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.
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