End-of-Life Care Training for Patients with Traumatic Brain Injury in Ghana: A Novel Curriculum and Its Initial Implementation

doi:10.3390/jcm14113643

. 2025 May 22;14(11):3643.

doi: 10.3390/jcm14113643.

End-of-Life Care Training for Patients with Traumatic Brain Injury in Ghana: A Novel Curriculum and Its Initial Implementation

John Bruno^{1

2

3}, Mayur Patel², Rebecca Henderson³, Michael Mathelier^{2

4}, Taylor N Smith^{2

5}, Joseph C Pompa², Cassandra Clay⁶, Marie-Carmelle Elie⁷, Sheba Afi Mansa Fiadzomor^{8

9}, Lawrence Nsohlebna Nsoh^{8

9}, Torben K Becker^{1

2}

Affiliations

¹ Division of Critical Care Medicine, Department of Emergency Medicine, College of Medicine, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
² Section of Global Health, Department of Emergency Medicine, College of Medicine, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
³ Department of Neurology, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
⁴ Department of Obstetrics & Gynecology, University of Alabama, Tuscaloosa, AL 35487, USA.
⁵ College of Medicine, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
⁶ College of Nursing, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
⁷ Department of Emergency Medicine, Saint Francis Hospital, Roslyn, NY 11576, USA.
⁸ Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
⁹ Ghana Armed Forces Medical Services, Ghana.

PMID: 40507404
PMCID: PMC12156043
DOI: 10.3390/jcm14113643

End-of-Life Care Training for Patients with Traumatic Brain Injury in Ghana: A Novel Curriculum and Its Initial Implementation

John Bruno et al. J Clin Med. 2025.

. 2025 May 22;14(11):3643.

doi: 10.3390/jcm14113643.

Authors

Affiliations

¹ Division of Critical Care Medicine, Department of Emergency Medicine, College of Medicine, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
² Section of Global Health, Department of Emergency Medicine, College of Medicine, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
³ Department of Neurology, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
⁴ Department of Obstetrics & Gynecology, University of Alabama, Tuscaloosa, AL 35487, USA.
⁵ College of Medicine, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
⁶ College of Nursing, University of Florida, 1600 Archer Road, Gainesville, FL 32608, USA.
⁷ Department of Emergency Medicine, Saint Francis Hospital, Roslyn, NY 11576, USA.
⁸ Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
⁹ Ghana Armed Forces Medical Services, Ghana.

PMID: 40507404
PMCID: PMC12156043
DOI: 10.3390/jcm14113643

Abstract

The implementation and practice of palliative medicine have numerous boundaries in low- and middle-income countries (LMICs), stemming from various cultural, legal, and religious concerns. Additionally, professional education in palliative care medicine in these countries is severely lacking, especially when compared with developed countries. Background/Objectives: To enhance and demystify palliative medicine practice to health care providers in LMICs. Methods: We developed a novel and comprehensive course in palliative care medicine and end-of-life (EOL) care, specifically within the context of management of patients with traumatic brain injury (TBI). We performed both immediate pre-course and post-course analysis of course participant comprehension and feedback, as well as a one-year post-course analysis and small group discussion. Results: The comprehension of the course material was strong, as participants scored an average of 13.9 points better on the post-test compared to the pre-test (49.6% vs. 35.7%, p < 0.001). Participants in the one-year follow-up session reported long-term applicability of the course material in their respective practice settings, with all participants reporting that they utilize the course material often. Small group discussion responses indicated a strong level of comprehension of the course material. Conclusions: Providing education in palliative medicine to health care professionals in LMICs is feasible, and likely to be both well-received and strongly influential to local medical practice. Local cultural and religious practices may be less of a barrier to the provision of palliative medicine than previously considered. Practicing palliative medicine, particularly at EOL, may strengthen patient-provider relationships, improve job satisfaction among health care providers, and improve the perception of medical care provided in LMIC medical settings.

Keywords: end-of-life; low- and middle-income countries; palliative care; traumatic brain injury.

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Conflict of interest statement

The authors declare no conflict of interest.

References

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[1] Etyang A.O., Scott J.A.G. Medical causes of admissions to hospital among adults in Africa: A systematic review and 2003. Glob. Health Action. 2013;6:19090. doi: 10.3402/gha.v6i0.19090. - DOI - PMC - PubMed

[2] Etyang A.O., Scott J.A.G. Medical causes of admissions to hospital among adults in Africa: A systematic review and 2003. Glob. Health Action. 2013;6:19090. doi: 10.3402/gha.v6i0.19090. - DOI - PMC - PubMed

[3] Ma J., Chi S., Buettner B., Pollard K., Muir M., Kolekar C., Al-Hammadi N., Chen L., Kollef M., Dans M. Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial. Crit. Care Med. 2019;47:1707–1715. doi: 10.1097/CCM.0000000000004016. - DOI - PMC - PubMed

[4] Ma J., Chi S., Buettner B., Pollard K., Muir M., Kolekar C., Al-Hammadi N., Chen L., Kollef M., Dans M. Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial. Crit. Care Med. 2019;47:1707–1715. doi: 10.1097/CCM.0000000000004016. - DOI - PMC - PubMed

[5] Sullivan D.R., Chan B., Lapidus J.A., Ganzini L., Hansen L., Carney P.A., Fromme E.K., Marino M., Golden S.E., Vranas K.C., et al. Association of Early Palliative Care Use with Survival and Place of Death Among Patients with Advanced Lung Cancer Receiving Care in the Veterans Health Administration. JAMA Oncol. 2019;5:1702. doi: 10.1001/jamaoncol.2019.3105. - DOI - PMC - PubMed

[6] Sullivan D.R., Chan B., Lapidus J.A., Ganzini L., Hansen L., Carney P.A., Fromme E.K., Marino M., Golden S.E., Vranas K.C., et al. Association of Early Palliative Care Use with Survival and Place of Death Among Patients with Advanced Lung Cancer Receiving Care in the Veterans Health Administration. JAMA Oncol. 2019;5:1702. doi: 10.1001/jamaoncol.2019.3105. - DOI - PMC - PubMed

[7] Seow H., Barbera L.C., McGrail K., Burge F., Guthrie D.M., Lawson B., Chan K.K.W., Peacock S.J., Sutradhar R. Effect of Early Palliative Care on End-of-Life Health Care Costs: A Population-Based, Propensity Score-Matched Cohort Study. JCO Oncol Pract. 2022;18:e183–e192. doi: 10.1200/OP.21.00299. - DOI - PMC - PubMed

[8] Seow H., Barbera L.C., McGrail K., Burge F., Guthrie D.M., Lawson B., Chan K.K.W., Peacock S.J., Sutradhar R. Effect of Early Palliative Care on End-of-Life Health Care Costs: A Population-Based, Propensity Score-Matched Cohort Study. JCO Oncol Pract. 2022;18:e183–e192. doi: 10.1200/OP.21.00299. - DOI - PMC - PubMed

[9] Connor S.R., Sepulveda Bermedo M.C. Global Atlas of Palliative Care at the End of Life. Worldwide Palliative Care Alliance; London, UK: 2014.

[10] Connor S.R., Sepulveda Bermedo M.C. Global Atlas of Palliative Care at the End of Life. Worldwide Palliative Care Alliance; London, UK: 2014.

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End-of-Life Care Training for Patients with Traumatic Brain Injury in Ghana: A Novel Curriculum and Its Initial Implementation

Affiliations

End-of-Life Care Training for Patients with Traumatic Brain Injury in Ghana: A Novel Curriculum and Its Initial Implementation

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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