Key facts
Palliative care
improves the quality of life of patients and that osds…a)f their families who are facing challenges
associated with life-threatening illness, whether physical, psychological,
social or spiritual. The quality of life of caregivers improves as well.
Each year, an
estimated 56.8 million people, including 25.7 million in the last year of life,
are in need of palliative care.
Worldwide, only
about 14% of people who need palliative care currently receive it.
Unnecessarily
restrictive regulations for morphine and other essential controlled palliative
medicines deny access to adequate palliative care.
Adequate national
policies, programmes, resources, and training on palliative care among health
professionals are urgently needed in order to improve access.
The global need for
palliative care will continue to grow as a result of the ageing of populations
and the rising burden of noncommunicable diseases and some communicable
diseases.
Early delivery of
palliative care reduces unnecessary hospital admissions and the use of health
services.
Palliative care
involves a range of services delivered by a range of professionals that all
have equally important roles to play – including physicians, nursing, support
workers, paramedics, pharmacists, physiotherapists and volunteers—in support of
the patient and their family.
Palliative care is
an approach that improves the quality of life of patients (adults and children)
and their families who are facing problems associated with life-threatening
illness. It prevents and relieves suffering through the early identification, correct
assessment and treatment of pain and other problems, whether physical,
psychosocial or spiritual.
Addressing
suffering involves taking care of issues beyond physical symptoms. Palliative
care uses a team approach to support patients and their caregivers. This
includes addressing practical needs and providing bereavement counselling. It
offers a support system to help patients live as actively as possible until
death.
Palliative care is
explicitly recognized under the human right to health. It should be provided
through person-centered and integrated health services that pay special
attention to the specific needs and preferences of individuals.
Palliative care is
required for a wide range of diseases. The majority of adults in need of
palliative care have chronic diseases such as cardiovascular diseases (38.5%),
cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%) and diabetes
(4.6%). Many other conditions may require palliative care, including kidney
failure, chronic liver disease, multiple sclerosis, Parkinson’s disease,
rheumatoid arthritis, neurological disease, dementia, congenital anomalies and
drug-resistant tuberculosis.
Pain and difficulty
in breathing are two of the most frequent and serious symptoms experienced by
patients in need of palliative care. For example, 80% of patients with AIDS or
cancer, and 67% of patients with cardiovascular disease or chronic obstructive
pulmonary disease will experience moderate to severe pain at the end of their
lives. Opioids are essential for managing pain.
Opioids can also
alleviate other common distressing physical symptoms including breathlessness.
Controlling such symptoms at an early stage is an ethical duty to relieve
suffering and to respect a person’s dignity.
Insufficient access to palliative care
Each year an
estimated 56.8 million people are in need of palliative care, most of whom live
in low- and middle-income countries. For children, 98% of those needing
palliative care live in low- and middle-income countries with almost half of
them living in Africa.
Worldwide, a number
of significant barriers must be overcome to address the unmet need for
palliative care:
national health
policies and systems often do not include palliative care at all;
training on
palliative care for health professionals is often limited or non-existent; and
population access
to opioid pain relief is inadequate and fails to meet international conventions
on access to essential medicines.
According to a WHO
survey relating to noncommunicable diseases conducted among 194 Member States
in 2019: funding for palliative care was available in 68% of countries and only
40% of countries reported that the services reached at least half of patients
in need (1).
The International
Narcotics Control Board found that in 2018, 79 per cent of the world’s
population, mainly people in low- and middle-income countries, consumed only 13
per cent of the total amount of morphine used for the management of pain and
suffering, or 1 per cent of the 388 tons of morphine manufactured worldwide.
Although that was an improvement over 2014, when 80 per cent of the world’s
population consumed only 9.5 per cent of the morphine used for the management
of pain and suffering, the disparity in the consumption of narcotic drugs for
palliative care between low- and middle-income countries and high-income
countries continues to be a matter of concern (2).
Other barriers to palliative care include:
lack of awareness
among policy-makers, health professionals and the public about what palliative
care is, and the benefits it can offer patients and health systems;
cultural and social
barriers, such as beliefs about death and dying;
misconceptions
about palliative care, such as that it is only for patients with cancer, or for
the last weeks of life; and
misconceptions that
improving access to opioid analgesia will lead to increased substance abuse.
What can countries do?
National health
systems are responsible for including palliative care in the continuum of care
for people with chronic and life-threatening conditions, linking it to
prevention, early detection and treatment programmes. This includes, as a
minimum, the following components:
health system
policies that integrate palliative care services into the structure and
financing of national health-care systems at all levels of care;
policies for
strengthening and expanding human resources, including training of existing
health professionals, embedding palliative care into the core curricula of all
new health professionals, as well as educating volunteers and the public; and
a medicines policy
which ensures the availability of essential medicines for managing symptoms, in
particular opioid analgesics for the relief of pain and respiratory distress.
Palliative care is
most effective when considered early in the course of the illness. Early
palliative care not only improves quality of life for patients but also reduces
unnecessary hospitalizations and use of health-care services.
Palliative care
needs to be provided in accordance with the principles of universal health
coverage. All people, irrespective of income, disease type or age, should have
access to a nationally- determined set of basic health services, including
palliative care. Financial and social protection systems need to take into
account the human right to palliative care for poor and marginalized population
groups.
As part of
multidisciplinary teams, the nursing workforce should be trained in
palliativecare skills, especially those who work with patients with serious
illness.
Specialist
palliative care is one component of palliative care service delivery. But a
sustainable, quality and accessible palliative care system needs to be
integrated into primary health care, community and home-based care, as well as
supporting care providers such as family and community volunteers. Providing
palliative care should be considered an ethical duty for health professionals.
WHO response
Palliative care
medicines, including those for pain relief, are included in WHO Essential
Medicines List and the WHO Essential Medicines List for Children. Palliative
care is recognized in key global mandates and strategies on universal health
coverage, noncommunicable diseases, and people-centred and integrated health
services. WHO Guidelines for the pharmacological and radiotherapeutic
management of cancer pain in adults and adolescents were released in 2019 (3).
In 2014, the first
ever global resolution on palliative care, World Health Assembly resolution
WHA67.19, called upon WHO and Member States to improve access to palliative
care as a core component of health systems, with an emphasis on primary health
care and community/home-based care. WHO’s work to strengthen palliative care
focuses on the following areas:
integrating
palliative care into all relevant global disease control and health system
plans;
assessing the
development of palliative care services;
developing
guidelines and tools on integrated palliative care across disease groups and
levels of care, addressing ethical issues related to the provision of
comprehensive palliative care;
supporting Member
States in improving access to palliative care medicines through improved
national regulations and delivery systems;
a special focus on
palliative care for people living with HIV, including development of
guidelines;
promoting increased
access to palliative care for children (in collaboration with UNICEF);
monitoring global
palliative care access and evaluating progress made in palliative care
programmes;
developing
indicators for evaluating palliative care services;
encouraging
adequate resources for palliative care programmes and research, especially in
resource-limited countries; and
building evidence
of models of palliative care that are effective in low- and middle-income
settings.
