Dr Natasha Azzopardi Muscat, Dr Tomas Zapata and Dr Satish Mishra, from WHO/Europe, argue that now is time to strengthen palliative care across the European Region
While palliative care is a crucial part of integrated, people-centred health services at all levels of care, for many people living in the European Region of the World Health Organization (WHO), accessing palliative care services remains a challenge. The recent pandemic highlighted the need for compassionate care and support at the end of life. Investment in education and training of health workers on palliative care would result in better care for all at the end of life.
Despite recent advances in palliative care and evidence of its efficacy, there are still too many inequities when it comes to access to and availability of palliative care. In many countries, palliative care has yet to be mainstreamed into service delivery models. In addition, the pandemic has disrupted palliative care services when the need for palliative care increased.
Investment in palliative care improves the quality of life, can reduce care costs at the end of life, and can be delivered anywhere.
Improving the quality of life
Strong evidence suggests that palliative care improves the quality of life of adults and children facing life-threatening illness, especially when introduced early during illness. (1) Palliative care achieves this by ensuring early identification of problems, the use of impeccable assessment and by taking a holistic approach to treating pain and other symptoms (physical, psychosocial or spiritual).
The European Association for Palliative Care (EAPC) estimates that every year, 4,428,663 people who would have benefited from access to palliative care die in Europe. Among these, an estimated 138,913 are children. (2) This equates to 65% of the European population who currently do not have access to palliative therapy. And where palliative care does exist, we still see differences in terms of access to and provision of palliative care. within and between countries.
Pain is one of the most common symptoms faced by people with life-limiting illnesses. That’s why pain management is an essential component of palliative care. We must ensure that people with life-threatening conditions have access to the medicines they need (3) and that these are accessible and affordable. This includes having access to strong opioids such as morphine.
At the same time, we need to ensure that these medications are prescribed and administered correctly; for this, we need healthcare professionals who are confident and well-trained. Yet, nearly half of European countries have no option for doctors to specialise in palliative care (1), and 83% of all European countries do not include this care in the education and training of medical undergraduates.
Reducing the costs of care
Palliative care neither postpones nor hastens death. (1) But we know that, when performed correctly and with the proper funding, it can improve a patient’s quality of life, reduce overall costs and, in some cases, result in the patient surviving longer. (4)
“The recent pandemic highlighted the need for compassionate care and support at the end of life. Investment in education and training of health workers on palliative care would result in better care for all at the end of life.”
At the same time, we are still seeing people in the European Region struggling to access this care. (5) So, there is still lots of work to ensure that the people who need care the most can access quality care when and where they need it without suffering financial hardship.
As the European Region is a fast ageing region – and people are living longer often with non-communicable conditions that require ongoing care – governments need to rethink how to include palliative care at scale in their national programmes and budgets. This is especially relevant as we consider that the financial cost of providing end-of-life care is increasing, with acute care now being the most significant component in this cost rise. (6)
One way to manage this rise in costs is to ensure a better balance between disease treatment and the management of symptoms at the end of life. This could also reduce the number of unnecessary hospital admissions, which is better for patients and their families and for overstretched and under-resourced health services. (3)
Palliative care can and should be available to everyone, everywhere
Palliative care should be available, regardless of diagnosis and age, and can be provided in any location, including hospitals, hospices or in the community.
Palliative care focuses on the wishes of the patient and their family. This aligns with our strategy and vision as outlined in our European Programme of Work (7), which calls for leaving no one behind and putting people at the centre of care.
Ideally, palliative care should be introduced early and integrated into the care of patients as part of a care pathway. Unfortunately, despite many countries’ commitment to supporting the development and integration of palliative care as part of universal health coverage, barriers remain.
For palliative care to be widely and readily available, WHO urges countries to:
- Develop palliative care services to meet the needs of all those with life-threatening conditions regardless of age (including children) (8) and diagnosis. (9)
- Ensure that palliative therapy is included in national policies.
- Ensure that people with life-limiting conditions can access the medicines they need to treat pain and other troublesome symptoms. (11)
- Develop education and training on palliative care for all healthcare workers and the public.
References
- Temel J. et al. (2016) Effects of early integrated palliative care in patients with lung and GI cancer. A randomised clinical trial. Journal of Clinical Oncology 35 (8):834-841.
- EAPC (2019) European Association for Palliative Care Atlas of Palliative Care in Europe.
- World Health Organization Model List of Essential Medicines (2021) https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02
- WHO – Palliative Care Fact Sheet https://www.who.int/news-room/fact- sheets/detail/palliative-care accessed November 2022.
- Arias-Casais N et al (2020) Trends analysis of specialized palliative care services in 51 countries of the WHO European Region in the last 14 years. Palliative Medicine 343 (8);1044-1056 https://pubmed.ncbi.nlm.nih.gov/32519584/.
- Normand et al. (2021) Health and social care near the end of life. WHO/European Observatory on Health Systems & policies.
- WHO (2020) European Programme of Work.
- WHO (2018) Integrating palliative care and symptom relief into paediatrics. https://apps.who.int/iris/bitstream/handle/10665/274561/9789241514453-eng.pdf?ua=1.
- WHO (2016) Planning and implementing palliative care services: a guide for programme managers. https://www.who.int/publications/i/item/planning-and-implementing-palliative-care-services-a-guide-for-programme-managers.
- WHO (2018) Integrating palliative care and symptom relief into primary health care. https://apps.who.int/iris/bitstream/handle/10665/274559/9789241514477-eng.pdf?ua=1
- WHO (2020) WHO guideline on ensuring balanced policies for access and safe use of controlled medicines. https://www.who.int/news/item/22-12-2020-who-guideline-on-ensuring-balanced-national-policies-for-access-and-safe-use-of-controlled-medicines
