Palliative care is a crucial aspect of healthcare that addresses suffering beyond just physical symptoms. It adopts a holistic, team-based approach to support patients and their caregivers, focusing on practical needs and offering bereavement counseling. The core aim of palliative care is to enable patients to live as actively and comfortably as possible until the end of life. Recognized as a human right, palliative care should be integrated into person-centered health services, tailored to individual needs and preferences.
Palliative care is essential for a wide spectrum of illnesses, predominantly chronic conditions. Cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%), and diabetes (4.6%) constitute the majority of cases requiring palliative support. However, conditions like kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disorders, dementia, congenital anomalies, and drug-resistant tuberculosis also frequently necessitate this specialized care.
Pain and breathlessness are prevalent and severe symptoms for patients needing palliative care. Notably, 80% of individuals with AIDS or cancer, and 67% with cardiovascular disease or chronic obstructive pulmonary disease experience moderate to severe pain in their final stages of life. Opioids are vital for effective pain management and can also alleviate breathlessness, among other distressing physical symptoms. Early and effective symptom control is not only an ethical imperative to minimize suffering but also to uphold a person’s dignity.
Addressing the Gap in Palliative Care Access
Globally, an estimated 56.8 million people require palliative care annually, with a significant majority residing in low- and middle-income countries. For children needing palliative care, 98% live in these resource-limited regions, with nearly half in Africa. Significant obstacles impede access to palliative care worldwide:
- Palliative care is often absent from national health policies and systems.
- Healthcare professionals frequently receive limited or no training in palliative care.
- Access to opioid pain relief is inadequate, failing to meet international standards for essential medicines.
A 2019 WHO survey across 194 Member States on noncommunicable diseases revealed that palliative care funding was available in only 68% of countries, and a mere 40% reported services reaching at least half of those in need. (1)
The International Narcotics Control Board reported in 2018 that 79% of the global population, mainly in low- and middle-income countries, consumed only 13% of the morphine used for pain and suffering management – a fraction of the 388 tons manufactured globally. While this was a slight improvement from 2014, the disparity in access to narcotic drugs for palliative care between wealthier and poorer nations remains a critical concern (2).
Further barriers hindering palliative care include:
- Limited awareness among policymakers, healthcare providers, and the public regarding palliative care, its benefits, and its role within health systems.
- Cultural and social beliefs surrounding death and dying.
- Misconceptions that palliative care is solely for cancer patients or only relevant in the final weeks of life.
- Unfounded fears that improved opioid access will lead to increased substance abuse.
Children receiving palliative care
Strengthening Palliative Care Systems: A National Responsibility
National health systems bear the responsibility of integrating palliative care into the continuum of care for individuals with chronic and life-threatening conditions. This integration should be linked with prevention, early detection, and treatment programs. Essential components include:
- Health system policies that embed palliative care services into the structure and financing of national healthcare systems at all levels.
- Policies to enhance human resources, including training for current health professionals, integrating palliative care into the core curricula for new professionals, and educating volunteers and the public.
- Medicines policies ensuring the availability of essential medicines for symptom management, particularly opioid analgesics for pain and respiratory distress.
Palliative care demonstrates maximum effectiveness when introduced early in the course of illness. Early palliative care not only enhances patients’ quality of life but also reduces unnecessary hospitalizations and healthcare service utilization. Therefore, accurate and timely Diagnosis For Palliative Care needs is paramount. Identifying patients who would benefit from palliative services early in their illness trajectory allows for proactive planning and intervention, leading to better symptom management and overall patient well-being.
Palliative care provision must align with universal health coverage principles. Access to a nationally-determined set of basic health services, including palliative care, should be universal, irrespective of income, disease, or age. Financial and social protection systems must acknowledge the human right to palliative care, especially for vulnerable and marginalized populations.
Nurses, as part of multidisciplinary teams, require specialized palliative care skills, particularly those working with seriously ill patients. Specialist palliative care is a component of service delivery, but a sustainable, high-quality, and accessible system necessitates integration into primary healthcare, community-based care, home care, and support for family and community volunteers. Providing palliative care should be considered an ethical duty for all health professionals, triggered by a diagnosis that indicates a patient’s need for such care.
WHO’s Commitment to Palliative Care Advancement
Palliative care medicines, including pain relief medications, are included in the WHO Essential Medicines List and the WHO Essential Medicines List for Children. Palliative care is recognized in key global mandates and strategies related to universal health coverage, noncommunicable diseases, and people-centered, integrated health services. The WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents were released in 2019 (3).
World Health Assembly resolution WHA67.19, the first global resolution on palliative care in 2014, urged WHO and Member States to improve palliative care access as a core health system component, emphasizing primary healthcare and community/home-based care. WHO’s efforts to strengthen palliative care focus on:
- Integrating palliative care into relevant global disease control and health system plans.
- Assessing the development of palliative care services worldwide.
- Developing guidelines and tools for integrated palliative care across diseases and care levels, addressing ethical considerations.
- Supporting Member States in enhancing access to palliative care medicines through improved regulations and delivery systems.
- Focusing on palliative care for people living with HIV, including guideline development.
- Promoting increased access to palliative care for children (in collaboration with UNICEF).
- Monitoring global palliative care access and evaluating program progress.
- Developing indicators for evaluating palliative care services.
- Encouraging adequate resources for palliative care programs and research, particularly in resource-limited countries.
- Building evidence for effective palliative care models in low- and middle-income settings.
(1) Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.
(2) The Report of the International Narcotics Control Board for 2019 (E/INCB/2019/1) https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf
(3) WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. https://www.who.int/publications/i/item/who-guidelines-for-the-pharmacological-and-radiotherapeutic-management-of-cancer-pain-in-adults-and-adolescents
