Only 10% of Patients Who Need Palliative Care Receive It

In medicine, we generally classify diseases into 2 categories: communicable diseases and noncommunicable diseases. The cause of the COVID-19 Pandemic we are currently fighting is the novel coronavirus, a communicable microorganism. Like viruses, bacteria and fungi also cause many deaths each year. However, noncommunicable diseases account for approximately 80% of all deaths. Leading examples include cancer, cardiovascular diseases, obesity, diabetes, dementia and chronic obstructive pulmonary disease (COPD).

As the burden of noncommunicable diseases continues to rise with the aging global population, there is an urgent and unmet need and demand for palliative care throughout the world.

Palliative care, also called "supportive care," consists of treatments given to people with serious and/or progressive illnesses and their relatives, from diagnosis throughout the course of illness, with the aim of improving quality of life and reducing symptoms.

The World Health Organization (WHO) says that only 10% of people who currently need palliative care receive it.

The WHO estimates that more than 56.8 million people need palliative care. Most of these patients (78%) live in low- and middle-income countries.

The WHO is calling for "urgent and concerted action" to increase access to quality palliative care services. To this end, it has published two new reports with the aim of helping countries assess the development of palliative care and improve the quality of palliative care services.

Every Year, 25 Million People Die Without Adequate Medical Relief 

The urgency of this issue was highlighted by The Lancet in its 2017 report on palliative care. This was the first study in which palliative care specialists made a worldwide estimate of the extent of serious suffering related to disease and injury, and the resulting need for palliative care and pain relief across the world.

The Lancet report states that more than 25.5 million people die every year without adequate relief from serious physical and psychological suffering.

The researchers identified a number of barriers to pain relief and palliative care, including what they called "opiophobia"—referring to prejudice and misinformation about the appropriate medical use of opioids (narcotic painkillers).

The researchers also identified as a problem medicine’s "overwhelming" focus on treatment and prolonging life, while neglecting care and quality of life for patients close to death.

The lack of access to morphine in many parts of the world plays a major role in inadequate pain control. Very complex bureaucratic problems can arise. For example, in sub-Saharan African countries, patients have to travel dozens of miles to register at a local police station because of legislation controlling access to morphine. In Turkey, there is no problem accessing morphine and similar opioid painkillers; however, we experience serious prejudice against these painkillers, which are quite safe when used correctly.

New WHO Reports – You Cannot Manage What You Do Not Measure

The first report calls for measuring palliative care development and establishing a global consensus on "a set of actionable indicators" that can provide reliable data to support clinical decision-making in this area.

The proposed model highlights the 6 components needed to provide optimal palliative care:

1. robust health policies related to palliative care;
2. the use of essential palliative care medicines;
3. the provision of palliative care within integrated health services;
4. education and training of health workers and volunteers in providing palliative care;
5. empowerment of people and communities; and
6. research related to palliative care.

Using the conceptual model, the researchers listed 18 indicators of palliative care. The report states that these indicators can be used by any country according to its individual needs.

Two subsets of indicators have been developed. The first subset consists of 10 core indicators considered essential for measuring palliative care within a country and for global comparative analysis.

The second subset includes strategic indicators. Nine indicators are considered the most appropriate and important to measure in countries where palliative care is in its early stages.

The second report focuses on "practical approaches and resources to support policy, strategy and implementation." The authors discuss practical strategies, policies and planning for palliative care programs and services, and highlight relevant resources available from the WHO.

At the point of care, quality palliative care can be improved and sustained in relation to care provided at home, and data can be collected and used to guide improvement efforts.