How cancer supportive and palliative care is developed: Comparing the policy-making process in three countries from three continents

The expression of ‘policy’ in palliative care: A critical review

“…However, in our corpus, this ground was more frequently associated with negative wording around the consequences of these universal problematisationsmainly in relation to 'burdens' and their detrimental impacts on healthcare systems as they are currently configured [79]. These included "financial" [54], "economic" [9] and "service demand" [80] burdens and were again sometimes couched in amplified terms; for example, "greatly increasing" care demands [80], "enormous" service pressures [83] and an "exponential growth" of service costs at death [52].…”

“…Here, in addition to the selection of confirmatory datasets (and the exclusions of others), the tendency to 'forecast' and amplify via crude extrapolations is prominent [9]. These tensions were reflected in the literature we identified and seem to move into the territory of 'wrongful inclusion', particularly in a 'Global North' context.…”

“…Here, powerful nominals "demographic shift" and "changes in the future demographics of dying" [52] were most apparent. The concept of "aging populations" was often cited [9]; as was the suggestion of an accelerating rate of change, for example: "the population is….aging faster" [53]; "demographic situations are changing rapidly" [54]. This foundational narrative was complemented by the identification of an associated shift from acute to non-communicable [55] and chronic conditions [56], as well as significant levels of "co-morbidity" [57].…”

“…The very basis of the existing healthcare system in both Global 'North' and 'South' contexts was at times itself problematised as being variously, "fragmented" [84], "patchy" [85] and made up of "silos" [86]. These issues were additionally expressed in relation to more operational "gaps" [79], "deficits" [87] and "barriers" [33] that tended to focus on features like low organisational capacity [88], low numbers in the specialist workforce [87], shortages in specialist beds and equipment [9] and poor assessment, referral and communication processes [89]. Various human-resource related shortfalls were also expressedlike deficits in palliative care education provision [79], an insufficiently skilled workforce [86] and knowledge and skills deficits [57].…”

“…Such expressions appeared to address a void, Clark [7] suggesting that, "before…2000 there was little systematic understanding of how palliative care was developing". Interest in this policy ground continues to grow, predominantly in relation to primary 'source' palliative care policy documentation [8] and in a variety of contexts: specialisms like cancer, dementia and heart failure [9][10][11]; organisations like hospices, pharmacies and hospitals [12][13][14] and geographies, such as, Ireland [15] and Uganda [16].…”