Palliative care

WHO defines palliative care as an approach that improves the quality of life of patients – adults and children – and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, impeccable assessment and treatment of pain and other problems, whether physical, psychosocial, or spiritual.

• provides relief from pain and other distressing symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten nor postpone death;
• integrates the psychological and spiritual aspects of patient care;
• offers a support system to help patients live as actively as possible until death;
• offers a support system to help the family cope during a patient’s illness and their own bereavement;
• uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
• will enhance quality of life, and may also positively influence the course of illness; and
• is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Barriers to the provision of palliative care

A number of significant barriers must be overcome to address the unmet need for palliative care in the Region.

• Only 8 European countries have national laws that include palliative care.
• Although 63% of western and 26% of central and eastern European countries have a standalone national palliative care plan, many countries do not have national health policies and systems that include palliative care.
• Only 29 European countries have an official accreditation process for physicians.
• While palliative care education is increasingly being included in medical and nursing school curricula across Europe, this is often as part of a module on another subject, such as cancer.
• Population access to opioid pain relief is inadequate and fails to meet international conventions on access to essential medicines in many European countries.

According to a WHO survey relating to noncommunicable diseases conducted among 194 Member States in 2019, funding for palliative care was available in 68% of countries and only 40% of countries reported that the services reached at least half of patients in need.

In 2018, the International Narcotics Control Board found that 79% of the world’s population, mainly people in low- and middle-income countries, consumed only 13% of the total amount of morphine used for the management of pain and suffering, or 1% of the 388 tons of morphine manufactured worldwide. Although that was an improvement over 2014, when 80% of the world’s population consumed only 9.5% of the morphine used for the management of pain and suffering, the disparity in the consumption of narcotic drugs for palliative care between low- and middle-income countries and high-income countries continues to be a matter of concern. In the Region, 38 countries report the availability of immediate release oral morphine (tablets or liquid) in primary care facilities and availability in over 50% of pharmacies. These countries were predominantly high-income countries.

Barriers to palliative care include:

• a lack of awareness among policy-makers, health professionals and the public about what palliative care is, and the benefits it can offer to patients and health systems;
• cultural and social barriers, such as beliefs about death and dying;
• misconceptions about palliative care, such as that it is only for patients with cancer, or for the last weeks of life; and
• misconceptions that improving access to opioid analgesia will lead to increased substance abuse.