Global Palliative Care and Cross-National Comparison: How Is Palliative Care Development Assessed?

Ramos, Natalia Arias; Garralda, Eduardo; Lima, Liliana De; Rhee, John Y.; Centeno, Carlos

doi:10.1089/jpm.2018.0510

Cited by 22 publications

(22 citation statements)

References 46 publications

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“…Conceptual work is continuing to refine the detailed dimensions that can make up an indicator of 21 published after the present study was designed, and supported by a systematic review, 9 contains eight subindicators within the policy domain, each with a clear definition. These would merit a separate research study at the global level.…”

Section: Discussionmentioning

confidence: 96%

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Palliative Care in Public Policy: Results from a Global Survey

Clelland

Steijn

Whitelaw

et al. 2020

Palliative Medicine Reports

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Background: Public policy has been a foundational component of the World Health Organization public health model for palliative care development since 1990. There is, however, limited evidence on the existence and character of palliative care policy at the country level. Objective: To identify, report on, and map the presence of national palliative care strategies, plans, legislation, and dedicated government resources in 198 countries. Design: An online survey generated 2017 data on indicators of national policy for palliative care. Subjects: In-country experts on palliative care. Measurements: The survey included specific questions on the existence and status of national strategies or plans, recognition of palliative care in national law, and dedicated government support. Results: Fifty-five countries have a national strategy or plan for palliative care of some sort, though levels of implementation vary. Forty-seven countries have some reference to palliative care in national law, and 24 have some form of stand-alone national law on palliative care provision or recognize it as a right in the constitution. Sixty-six countries have a dedicated section within government with responsibility for palliative care. Conclusions: There is a long way to go before palliative care around the world is universally supported by public policy intentions that will support its required development.

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Section: Discussionmentioning

confidence: 96%

“…Responses to the survey were used to score each country across 10 indicators of palliative care, drawn from the emerging literature. 9 Full results 8 and details of the study protocol 10 are described elsewhere.…”

Section: Methodsmentioning

confidence: 99%

Palliative Care in Public Policy: Results from a Global Survey

Clelland

Steijn

Whitelaw

et al. 2020

Palliative Medicine Reports

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“…We established 10 indicators of palliative care development, drawn from the emerging literature 23 and linked to specific questionnaire items (Table 2). For each indicator, we established an outcome range of six levels, fitted to the palliative care development categories and the definitions adopted.…”

Section: Discussionmentioning

confidence: 99%

Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017

Clark

Clelland

Garralda

et al. 2020

Journal of Pain and Symptom Management

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Context. Palliative care is gaining ground globally and is endorsed in high-level policy commitments, but service provision, supporting policies, education, and funding are incommensurate with rapidly growing needs. Objectives. The objective of this study was to describe current levels of global palliative care development and report on changes since 2006. Methods. An online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI), and Universal Health Coverage (UHC). Results. Numbers (percentages) of countries in each development category were as follows: 1) no known palliative care activity, 47 (24%); 2) capacity-building, 13 (7%); 3a) isolated provision, 65 (33%); 3b) generalized provision, 22 (11%); 4a) preliminary integration into mainstream provision, 21 (11%); 4b) advanced integration, 30 (15%). Development levels were significantly associated with WBIL (r S ¼ 0.4785), UHC (r S ¼ 0.5558), and HDI (r S ¼ 0.5426) with P < 0.001. Net improvement between 2006 and 2017 saw 32 fewer countries in Categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b. Conclusion. Palliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health-related suffering amenable to palliative care interventions is predicted by 2060. With an increasing need, palliative care is not reaching the levels required by at least half of the global population.

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“…Other measures included the inclusion of palliative care in health policies, improving educational opportunities for health professionals by developing specialized training, and improving measures to facilitate the use of essential medicines for pain and symptom relief. 4 Indicators estimating the provision of specialized services have been widely used in regional studies 5 and are recommend by experts for the monitoring of palliative care development globally. 6 Studies assessing development of specialized services have been used as advocacy tools for monitoring palliative care development.…”

Section: Introductionmentioning

confidence: 99%

Trends analysis of specialized palliative care services in 51 countries of the WHO European region in the last 14 years

et al. 2020

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Background: Service provision is a key domain to assess national-level palliative care development. Three editions of the European Association for Palliative Care (EAPC) Atlas of Palliative Care monitored the changes in service provision across Europe since 2005. Aim: To study European trends of specialized service provision at home care teams, hospital support teams, and inpatient palliative care services between 2005 and 2019. Design: Secondary analysis was conducted drawing from databases on the number of specialized services in 2005, 2012, and 2019. Ratios of services per 100,000 inhabitants and increase rates on number of services for three periods were calculated. Analysis of variance (ANOVA) analyses were conducted to determine significant changes and chi-square to identify countries accounting for the variance. Income-level and sub-regional ANOVA analysis were undertaken. Setting: 51 countries. Results: Forty-two countries (82%) increased the number of specialized services between 2005 and 2019 with changes for home care teams (104% increase-rate), inpatient services (82%), and hospital support teams (48%). High-income countries showed significant increase in all types of services ( p < 0.001), while low-to-middle-income countries showed significant increase only for inpatient services. Central–Eastern European countries showed significant improvement in home care teams and inpatient services, while Western countries showed significant improvement in hospital support and home care teams. Home care was the most prominent service in Western Europe. Conclusion: Specialized service provision increased throughout Europe, yet ratios per 100,000 inhabitants fell below the EAPC recommendations. Western Europe ratios’ achieved half of the suggested services, while Central–Eastern countries achieved only a fourth. High-income countries and Western European countries account for the major increase. Central–Eastern Europe and low-to-middle-income countries reported little increase on specialized service provision.

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Global Palliative Care and Cross-National Comparison: How Is Palliative Care Development Assessed?

Cited by 22 publications

References 46 publications

Palliative Care in Public Policy: Results from a Global Survey

Palliative Care in Public Policy: Results from a Global Survey

Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017

Trends analysis of specialized palliative care services in 51 countries of the WHO European region in the last 14 years

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