Only 10% of Patients Who Need Palliative Care Get It: WHO Report

Across the world, there is an urgent demand for palliative care as the global population ages and the burden of noncommunicable diseases continues to increase.

At present, only 10% of the people who need palliative care are receiving it, says the World Health Organization (WHO).

The agency estimates that more than 56.8 million people are in need of palliative care. Most of these patients (78%) live in low- and middle-income countries.

The WHO is calling for "urgent and concerted action" to increase access to quality palliative care services. To this end, it has released two new reports. The goal is to help countries assess the development of palliative care and improve the quality of palliative care services.

The urgency of this issue was emphasized by a 2017 report in The Lancet. That was the first study in which investigators provided a worldwide estimate of the extent of serious suffering related to illness and injury and the resultant need for palliative care and pain relief.

As reported by Medscape Medical News, that report found that more than 25.5 million people die every year without adequate relief for serious physical and psychological suffering. It identified a number of barriers to pain relief and palliative care, including what the researchers termed "opiophobia" in reference to prejudice and misinformation regarding the appropriate medical use of opioids. The investigators also cited as a problem the focus in medicine on cure and on extending life while neglecting caregiving and quality of life as patients near death.

In many parts of the world, lack of access to morphine plays a huge part in inadequate pain control, commented David Kerr, MD, professor of cancer medicine at the University of Oxford, Oxford, United Kingdom, in a Medscape blog. Very complex problems regarding bureaucracy may occur. For example, in sub-Saharan African countries, "patients have to travel tens of miles to register at their local police station because of the legislation around control of access to morphine," Kerr said.

New WHO Reports

The first report from the WHO calls for the creation of a global consensus on "a set of actionable indicators" that can measure the development of palliative care and provide reliable data to support decision making.

The proposed model highlights six components essential for providing optimal palliative care: robust health policies related to palliative care; use of essential palliative care medicines; provision of palliative care within integrated health services; education and training of healthcare workers and volunteers in providing palliative care; empowerment of people and communities; and research related to palliative care.

Using the conceptual model, the investigators listed 18 indicators of palliative care. The report notes that these indicators can be used by any country in accordance with their individual needs.

Two subsets of indicators were developed. The first subset consists of 10 core indicators that are considered essential for measuring palliative care within the country itself and for global comparative analysis.

The second subset comprises strategic indicators. Nine indicators are considered the most feasible and important to measure in countries where palliative care is in initial stages of development.

The second report from the WHO focuses on "practical approaches and resources to support policy, strategy and practice." The authors discuss some practical strategies, policies, and planning for palliative care programs and services and highlight relevant resources that are available from the WHO.

Key interventions were identified at three points of implementation.

At the national level, the report urges countries to incorporate quality considerations into all levels of palliative care planning, including policy, strategy, and service delivery with attention to resources, implementation and monitoring. Countries should align national palliative care planning with a clearly articulated national strategic direction on quality.

At the district level, the WHO calls for a commitment to quality palliative care with a strong point of linkage between national plans and operational activity at the point of care. Data collected at this level can be used to improve the quality of palliative care through a particular focus on understanding and addressing health inequalities at the district level. Communities can be engaged to improve the quality of palliative care, create service delivery that is truly people centered, and address misconceptions about palliative care.

At the point-of-care level, quality palliative care can be improved and maintained with regard to care provided at home, and data can be collected and used to drive improvement efforts.

WHO. Report no. 1, Full text; Report no. 2. Full text

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