Palliative Care: The Way Forward

Non-communicable diseases (NCDs) have been leading the burden of disease in the Eastern Mediterranean Region, with 2.2 million lives lost annually to NCDs.1 The need for palliative care is indispensable as the burden of NCDs rises with time. Around 5% of adult patients require PC at the end of life2 and access to palliative care seems to be limited in this region.

Despite the differences in the development of palliative care among the Eastern Mediterranean countries, palliative care is a relatively new emerging discipline in this region and is facing different barriers; however, we feel, the way forward exhibits several opportunities. Upon observing palliative care from a closer perspective; the “Atlas of Palliative Care in the Eastern Mediterranean Region” recently mapped palliative care services in the region.8 The Kingdom of Saudi Arabia (KSA) has been one of the first countries in the region to introduce and expand palliative care across its regions in the early 1990’s.8 The kingdom seems to have one of the most advanced palliative care services in the region; with the highest number of palliative care programs, including both hospital and home/community based palliative care programs. Palliative care in the KSA has been acknowledged as an integral medical specialty along with having an official licensing program for physicians. At the educational level, the KSA has integrated palliative care education into the medical residency and fellowship programs and is also active in conducting palliative care research.

In comparison to the KSA, palliative care in other GCC countries seems to be in its early stages, where it has been introduced during the late 2000, and services are currently delivered mainly through hospital based programs.3 Home or community based services appear to be limited. At the educational level, several training programs for palliative care physicians have been developed and delivered.

Palliative Care Hospital

Despite the various current achievements by relevant health authorities, efforts that support integrating the service into the healthcare system, creating adequate national polices to regulate palliative care, identifying gaps in accessing palliative care essential medications, providing more education and training to healthcare professionals and creating awareness among general public appear to be promising.4

We believe, integrating palliative care into the countries’ healthcare system and consequently in its health financing model would be vital for providing accessible, high quality and effective palliative care services. Creating opportunities for advancing palliative care in the Eastern Mediterranean region may requires further enhancing palliative care initiatives at different levels, such as:

  • Policy level-where this entails ensuring the availability of national policies, strategies and standards that support provision of palliative care. 
  • Community/home based palliative care level-where this includes supporting the provision of palliative care at home.
  • Awareness raising level-where this involves raising the awareness of the general public about palliative care and its benefits.
  • Education level- where this requires ensuring the availability of trained healthcare professionals. Acquiring knowledge and skills in palliative care is fundamental for providing high quality palliative care services. This can be achieved through integrating palliative care into the medical and nursing curricula and the continuing education programs. The role of palliative care training has been vital and reflected in various outcomes such as recommending less aggressive interventions as opposed to major surgeries for patients with life-limiting illnesses.5

Accordingly, we believe that a national will that recognizes and acknowledges the importance of palliative care and the detrimental consequences of its absence would be a key factor for ensuring the success of such efforts and the way forward for rendering palliative care accessible and affordable to all those who need it.


By: Farah Demachkieh

References

  1. World Health Organization. Non-communicable diseases. 2018. Retrieved from http://www.emro.who.int/entity/ncds/index.html
  2. Alliance WP, World Health Organization. Global atlas of palliative care at the end of life. London: Worldwide Palliative Care Alliance. 2014 Jan
  3. Osman H, Rihan A, Garralda E, Rhee JY, Pons JJ, de Lima L, Tfayli A, Centeno C. Atlas of Palliative Care in the Eastern Mediterranean Region. Houston: IAHPC Press; 2017.
  4. Fadhil I, Lyons G, Payne S. Barriers to, and opportunities for, palliative care development in the Eastern Mediterranean Region. The Lancet Oncology. 2017 Mar 1;18(3):e176-84.
  5. Bateni SB, Canter RJ, Meyers FJ, Galante JM, Bold RJ. Palliative Care Training and Decision-Making for Patients with Advanced Cancer: A Comparison of Surgeons and Medical Physicians. Surgery. 2018 Apr 27.

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