Global palliative care: from need to action

Katherine Sleeman and colleagues report the first worldwide projection of the future global burden of serious health-related suffering. The calculation followed the methods used by the Lancet Commission on Palliative Care and Pain Relief assessing global palliative care need. Combining these methods with WHO’s revised global and regional projections of mortality up to 2060,3 the authors estimate the global burden of serious health-related suffering requiring palliative care by world regions and age groups for 20 health conditions. The vision of the future delivered by this Article is alarming: “By 2060, an estimated 48 million people (47% of all deaths globally) will die each year with serious healthrelated suffering, and 83% of these deaths will occur in low-income and middle-income countries”.1 These numbers indicate that 130000 people worldwide will die every day with serious health-related suffering by 2060, the equivalent to twice the size of a Super Bowl stadium. The real burden of serious health-related suffering is even greater because the authors’ calculations are based on mortality data and do not include the burden of people living with serious health-related suffering who do not die in a given period

The importance of assessing the need for palliative care to avoid unnecessary suffering at life's end

El interesante estudio de Martínez Ríos y col1, sobre pacientes susceptibles de cuidados paliativos que fallecen en domicilio en Málaga, concluye que un tercio de ellos no se identificaron como pacientes paliativos en su historia clínica y, por tanto, no se incluyeron en el Proceso Asistencial Integrado de Cuidados Paliativos de la Junta de Andalucía. Se recoge en el mismo trabajo que la proporción de pacientes fallecidos en el domicilio en 2015, e identificados como susceptibles de cuidados paliativos, fue muy alta para pacientes con cáncer (87%) y muy baja para pacientes con EPOC (38%), insuficiencia cardíaca (23%) y demencias (20%)

Palliative care coverage across European National Health Systems: proposal of a synthetic indicator

Background: The coverage of palliative care (PC) may be understood as a country’s capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countries´ coverage capacities. Method: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. Results: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. Conclusion: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs

Trends analysis of specialized palliative care services in 51 countries of the WHO European region in the last 14 years

Background: Service provision is a key domain to assess national-level palliative care development. Three editions of the European Association for Palliative Care (EAPC) Atlas of Palliative Care monitored the changes in service provision across Europe since 2005. Aim: To study European trends of specialized service provision at home care teams, hospital support teams, and inpatient palliative care services between 2005 and 2019. Design: Secondary analysis was conducted drawing from databases on the number of specialized services in 2005, 2012, and 2019. Ratios of services per 100,000 inhabitants and increase rates on number of services for three periods were calculated. Analysis of variance (ANOVA) analyses were conducted to determine significant changes and chi-square to identify countries accounting for the variance. Income-level and sub-regional ANOVA analysis were undertaken. Setting: 51 countries. Results: Forty-two countries (82%) increased the number of specialized services between 2005 and 2019 with changes for home care teams (104% increase-rate), inpatient services (82%), and hospital support teams (48%). High-income countries showed significant increase in all types of services (p < 0.001), while low-to-middle-income countries showed significant increase only for inpatient services. Central–Eastern European countries showed significant improvement in home care teams and inpatient services, while Western countries showed significant improvement in hospital support and home care teams. Home care was the most prominent service in Western Europe. Conclusion: Specialized service provision increased throughout Europe, yet ratios per 100,000 inhabitants fell below the EAPC recommendations. Western Europe ratios’ achieved half of the suggested services, while Central–Eastern countries achieved only a fourth. High-income countries and Western European countries account for the major increase. Central–Eastern Europe and low-to-middle-income countries reported little increase on specialized service provision

Mapping pediatric palliative care development in the WHO-European Region: children living in low-middle income countries are less likely to access it

Context: Approximately 170,000 children in need of palliative care die every year in Europe without access to it. This field remains an evolving specialty with unexplored development. Objectives: To conduct the first regional assessment of pediatric palliative care (PPC) development and provision using data from the European Association for Palliative Care atlas of palliative care 2019. Methods: Two surveys were conducted. The first one included a single question regarding PPC service provision and was addressed by European Association for Palliative Care atlas informants. The second one included 10 specific indicators derived from an open-ended interview and rating process; a specific network of informants was enabled and used as respondents. Data were analyzed and presented in the map of the figure. Results: Data on PPC service provision were gathered from 51 of 54 (94%) European countries. Additional data were collected in 34 of 54 (62%) countries. A total of 680 PPC services were identified including 133 hospices, 385 home care services, and 162 hospital services. Nineteen countries had specific standards and norms for the provision of PPC. Twenty-two countries had a national association, and 14 countries offered education for either pediatric doctors or nurses. In seven countries, specific neonatal palliative care referral services were identified. Conclusion: PPC provision is flourishing across the region; however, development is less accentuated in low-to-middle-income countries. Efforts need to be devoted to the conceptualization and definition of the models of care used to respond to the unmet need of PPC in Europe. The question whether specialized services are required or not should be further explored. Strategies to regulate and cover patients in need should be adapted to each national health system

Additional indicators to assess palliative care development

This is a short compilation of Health Indicators Assessing the Level of Palliative Care Development at the International Level. These are additional indicators to another published book: Brief Manual on Health Indicators Monitoring Global Palliative Care Development (http://hdl.handle.net/10171/56523)

Mapping study on Palliative Care Development in 54 European Countries

(Tesis en inglés) Se estima que cinco millones de personas, de las cuales 177,000 son niños, mueren cada año en la región Europea sin acceso a cuidados paliativos. La región enfrenta el desafío de responder a esta demanda. Los objetivos de este estudio son: a) evaluar el estado actual del desarrollo de cuidados paliativos en la región utilizando los dominios de la Estrategia de Salud Pública de la OMS como marco; b) evaluar la integración de los cuidados paliativos en otros campos del sistema de salud; c) explorar el desarrollo de los cuidados paliativos pediátricos. Para lograr esos objetivos se crearon redes de expertos para informar sobre el desarrollo de cuidados paliativos y su integración. Los indicadores para evaluar el desarrollo se identificaron mediante una revisión sistemática y los mejores se seleccionaron mediante un proceso de consenso internacional con expertos en el tema. Se obtuvieron indicadores para evaluar la integración luego de entrevistas abiertas con expertos y un proceso de calificación. Las encuestas electrónicas se construyeron con base en los indicadores seleccionados y se enviaron a las redes de informantes. Los datos se recopilaron y analizaron, y los resultados se presentaron cartográficamente agregando infogramas. Se realizó un análisis específico de tendencias comparativas en la provisión de servicios especializados comparando datos del estudio actual con bases de datos de las evaluaciones de 2007 y 2013. Veinticuatro expertos internacionales que participaron en el proceso de consenso seleccionaron los 25 mejores indicadores para evaluar el desarrollo general. Para estudiar la integración en el sistema de salud, se obtuvieron 37 indicadores para atención primaria, pediatría, cardiología, oncología, centros de atención para mayores y voluntariado. Un total de 321 expertos respondieron las encuestas. Los datos de 51/54 (94%) países de la región se recopilaron, analizaron y presentaron en el Atlas de Cuidados Paliativos EAPC 2019. El Atlas calculó que más de cinco millones de personas que mueren cada año en Europa experimentan un grave sufrimiento relacionado con la salud. Se estima que existen más de 6,388 servicios de cuidados paliativos especializados en Europa en todos los niveles de atención que abordan los casos más complejos. Con respecto a los Atlas anteriores de 2007 y 2013, existe una tendencia general a aumentar el número de servicios especializados en toda la región, pero de manera más marcada en Europa occidental. La mitad de los países europeos tienen menos de 0,7 servicios por cada 100.000 habitantes, muy por debajo de los 2,0 recomendados por EAPC. Se ha generalizado un marco legal en los países europeos que facilita la provisión y organización de servicios. Existe una clara tendencia a que los cuidados paliativos formen parte de la educación obligatoria de los Grados de Medicina y Enfermería. La Medicina Paliativa es una especialidad, subespecialidad o tiene una certificación equivalente en 29/51 países. La disponibilidad de opioides sigue siendo limitada y desigual, siendo mayor en los países de Europa occidental. Más de 177,000 niños necesitan cuidados paliativos cada año en Europa. El estudio Atlas identificó por primera vez 38 países que ya han desarrollado recursos específicos de cuidados paliativos para niños

The importance of assessing the need for palliative care to avoid unnecessary suffering at life's end

El interesante estudio de Martínez Ríos y col1, sobre pacientes susceptibles de cuidados paliativos que fallecen en domicilio en Málaga, concluye que un tercio de ellos no se identificaron como pacientes paliativos en su historia clínica y, por tanto, no se incluyeron en el Proceso Asistencial Integrado de Cuidados Paliativos de la Junta de Andalucía. Se recoge en el mismo trabajo que la proporción de pacientes fallecidos en el domicilio en 2015, e identificados como susceptibles de cuidados paliativos, fue muy alta para pacientes con cáncer (87%) y muy baja para pacientes con EPOC (38%), insuficiencia cardíaca (23%) y demencias (20%)