Addressing suffering goes beyond treating just the physical symptoms of an illness. Palliative care embraces a holistic, team-based approach to support patients and their loved ones facing serious health challenges. This encompasses attending to practical needs and offering bereavement support, aiming to empower patients to live as fully as possible until the end of life.
Palliative care is fundamentally recognized as a human right to health. It should be delivered through patient-centered and integrated healthcare services, specifically tailored to meet the unique needs and preferences of each individual.
Who Needs Palliative Care?
Palliative care is essential for a broad spectrum of illnesses. Chronic conditions are the most common reasons adults require palliative care, including cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Beyond these, numerous other conditions can necessitate palliative care, such as kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disorders, dementia, congenital anomalies, and drug-resistant tuberculosis.
Pain and breathing difficulties are prevalent and distressing symptoms for individuals needing palliative care. For instance, a significant majority of patients with AIDS or cancer (80%), and a substantial number with cardiovascular disease or chronic obstructive pulmonary disease (67%), will experience moderate to severe pain as they approach the end of their lives. Opioid medications are crucial for effective pain management in these situations.
Opioids also play a vital role in alleviating other distressing physical symptoms, including shortness of breath. Addressing these symptoms promptly is not only ethically sound but also essential for relieving suffering and upholding a person’s dignity.
The Urgent Need for Palliative Care Access
Globally, an estimated 56.8 million people require palliative care annually, with the majority residing in low- and middle-income countries. For children needing this care, a staggering 98% live in these resource-limited nations, with almost half of them in Africa.
However, significant obstacles hinder access to palliative care worldwide:
- Palliative care is often overlooked in national health policies and systems.
- Healthcare professionals frequently receive limited or no training in palliative care principles and practices.
- Access to opioid pain relief medications remains inadequate, failing to meet international standards for essential medicines.
A 2019 WHO survey across 194 Member States regarding noncommunicable diseases revealed that palliative care funding was available in only 68% of countries. Alarmingly, only 40% of countries reported that palliative care services reached at least half of the patients who needed them (1).
Data from the International Narcotics Control Board in 2018 highlighted a stark disparity: 79% of the world’s population, primarily in low- and middle-income countries, consumed just 13% of the total morphine used for pain and suffering management, or a mere 1% of the 388 tons manufactured globally. While this represented a slight improvement from 2014, the gap in access to narcotic drugs for palliative care between wealthier and poorer nations remains a serious concern (2).
Further barriers to palliative care include:
- Lack of understanding among policymakers, healthcare providers, and the public about palliative care’s nature and benefits for both patients and healthcare systems.
- Cultural and societal beliefs surrounding death and dying that can hinder acceptance of palliative approaches.
- Misconceptions about palliative care, such as the false beliefs that it is 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 drug abuse.
Palliative care definition illustrated: Compassionate palliative care for children ensures comfort and dignity, addressing physical, emotional, and social needs.
Strengthening Palliative Care Systems Globally
National health systems bear the responsibility of integrating palliative care into the continuum of care for individuals facing chronic and life-threatening illnesses, connecting it with prevention, early detection, and treatment programs. This integration should encompass at least the following crucial elements:
- Health system policies: Policies that systematically incorporate palliative care services into the structure and financing of national healthcare systems at all levels of care.
- Human resource development: Policies focused on strengthening and expanding the palliative care workforce. This includes comprehensive training for current healthcare professionals, integrating palliative care into the core curriculum for all new healthcare professionals, and educating volunteers and the public.
- Medicines policy: A medicines policy that guarantees the availability of essential medications for symptom management, particularly opioid analgesics for pain and respiratory distress relief.
Palliative care delivers the greatest benefits when introduced early in the course of illness. Early integration of palliative care not only enhances patients’ quality of life but also demonstrably reduces unnecessary hospitalizations and the overall utilization of healthcare services.
Palliative care must be delivered in alignment with the principles of universal health coverage. Every individual, regardless of income, disease, or age, deserves access to a nationally-determined set of essential health services, which unequivocally includes palliative care. Financial and social protection systems must acknowledge 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.
Specialized palliative care represents one facet of service delivery. However, a sustainable, high-quality, and accessible palliative care system necessitates integration into primary healthcare, community-based and home-based care, and robust support for informal caregivers like family and community volunteers. Providing palliative care should be considered a fundamental ethical obligation for all healthcare professionals.
WHO’s Commitment to Palliative Care
Palliative care medicines, including those essential for pain relief, are included in the WHO Essential Medicines List and the WHO Essential Medicines List for Children. Palliative care is recognized within key global mandates and strategies concerning 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, released in 2019, provide crucial guidance (3).
In 2014, the landmark World Health Assembly resolution WHA67.19, the first global resolution on palliative care, urged WHO and Member States to prioritize improving access to palliative care as a core component of health systems, with a strong emphasis on primary healthcare and community/home-based care models. WHO’s ongoing efforts to strengthen palliative care are focused on:
- Integrating palliative care into all relevant global disease control and health system plans.
- Assessing the current state of palliative care service development worldwide.
- Developing comprehensive guidelines and tools for integrated palliative care across various disease groups and levels of care, addressing ethical considerations in palliative care provision.
- Supporting Member States in enhancing access to essential palliative care medicines through improved national regulations and delivery systems.
- Maintaining a special focus on palliative care for individuals living with HIV, including the development of specific guidelines.
- Promoting increased access to palliative care for children, in close collaboration with UNICEF.
- Monitoring global palliative care access and evaluating progress in palliative care programs.
- Developing key indicators to evaluate the effectiveness and quality of palliative care services.
- Advocating for adequate resource allocation for palliative care programs and research, especially in resource-constrained countries.
- Building evidence-based models of palliative care that are effective and adaptable 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
