Daniel Munday

Daniel Munday
The University of Edinburgh | UoE · Usher Institute

MBBS FFARCSI DRCOG MRCGP DipPallMed PhD FRCP PGCertMedEd FHEA DTM&H
Developing primary palliative care as part of integrated chronic disease management in rural Nepal.

About

78
Publications
24,256
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Introduction
With a background in anaesthesia, general practice and palliative medicine I worked as Associate Clinical Professor in Palliative Medicine at Warwick Medical school from 2008 to 2013. Since 2013 I have worked in research and development of palliative care and primary care in Nepal and India. I am currently working in a rural district in Nepal developing and evaluating a model of primary palliative care which can be implemented as part of integrated chronic disease management in remote areas.
Additional affiliations
July 2014 - May 2019
The University of Edinburgh
Position
  • Lecturer

Publications

Publications (78)
Article
Full-text available
Introduction Quality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain....
Article
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Background One way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural co...
Article
Objectives Faith-based organisations (FBOs) in India provide health services particularly to marginalised communities. We studied their preparedness and delivery of palliative care during COVID-19 as part of a mixed-method study. We present the results of an online questionnaire. Methods All FBOs providing palliative care in India were invited to...
Article
Aims With noncommunicable diseases rising in prevalence, Nepal has a significant need for palliative care, but little research has been conducted to evaluate this in depth. This study aimed to generate a quantified estimate of the projected need for palliative care in Nepal. Subjects and Methods The World Health Organization mortality rates were m...
Article
Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030—Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) inc...
Article
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Context Palliative care has not developed widely in rural North India. Since 2010, the Emmanuel Hospitals Association (EHA) has been developing a model of palliative care appropriate for this setting, based on teams undertaking home visits with the backup of outpatient and inpatient services. A project to further develop the model operated from 201...
Article
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Nestling in the Himalayas, between India and China, the Federal Democratic Republic of Nepal is a land of deep contrasts. Over the last 60 years, many visitors have come to Nepal to trek up close to one of its magnificent peaks – Nepal boasts eight of the 14 highest mountains in the world – to visit the exotic temples and stupas of Kathmandu or in...
Article
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Introductions: Developing palliative care in rural Nepal is essential to integrate the service into the national health system. This study was done with the aim of assessing the need of patients requiring palliative care in rural Nepal. Methods: This was a cross-sectional population based study in Thaha Municipality using a 30-cluster sampling meth...
Article
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Introductions: Developing palliative care services in acute hospitals is important to address the need of patients dying from malignant and non-malignant diseases. This study is carried out to assess the need of palliative care in Patan Hospital to inform the planning process for starting palliative care services. Methods: A cross-sectional, point...
Article
Palliative care in Nepal has been developing over the last 20 years, led by pioneering doctors and nurses who have gained experience in the specialty often whilst working overseas or who have had the opportunity to do clinical attachments abroad. Recently, in collaboration with international palliative care specialists, a national strategy has been...
Article
Purpose of review: Chronic breathlessness is common in patients with advanced illness who require palliative care. Achieving good symptom control can be challenging. More people with advanced illness live in low and middle income than in high-income countries, but they are much less likely to receive palliative care. Most of the emerging evidence...
Article
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More than 128·6 million people across 33 countries require life-saving humanitarian assistance, 92·8 million of whom are particularly vulnerable. Palliative care, however, has been omitted from efforts to tackle humanitarian crises. Palliative care is, according to WHO, “an approach that improves the quality of life of patients and their families f...
Poster
Full-text available
This study id a feasibility study of African POS in palliative care of Nepal in both hopital and hospice setting.
Article
Aims and objectives: To explore the experiences of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, their carers and healthcare professionals following emergency admission to acute care hospital. Background: Emergency admissions of people with lung cancer and COPD have increased and there is global concern abo...
Article
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Objectives: The high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences...
Article
Problem: District hospitals in Nepal struggle to provide essential services such as caesarean sections. Approach: Retention of health workers is critical to the delivery of long-term, quality health-care services. To promote retention and enhance performance in rural public hospitals, the Government of Nepal and the Nick Simons Institute progres...
Article
Objectives: Loss of self and the transition to patient-hood have been widely discussed in relation to the experience of advanced illness. Individuals however often maintain identities or selves beyond those demanded by the circumstances of being a patient. This study explores the presentation of this personal identity and interactions between intr...
Article
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Approximately 600,000 people die in the UK annually, usually after months or years of increasing debility. Many patients with advanced conditions are not identified for appropriate support before they die because they are not seen as having "palliative" care needs. General practice information technology systems can improve care by identifying pati...
Article
Background Many patients with advanced conditions are not identified for advance care planning because they are not seen as having “palliative” care needs. In some countries General Practice information technology systems can improve care by identifying patients with deteriorating health so that they can be considered for an ACP and their care revi...
Article
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Patients diagnosed with a life threatening condition like cancer suffer physically, socially and mentally. Their quality of life can be improved by effective communication and good symptom control even when the disease is incurable. Pain is the most common symptom and can be controlled by optimal use of analgesics especially oral morphine if severe...
Conference Paper
Background: Despite the increase in emergency admissions of patients with lung cancer and Chronic Obstructive Pulmonary Disease (COPD), little is known about the patient experience in hospital. Understanding this is important to ensure that services are organised and patients receive high quality, compassionate care. Research aims: To explore the e...
Conference Paper
Aim: Emergency admissions of patients with advanced cancer and other chronic illnesses continue to increase in the UK, leading to quality of care and public health challenges. Patients with lung cancer and COPD are amongst the commonest groups admitted. Whilst numbers and frequency of emergency admission have been investigated, few studies report p...
Conference Paper
Background: Patient and public involvement has become an important element within healthcare research. It aims to enhance the relevance, acceptability and appropriateness of research (INVOLVE 2012, Staniszewska et al 2011). The EURECA study examined emergency admission by patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and Lung...
Conference Paper
Aims: Patients with advanced disease are often admitted to emergency departments (ED) by ambulance. Few studies have explored the experience of paramedics in managing such patients and whether they report alternatives to transporting patients to ED after emergency calls. A year after mandatory online end of life care training in one UK ambulance se...
Article
Objective Multimorbidity is increasingly common in the last year of life, and associated with frequent hospital admissions. The epidemiology is well described, but patient perspectives are less understood. We report the experiences and perceptions of people with advanced multimorbidity to inform improvements in palliative and end-of-life care. Desi...
Article
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To develop a model of care coordination for patients living with advanced progressive illness and their unpaid caregivers, and to understand their perspective regarding care coordination. A prospective longitudinal, multi-perspective qualitative study involving a case-study approach. Serial in-depth interviews were conducted, transcribed verbatim a...
Article
District nurses (DN) play a key role in supporting patients with palliative care needs in the community. Gold Standards Framework (GSF) is a service improvement tool that was developed over 10 years ago for primary care, to enable GP practices to proactively support patients with palliative care needs. This study explores the experiences of DNs wor...
Article
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Most patients receive palliative care only in the last two months of life. The use of information technology currently in place in general practices provides an opportunity to identify people for supportive and palliative care at an earlier stage. To assess the impact and acceptability of a primary care electronic record search to identify patients...
Article
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Coordination of care for individuals with advanced progressive conditions is frequently poor. To identify how care is coordinated in generalist settings for individuals with advanced progressive conditions in the last year of life. A mixed methods study of three UK generalist clinical settings producing three parallel case studies: an acute admissi...
Article
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Background: Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit. Objectives: To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards. Methods: A two-phase mixed methods ac...
Article
Barilan’s (2012) essay “From Hope in Palliative Care to Hope as a Virtue and a Life Skill” provides a novel way of exploring hope as experienced by people at the end of life. He proposes that hope can be usefully seen as an Aristotelian virtue; something to be “conscientiously chosen” as a “habit of behavior, perceptiveness and mental response, hol...
Article
Domiciliary non-invasive positive-pressure ventilation (NIPPV) is increasingly employed to provide respiratory support in chronic respiratory failure (CRF) due to COPD. Whilst there are associated positive financial implications in a particular sub-section of patients due to reduction in hospital admission stays, significant debate remains around i...
Article
Aims Recently completed research demonstrated that ambulance crews had received little training in managing terminally ill patients and showed marked variation in what they consider to be a valid DNAR or what they would accept as an advance care plan indicating that a patient would not want to be admitted to hospital. This research informed the dev...
Conference Paper
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Background: The Cancer Reform Strategy’s commitment to shifting care from inpatient to community settings clashes with recent evidence showing increasing emergency admissions of cancer patients. These admissions are costly for the health service and burdensome for patients. Aims: To systematically review the UK literature describing the reasons for...
Article
Much attention has been given in recent years to the concept of illness trajectories and their potential use in the planning of services provided to those with life limiting illnesses. This study examines how trajectories are experienced by bereaved individuals and whether the memories retained by the bereaved or the experience of grief differ acco...
Article
West Midlands South HIEC ACP project aims to encourage the use of advance care planning (ACP) more widely by training and supporting a multidisciplinary group of health care professionals from local acute trusts, community services and hospices who provide care for patients at the end of life. The project includes a study day focusing on definition...
Article
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To synthesize evidence of family members recognizing that their relative is likely to die within the year, and identifying the need for palliative care. A meta-ethnography of studies of family members in multiple sclerosis (MS), Parkinson's disease (PD) and motor neuron disease (MND). Review methods: Systematic search in electronic databases; thema...
Article
Introduction and aimsAppropriate, effective and timely generalist care for patients and their families towards the end of life is recognised as an essential component of high quality, equitable care. Improving coordination of care is one of the core objectives of the UK Department of Health End of Life Care Strategy. We aimed to identify the contex...
Article
Introduction and aimIncreased coordination and collaboration have been highlighted as improving the provision of health and social care for people at the end of life. We aimed to review the literature concerning coordination or collaboration of care to determine whether coordination and collaboration improves the quality of care delivered by genera...
Article
Introduction and aimsFollowing a successful bid to undertake research into co-ordination of palliative care needs of patients within the generalist setting, the research team was offered the opportunity to employ an NHS manager to become a ‘Management Fellow.’ The aim was to provide a means to embed research expertise in the local NHS area through...
Article
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Facilitation is the process of providing support to individuals or groups to achieve beneficial change. It is intrinsic to the Gold Standards Framework (GSF) for palliative care, a programme introduced widely in UK general practices. To explore how GSF facilitators fulfil their role and the impact of the facilitators' backgrounds and approach on pr...
Article
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Background: Improving quality of end-of-life care is a key driver of UK policy. The Gold Standards Framework (GSF) for Palliative Care aims to strengthen primary palliative care through facilitating implementation of systematic clinical and organisational processes. Objectives: To describe the general practices that participated in the GSF progr...
Article
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To explore the experiences and perceptions of general practitioners and community nurses in discussing preferences for place of death with terminally ill patients. Qualitative study using semistructured interviews and thematic analysis. 17 general practitioners and 19 nurses (16 district nurses, three clinical nurse specialists). 15 general practic...
Article
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High quality end-of-life care in the community is achieved with effective multidisciplinary teamwork, interprofessional communication between GPs and district nurses, and early referral of patients to district nurses. These aspects of palliative care are highlighted in the Gold Standards Framework, a programme recently established in UK primary car...
Article
Better information is needed about prognosis and treatment, along with decision aids to help patients interpret it
Article
Full-text available
Palliative care is an important, complex aspect of primary care, requiring a multidisciplinary approach. The Gold Standards Framework (GSF), a programme used by over 3,000 UK practices, aims to facilitate high-quality palliative care through the introduction of systematic clinical and organizational processes. Quality payments for palliative care a...
Article
It is estimated that 8% of cancer patients could benefit from advanced pain management techniques; some 12,000 patients per year in the UK. In 2002, Linklater et al. surveyed palliative medicine consultants to assess their access and attitude to such techniques, finding under-utilization with a lack of formal arrangements for referral. We report a...
Article
This thesis explores the complex discipline of community palliative care. Palliative patients suffer from a range of conditions, have complex, evolving clinical problems and receive care from a wide variety of health and social care professionals. Understanding these issues is central to effective service provision and maintaining continuity of car...
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Palliative care within the community requires well coordinated multidisciplinary teamworking, involving both primary and secondary care practitioners. 'Out-of-hours' periods are a potentially problematic time for delivery of high quality care. We report on two national surveys-one of medical directors of out-of-hours general practitioner cooperativ...
Article
Full-text available
Palliative care within the community requires well coordinated multidisciplinary teamworking, involving both primary and secondary care practitioners. ‘Out-of-hours'periods are a potentially problematic time for delivery of high quality care. We report on two national surveys—one of medical directors of out-of-hours general practitioner cooperative...

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