Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases

Abstract

Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key ‘bottlenecks’: inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.

New public health approaches to palliative care, a brave new horizon or an impractical ideal? An Integrative literature review with thematic synthesis

“…If the social nature of death is not acknowledged in explicit terms, there is ample opportunity for the development of interventions under the banner of a new public health approaches that only serve to distance palliative medicine from the social roots of death and dying while creating structures that obstruct people in their desire to partake in the caregiving process. Since our initial search and the writing of this article, there have been additional publications in the field that are beginning to address some of these issues 122 ; however, as new interventions are developed and implemented, 121 and the scope is broadened, 123 there remains an inherent need to acknowledge the arguments laid out in this article.…”

Caring Advanced Cancer Patients at Home During COVID-19 Outbreak: Burnout and Psychological Morbidity Among Palliative Care Professionals in Italy

“…Working on a deeper PC integration in a broader community healthcare context could improve PCPs personal accomplishment and professional satisfaction (42)(43)(44)(45)(46)(47).…”

“One Health” Approach for Health Innovation and Active Aging in Campania (Italy)

“…The governance approach of Campania RS to address the needs of an aging population translates in strengthening disease prevention and health promotion in the entire life-course through empowerment and digital solutions, and in supporting independent living at home and in community, strengthening self-management of age-related conditions and reducing isolation. Such proactive, user-centered system empowers citizens and informal caregivers to take greater responsibility for health and well-being, by providing information and advising on healthy lifestyles, to stay active and healthy as long as possible (56)(57)(58). Similarly, age-friendly environments are beneficial to individuals and society throughout the entire life-course (59) and are enabled by digital solutions.…”