Palliative care is a holistic approach to healthcare that focuses on improving the quality of life for patients and their families facing problems associated with life-limiting illness. It addresses physical, emotional, social, and spiritual needs, ensuring comprehensive support beyond just treating the disease itself. For many, understanding when palliative care becomes relevant involves recognizing the common diagnoses where this type of care is most beneficial.
Palliative care is a human right, essential for person-centered healthcare services. It is designed to cater to the specific needs and preferences of each individual, offering a support system that enables patients to live as actively as possible until the end of life. This care extends to caregivers as well, providing them with necessary support and bereavement counseling.
While palliative care is applicable to a wide spectrum of illnesses, certain chronic diseases are more frequently associated with its need. Understanding these common diagnoses is crucial for both patients and healthcare providers to ensure timely and effective intervention. The majority of adults requiring palliative care suffer from chronic conditions, with cardiovascular diseases leading at 38.5%, followed by cancer at 34%. Chronic respiratory diseases account for 10.3%, AIDS for 5.7%, and diabetes for 4.6%. Beyond these, a variety of other conditions may necessitate palliative care, including kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological diseases, dementia, congenital anomalies, and drug-resistant tuberculosis.
Children receiving palliative care
Alt text: A compassionate nurse provides palliative care to a child, emphasizing the supportive and holistic nature of treatment for young patients facing serious illnesses.
Among the distressing symptoms patients face, pain and breathlessness are particularly prevalent and severe. For instance, a significant majority—80% of patients with AIDS or cancer, and 67% of those with cardiovascular disease or chronic obstructive pulmonary disease—experience moderate to severe pain as they near the end of their lives. Opioids play a vital role in managing this pain effectively.
Opioids are not only crucial for pain management but also for alleviating other distressing physical symptoms like breathlessness. Early and effective symptom control is not just a medical necessity but an ethical imperative to relieve suffering and uphold a person’s dignity.
Despite the clear need and benefits, access to palliative care remains insufficient globally. An estimated 56.8 million people require palliative care annually, with a disproportionate number residing in low- and middle-income countries. For children, the disparity is even starker, with 98% of those in need living in these resource-limited regions, nearly half of them in Africa.
Several significant barriers contribute to this unmet need 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 for populations is inadequate, failing to meet international standards for essential medicines.
A WHO survey in 2019 highlighted that while 68% of countries reported funding for palliative care, only 40% indicated that services reached at least half of the patients in need. Data from the International Narcotics Control Board in 2018 further illustrates the inequity: 79% of the global population, largely in low- and middle-income countries, consumed a mere 13% of the morphine used for pain management globally. This disparity in access to narcotic drugs for palliative care between wealthier and less affluent nations remains a critical concern.
Additional obstacles hindering palliative care access include:
- Lack of understanding among policymakers, healthcare providers, and the public about palliative care and its advantages for patients and healthcare systems.
- Cultural and social taboos surrounding death and dying.
- Misconceptions about palliative care, such as it being solely for cancer patients or only relevant in the final weeks of life.
- Unfounded fears that improved access to opioid analgesics will lead to increased substance abuse.
To address these challenges, countries must take proactive steps. 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 begin at the point of prevention, early detection, and treatment programs. Minimum essential components include:
- Health system policies that seamlessly incorporate palliative care services into the framework and financial structures of national healthcare systems across all levels of care.
- Policies focused on strengthening and expanding human resources, encompassing training for current health professionals, integrating palliative care into the core curricula for all new healthcare professionals, and educating volunteers and the general public.
- Medicines policies that guarantee the availability of essential medicines for symptom management, particularly opioid analgesics for pain and respiratory distress relief.
Palliative care demonstrates maximum effectiveness when introduced early in the illness trajectory. Early palliative care not only significantly enhances patients’ quality of life but also demonstrably reduces unnecessary hospitalizations and the overall utilization of healthcare services.
Palliative care provision must adhere to the principles of universal health coverage. Every individual, regardless of income, disease type, or age, should have access to a nationally defined set of basic health services, which unequivocally includes palliative care. Financial and social protection systems must acknowledge and uphold the human right to palliative care, especially for vulnerable and marginalized populations.
Nurses, as integral members of multidisciplinary teams, require specialized training in palliative care skills, particularly those working with patients facing serious illnesses.
Specialist palliative care is a crucial component of service delivery. However, a sustainable, high-quality, and accessible palliative care system necessitates integration within primary healthcare, community-based and home-based care settings, alongside robust support for family caregivers and community volunteers. Providing palliative care should be recognized as an ethical obligation for all healthcare professionals.
The WHO actively supports global palliative care efforts. 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 vital global mandates and strategies concerning universal health coverage, noncommunicable diseases, and person-centered integrated health services. The WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents, released in 2019, provide further guidance.
In 2014, the landmark World Health Assembly resolution WHA67.19 urged the WHO and Member States to enhance access to palliative care as a fundamental element of health systems, emphasizing primary healthcare and community/home-based care models. WHO’s ongoing initiatives to strengthen palliative care are centered around:
- Integrating palliative care into all relevant global disease control and health system strategies.
- Assessing the progress of palliative care service development globally.
- Developing guidelines and tools for integrated palliative care across various disease categories and levels of care, addressing ethical considerations in comprehensive palliative care delivery.
- Supporting Member States in improving access to palliative care medicines through refined national regulations and delivery systems.
- Maintaining a special focus on palliative care for individuals 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 the effectiveness of palliative care programs.
- Developing key indicators for evaluating palliative care services.
- Advocating for adequate resource allocation to palliative care programs and research, especially in resource-constrained countries.
- Building evidence-based models of palliative care that are effective in low- and middle-income settings.
References
(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
