Comprehensive and Integrated Palliative Care for People With Advanced Chronic Conditions: An Update From Several European Initiatives and Recommendations for Policy

Abstract

The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer. There is a great need to identify these patients and integrate an early palliative approach according to their individual needs in all settings, as suggested by the World Health Organization. Several tools have recently been developed in different European regions to identify patients with chronic conditions who might benefit from palliative care. Similarly, several models of integrated palliative care have been developed, some with a public health approach to promote access to all in need. We describe the characteristics of these initiatives and suggest how to develop a comprehensive and integrated palliative approach in primary and hospital care and to design public health and community-oriented practices to assess and respond to the needs in the whole population. Additionally, we report ethical challenges and prognostic issues raised and emphasize the need for research to test the various tools and models to generate evidence about the benefits of these approaches to patients, their families, and to the health system.

Palliative care from diagnosis to death

“…33 A WHO web platform dedicated to integrated people centred palliative care (www. integratedcare4people.org/communities/integrated-peoplecentred-palliative-care/) has been launched to share good practice, experiences, and lessons.…”

Palliative care for people living with cardiac disease

“…2 Primarily, integrating PC in the patient care, and not transferring patients to the PC units, is the current paradigm of providing PC in patients with cardiac disease. 57,[93][94][95] The optimal…”

Home-Based Palliative Care and Aging in Place and Community

“…(Diane E. Meier) Estimates claim that in the high-income countries, 69 to 82 percent of people who die would benefit from palliative care. 2 Some claim that if everyone had access to palliative care, as we understand it today, the lives of 100 million people would be improved. 3 In 2014, the World Health Assembly established the first global resolution on palliative care.…”