and 56.6% had children below 18 years. Findings indicated moderate perceived stress (Mean = 15.87, SD = 5.861), low resilience (Mean = 29.18, SD = 5.197), and high moral distress (Mean = 4.72, SD = 2.564). Females, unmarried individuals, and younger age groups exhibited higher PSS (p = 0.009, p < 0.001, and P<0.001) and lower resilience (p = 0.024, p = 0.034, and p = 0.001). Not having children below 18 years correlated with higher perceived stress (P < 0.001). In linear regression analysis, age and gender emerged as significant predictors of both perceived stress and resilience. Female participants reported stress related to the risk of contracting COVID-19 (p = 0.001), transmitting it to others (p = 0.017), social isolation (P < 0.001), and having children at home due to school closures (p = 0.000). A cohort of 239 participants repeated the survey within a two-month interval, revealed a statistically significant decrease in the CD-RISC scores (p < 0.001).ConclusionOncology HCPs in Jordan experienced moderate stress, high moral distress, and poor resilience during the COVID-19 pandemic. These factors may negatively affect the quality of oncology care. Urgent measures are necessary to support HCPs in coping with unforeseen circumstances in the future

Critical Analysis of Palliative Homecare Using the i∗ Framework\u27s Strategic and Social Requirements Modelling Applied to a Cancer Care Organisation

Home Health Care (HHC) is an essential and critical part of palliative care and especially for terminal cancer patients. This research is aimed as a first attempt to align with the research gap in modelling the social requirements of palliative care processes and the HHC process in particular. Consequently, this research is a first attempt at developing an $\mathbf{i}^{\ast}$ framework visual goal-oriented and social requirements models of the HHC process of the domain of palliative care with a reflected application using a case study from a leading regional cancer centre in the Middle East, namely KHCC. Furthermore, this research has made it possible for palliative care domain experts in the HHC process and using the associated $\mathbf{i}^{\ast}$ framework strategic dependency and strategic rationale models to visually trace the most critical and strategic actors in the HHC process along with the highly interacting dependers and dependees. Finally, the HHC $\mathbf{i}^{\ast}$ strategic models contribute to bridging the gap between the world of palliative care requirements and their reflective computer-based information systems and $\mathbf{IoT}$ smart devices. Hence, this sheds light towards the realisation of the field of palliative care as being a “systems of systems” virtual organisation with the respective socio-technical systems involvement, for the best care of the palliative patient and especially terminal cancer patients. A further corollary of this research is the insufficiency and less representativeness of palliative care process models to utilise in guiding the development of the HHC $\mathbf{i}^{\ast}$ framework strategic models without linking to the full associated strategic and policy documents of palliative care

Providing person-centered palliative care in conflict-affected populations in the Middle East: What matters to patients with advanced cancer and families including refugees?

IntroductionUniversal health coverage highlights palliative care as an essential component of health services. However, it is unclear what constitutes person-centered care in populations affected by conflict, as they may have specific concerns in the dimensions of physical, emotional, social, and spiritual wellbeing. This study aimed to identify what matters to patients with advanced cancer and family caregivers in Jordan including refugees, to inform appropriate person-centered assessment and palliative care in conflict-affected populations.MethodsCross-sectional face-to-face, semi-structured interviews were conducted at two sites in Amman. Adult patients with advanced cancer and family caregivers were purposively sampled to maximize diversity and representation. Interviews were digitally audio recorded, anonymized, and transcribed verbatim for thematic analysis.FindingsFour themes were generated from 50 patients (22 refugees; 28 Jordanians) and 20 caregivers (7 refugees; 13 Jordanians) (1). Information, communication, and decision-making. Truth-telling and full disclosure from clinicians was valued, and participants expressed concerns that information was not shared in case patients would disengage with treatment. (2) Priorities and concerns for care and support. Participants’ top priority remained cure and recovery (which was viewed as possible). Other priorities included returning to their “normal” life and their “own” country, and to continue contributing to their family. (3) Role of spirituality and Islam. Most participants had strong faith in God and felt that having faith could comfort them. For refugees whose social network was fractured due to being away from home country, prayer and Quran reading became particularly important. (4) Unmet support needs of family caregivers. Family caregivers were affected physically and emotionally by worrying about and caring for the patients. They needed support and training, but often could not access this.DiscussionTruth-telling is highly valued and essential to achieving person-centered care and informed decision-making. This study also reveals specific concerns in conflict-affected populations, reflecting the experience of prior losses and fracturing of existing social networks and support. The role of religion is crucial in supporting refugee communities, and consideration should be paid to the needs of patients and caregivers when caring for a patient at home without access to their communities of origin and the support they accessed

Liquidity Risk Exposure in Islamic and Conventional Banks

This research aims to identify the factors influencing the ability of Islamic Banks (IB) and Conventional Banks (CB) to manage liquidity risk; determine the effects of the global financial crisis on Islamic and conventional banks, and propose some mechanisms to improve resilience against liquidity risk. Univariate and panel regression analyses were used. This was made by highlighting the factors affecting Liquidity Risk Exposure (LRE) in relation to a cross-country sample that utilises both accounting and economic data. 204 banks were investigated in the Middle East and North Africa (MENA) region, as well as South-Eastern Asian (SEA) countries during 2005-2012. Results revealed that IB recorded the highest average Liquidity Risk (LR) exposure compared to CB. There are significant differences between IB and CB banks in terms of LR factors. It is found that 92% of LR exposures are instigated by financial crises, banks' gearing, gross domestic product (GDP), off-balance sheet items, total securities held by the banks, non-earning assets divided by total assets for banks and liquid assets in CB. Keywords: Liquidity Risk, Islamic banks, Risk management. JEL Classification: G3

The Profile of Non-Communicable Disease (NCD) research in the Middle East and North Africa (MENA) region: Analyzing the NCD burden, research outputs and international research collaboration.

OBJECTIVES: Despite the rising risk factor exposure and non-communicable disease (NCD) mortality across the Middle East and the North African (MENA) region, public health policy responses have been slow and appear discordant with the social, economic and political circumstances in each country. Good health policy and outcomes are intimately linked to a research-active culture, particularly in NCD. In this study we present the results of a comprehensive analysis of NCD research with particular a focus on cancer, diabetes and cardiovascular disease in 10 key countries that represent a spectrum across MENA between 1991 and 2018. METHODS: The study uses a well validated bibliometric approach to undertake a quantitative analysis of research output in the ten leading countries in biomedical research in the MENA region on the basis of articles and reviews in the Web of Science database. We used filters for each of the three NCDs and biomedical research to identify relevant papers in the WoS. The countries selected for the analyses were based on the volume of research outputs during the period of analysis and stability, included Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Turkey and the United Arab Emirates. RESULTS: A total of 495,108 biomedical papers were found in 12,341 journals for the ten MENA countries (here we consider Turkey in the context of MENA). For all three NCDs, Turkey's output is consistently the highest. Iran has had considerable growth in research output to occupy second place across all three NCDs. It appears that, relative to their wealth (measured by GDP), some MENA countries, particularly Oman, Qatar, Kuwait and the United Arab Emirates, are substantially under-investing in biomedical research. In terms of investment on particular NCDs, we note the relatively greater commitment on cancer research compared with diabetes or cardiovascular disease in most MENA countries, despite cardiovascular disease causing the greatest health-related burden. When considering the citation impact of research outputs, there have been marked rises in citation scores in Qatar, Lebanon, United Arab Emirates and Oman. However, Turkey, which has the largest biomedical research output in the Middle East has the lowest citation scores overall. The level of intra-regional collaboration in NCD research is highly variable. Saudi Arabia and Egypt are the dominant research collaborators across the MENA region. However, Turkey and Iran, which are amongst the leading research-active countries in the area, show little evidence of collaboration. With respect to international collaboration, the United States and United Kingdom are the dominant research partners across the region followed by Germany and France. CONCLUSION: The increase in research activity in NCDs across the MENA region countries during the time period of analysis may signal both an increasing focus on NCDs which reflects general global trends, and greater investment in research in some countries. However, there are several risks to the sustainability of these improvements that have been identified in particular countries within the region. For example, a lack of suitably trained researchers, low political commitment and poor financial support, and minimal international collaboration which is essential for wider global impact

Linking Palliative Homecare to the Universal Health Coverage Principles and the United Nations Sustainability Development Goals Using the i* Framework’s Strategic and Social Requirements Modelling, Applied to a Cancer Care Organisation

Adherence to the Universal Health Coverage (UHC) principles in relation to palliative care is a key WHO directive to attain as a right for every citizen. However, UHC principles have been observed to be hindered by several barriers. Moreover, the UNSDGs, and in particular the UNSDG 3, demands “Good Health and Well Being” with the two key indicators UNSDG 3.8.1 and 3.8.2 that can be considered as metrics to assess governance conformance to palliative care. This paper reports on addressing the current research gap in linking the UHC principles to UNSDGs and, in particular, UNSDG3 and the WHO identified Palliative Care Barriers (PCB) using the i* framework Strategic Dependency (SD) and Strategic Rationale (SR) models applied to Home Healthcare Care (HHC) of a regional cancer care organisation, namely King Hussain Cancer Center (KHCC). Building on our i* HHC SD and SR developed models, and for HHC being an essential and critical part of palliative care, an integrated framework has been developed that not only links UHC principles and WHO barriers of palliative care to UNSDG 3, but a full network of dependencies that facilitates observing the linkages and impact of the most critical and strategic actors in HHC on the UHC, barriers to palliative care and UNSDG 3. Furthermore, such highly comprehensive UHC-PCB-UNSDG-i* framework network instantiations have led to identifying patterns of categories or groups of associations between UNSDG3 KPIs, UHC principles, WHO PCB and HHC actors. Hence, this contributes to healthcare policy and decision makers to revisit their policies, plans, budgets, and constraints for the deficiencies in the qualitative satisfaction of the UHC principles and how PCB can be alleviated in association with the actors in the i* SD and SR models and associated goals, tasks and resources. A further corollary of this research is that change impact analysis can be timely attained to study the impact of a change driven by updating goals, tasks, and resources of the i* model to improve adherence to the UNSDG3 KPIS and UHC principles. Finally, this work has inspired work in progress to develop a data analytics platform from the evolving instances of applying palliative care processes using the resultant UHC-PCB-UNSDG-i* framework

Concerns and priority outcomes for children with advanced cancer and their families in the Middle East: A cross-national qualitative study

IntroductionPalliative care access is limited in the Middle-East, with few specialist centers and forcibly displaced migrants facing additional struggles to access care. Little is known about the specificities of providing palliative care to children and young people (CYP) with cancer. They are rarely asked directly their concerns and needs, which limits the provision of quality patient-centered care. Our study aims to identify the concerns and needs of CYP with advanced cancer and their families, in Jordan and Turkey.MethodA qualitative cross-national study in Jordan and Turkey with framework analysis was conducted two pediatric cancer centers in Jordan and Turkey. In each country, 25 CYP, 15 caregivers and 12 healthcare professionals participated (N=104). Most caregivers (70%) and healthcare professionals (75%) were women.ResultsWe identified five areas of concern: (1) Physical pain and other symptoms (e.g. mobility, fatigue); (2) Psychological concerns and needs (e.g. anger, psychological changes); (3) Spirituality, uncertainty over the future and use of “Tawakkul” (e.g. use of religion as a coping mechanism); (4) Negative impact on social life (e.g. social isolation, loss of support); (5) Burden on caregiver and their families (e.g. financial issues, siblings left behind). Psychological concerns were a priority for both CYPs and caregivers (particularly for refugee and displaced families) but often overlooked during routine care. CYP were able to share their own concerns and care priorities.ConclusionsAdvanced cancer care must ensure assessment and management of concerns across the concerns identified. Developing child- and family-centered outcomes would ensure monitoring the quality of care. Spirituality had a more important role compared to similar investigation in other regions