Caterina Magnani is a physician specialized in anesthesiology and general practice, and Head of Research at Antea Palliative Care Centre in Rome, Italy. Together with colleagues of Antea, she has translated the ‘EAPC Primary Palliative Care Toolkit’ into Italian. Carlo Peruselli, as a collective member of the EAPC, has reviewed the translated document.
Here, she explains why primary palliative care development is currently one of the main challenges in Italy.
In March 2017, the Italian Ministry of Health published a document that reports an updated version of the ‘Essential Health Care Levels’ 1 that must be provided by the National Health Care System. Two levels of home-based palliative care programmes have been defined: the ‘basic’ and the ‘specialist’. A ‘basic’ palliative care programme, as defined by the Italian official document, is a series of interventions, coordinated by the general practitioner (GP), aimed to ensure the palliative approach. It is quite similar to the ‘primary palliative care’ (PPC) concept and it provides optimal symptom management and adequate communication with patients and families. 2 Instead, a ‘specialist’ palliative care programme is defined as high-intensity health assistance, delivered by dedicated multi-professional staff and reserved exclusively to patients with complex symptom management and clinical instability. Specialist palliative care teams are composed of physicians and nurses with a high level of competence in palliative care, social workers, a psychologist and other healthcare professionals with experience in palliative care.
Now, thanks to this change, Italy has to face a big challenge: the development of a primary palliative care culture!
Furthermore, global average life expectancy has increased and people are living longer with a rise of chronic illness so that many patients will need skilled primary palliative care.
Antea is a non-profit organisation that has provided palliative care in Rome since 1987, education programmes and clinical research. Now, we plan to encourage the spread of an early palliative care approach through a project aimed at implementing educational initiatives.
First, we decided to translate into Italian the ‘EAPC Toolkit for the development of Palliative Care in the community’, 3 which we firmly believe enables individuals and organizations to implement innovative projects in primary palliative care (PPC). Anyone who is interested in promoting PPC development should use the toolkit questions to get a better understanding of barriers and opportunities for PPC, and its dissemination throughout our country. (See ‘Links and Resources’ below to download the Italian translation of the toolkit).
Next steps …
The next step of our project is to provide an Italian version of the ‘Supportive and Palliative Care Indicators Tool’ (SPICT),4 in order to help physicians to identify patients who could benefit from an early supportive and palliative care approach. We also plan to start training programmes on symptom management and good communication techniques facilitated by expert palliative care clinicians and educators. This training will target groups of GPs, nurses and hospital medical specialists (oncology, neurology, geriatrics and general medicine departments), to improve their skills in early identification of patients with palliative care needs, pain and other symptom management and good communication. We plan to run the courses in GPs’ medical centres and acute care hospitals so that everyone can participate without moving from the workplace.
Our project is only at the beginning but we firmly believe that primary palliative care is the first, indispensable step towards the improvement of quality of life of people with deteriorating health,5 and we are highly motivated to continue our mission.
- Decreto del presidente del consiglio dei ministri 12 gennaio 2017. Definizione e aggiornamento dei livelli essenziali di assistenza, di cui all’articolo 1, comma 7, del decreto legislativo 30 dicembre 1992, n. 502. (17A02015) G.U. Serie Generale n. 65 del 18 marzo 2017.
- Scaccabarozzi G, Lovaglio PG, Limonta F, Floriani M, Pellegrini G. Quality assessment of palliative home care in Italy. J Eval Clin Pract. 2017 Aug;23(4):725-733.
- Murray SA, Firth A, Schneider N, Van den Eynden B, Gomez-Batiste X, Brogaard T et al. Promoting palliative care in the community: Production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care. Palliat Med. 2015 Feb; 29 (2):101.
- Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. BMJ Support Palliat Care. 2014 Sep; 4(3): 285-90.
- Murray SA, Kendall M, Mitchell G, Moine S, Amblàs-Novellas J, Boyd K. Palliative care from diagnosis to death. BMJ. 2017 Feb 27; 356: j878.
Links and resources
- Antea Palliative Care Centre.
- Contact Dr Caterina Magnani by email.
- European Association for Palliative Care Reference Group on Primary Care.
- Download a copy of the Italian translation of the ‘EAPC Primary Palliative Care Toolkit’ here. [Scroll down to the publications section of the web page]. English, French and German translations are also available to download.
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