A Culturally Relevant Palliative Care Curriculum:

Developing human resources for health in the US Affiliated Pacific Islands

In the US Affiliated Pacific Islands (USAPI*) cancer is often diagnosed late and treatment options are few. Traditionally people care for loved ones at home but in modern times, loved ones are taken to the hospital for their final weeks and days of life as family caregivers feel they do not have the skills to care for loved at home. Additionally healthcare professionals have identified a need for palliative care training so they can manage the suffering of the patients and maintain quality of life whether in the hospital or at home.

Pallitative Care

Palliative Care is seen as care that relieves emotional, spiritual and physical suffering and should ideally begin at the time of diagnosis. It is carried out by a team and includes the patient as well as the patient’s support system of family and friends. Palliative care can be offered at the same time as curative treatments and strives to offer comfort, support and options to people so they can experience quality of life as long as they live.

The Palliative Care Curriculum:

To improve traditional practices, strengthen community programs and better educate the medical community, a culturally relevant self-instructional curriculum was developed by the USAPI Comprehensive Cancer Control Programs (CCCP) in collaboration with the Pacific Center of Excellence in the Elimination of Disparities (Pacific CEED). Kōkua Mau provided the expertise in palliative care and different palliative care experts authored the different modules.

Developing and Testing the Palliative Care Curriculum

A series of workshops took place in Honolulu, California, Commonwealth of the Northern Marianas (CNMI), and Republic of Palau with USAPI Cancer Coordinators, Cancer Coalition members, cancer survivors, policy makers, and community members leading to the development of a regional palliative care curriculum. The curriculum's core content was piloted in April 2009 during a 2.5 day course in Honolulu and further field-tested in the Republic of Palau in July 2009.

Content is based on the pilot courses, course evaluations and cultural knowledge, professional skills and teaching expertise of Kōkua Mau, Hawaii's Hospice and Palliative Care Organization and Department of Family Medicine & Community Health with each expert overseeing the development of 1-2 modules.

The curriculum was completed in May 2010 and was presented in a series of meetings beginning with a meeting of the CCCP coordinators in Honolulu in June and then in Yap and Palau in June, Majuro, Federated States of Micronesia (FSM) in July and Republic of the Marshall Islands (RMI) in August. Each jurisdiction was asked to identify who the best audience is for the course, who could teach the course and how it could best be used.

Description of the Curriculum:

This 8-module curriculum is specifically designed to teach USAPI healthcare practitioners the core concepts and skills of palliative and end-of-life care through a series of lectures that are supported by power point slides, exercise and case studies.

The modules can be used as stand-alone sessions or the entire curriculum can be taught with each successive module building on the previous ones and encouraging reflection on the development of a regionalized palliative care system. The curriculum is designed to be tailored to fit your culture and health care system. An Adaptation Guide accompanies the curriculum and exercises and role plays can help determine appropriate modifications and additions. Each module lasts 2 hours.

Topics covered:

Module 1: Introduction to Palliative Care
Module 2: Pain Management
Module 3 & 4: Symptom Management (Constipation, Incontinence, Dyspnea, Anorexia)
Module 5: Care at the End of Life (Active Dying)
Module 6: Essentials to Communication
Module 7: Spirituality
Module 8: Insights into Caregiver Issues

More about the 8-module curriculum

Adapting the Pallaitve Care Curriculum to the local needs is at the core

The palliative care curriculum is being taught and adapted in various jurisdictions.

A train the trainer model has been employed to build the capacity of local providers. Trainers from Honolulu have worked with local clinicians so they will be able to not only teach the curriculum but integrate the information into their practice.

Week long, intensive trainings have been held in FSM and Guam. Palau will be offering it in their College of Health. American Samoa, CNMI and Marshall Islands are all discussing possible ways to use and teach the curriculum and will hopefully offer training in the coming years.

Pacific CEED and Kōkua Mau are very interested in working with other organizations, individuals or researchers on our Palliative Care Curriculum for the Pacific. The curriculum has to be taught tailor -made in each community and we will gladly discuss it with you in more detail. For further information, contact Jeannette Koijane

* 10 US Affiliated Pacific Island Jurisdictions: Territories of American Samoa and Guam; Commonwealth of the Northern Marianas Islands, Republic of Palau (Belau); Federated States of Micronesia (Yap, Chuuk, Pohnpei, Kosrae); Republic of the Marshall Islands

The area covered is far greater in size that the Continental United States. There are less than 500,000 people living in the USAPI on many small islands separated by long distances and some accessible only boat. At least 10 different languages are spoken.