National palliative care programmes WHO core self-assessment tool

Professor Xavier Gómez-Batiste, Director, The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, and Chair of Palliative Care, Facultat de Ciències de la Salut i Benestar, Universitat de Vic, Barcelona, Spain

Thank you very much for this interesting debate on palliative care indicators. We’d like to share with you a tool that we have adapted, in collaboration with two other
WHO European Collaborating Centres, to assess the needs of national palliative care programmes. We have been using this tool in Barcelona since 2010 and it was also used at an Open Society Institute meeting in 2011.

Prof. Xavier Gómez-Batiste (back row, right) and his team at The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Catalan Institute of Oncology

Prof. Xavier Gómez-Batiste (back row, right) and his team at The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Catalan Institute of Oncology

An assessment of need for palliative care in different countries or regions could be based on the following considerations:

1. A combination of different indicators and measures:

  • Quantitative and qualitative
  • Structure (number of services) plus,
  • Process (number of patients supported by specialist services) plus,
  • Outcomes (coverage for cancer and non-cancer patients).

2. Although many countries do not have good information systems to assess the need for palliative care, we do know how to build estimates of mortality caused by chronic conditions based on the prevalence of patients with chronic conditions who are in need of palliative care.

3. We now know (our prevalence papers are being published very soon) that in
most high income countries where the ageing population (>65yrs) is more than  18%, that;

  • The mortality of chronic diseases is around 75%, (proportion cancer/non-cancer (50% cancer, 50% non-cancer).
  • The prevalence of patients with chronic conditions in need of palliative care is around 1.2%, most of them elderly, with a mean age of 80 years. More than 50% are suffering from geriatric-associated conditions rather than specific diseases; most of them are living in the community and the proportion of cancer/non-cancer is about 1:9.
  • This means that in the next few years, those most urgently in need of early palliative care will be non-cancer patients in the community.

4. Appropriate indicators are changing over time depending on the development of programmes and services; morphine or opioid availability/accessibility/ consumption could be good initially when most of the services are focused on cancer patients, but imprecise afterwards.

5. Indicators that are quantitative and qualitative are very useful. For instance, the proportion of cancer/non-cancer patients supported by specialist palliative care services is a very good indicator of the degree of adaptation of services to needs.

To find out more…
You are welcome to download a PDF version of our ‘National palliative care programmes WHO core self-assessment tool’ or please contact us at: xgomez.WHOCC@iconcologia.net


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One Response to National palliative care programmes WHO core self-assessment tool

  1. pallcare says:

    As good as the checklist is, I think that it does not offer an alternative for the proposed indicator in the NCD framework of WHO. If we have but one shot, I would rather have an outcome
    indicator than a structure or process indicator, and opioid consumption is an outcome indicator rather than any of the other two. The combination of qualitative / quantitative that Xavier mentions requires a lot of resources for assessment, as these data are not already available. In most countries in the world no or only very few specialist services are available, so for these countries the combination that Xavier suggests would make little sense. In most countries the first step of palliative care development was to acknowledge that palliative care is important for HIV/AIDS patients, and maybe for malaria and XDR-TB patients, and the next important step will be to realize it is also important for cardiac failure patients and for cancer patients. So Xavier’s suggestion would be a good way forward for developed countries, but less so for resource poor settings in developing countries.
    Again I would hold it that the indicator in the NCD framework is more relevant to developing countries, similar to the map of palliative care development that is just being released by WPCA.

    This is not a formula 1 racing course for the definition of the world champion of palliative care, but rather a dirt track ralley to see who is using his resources optimally to get to the goal line first (or at all).

    Lukas Radbruch

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