Palliative care: an indispensable component for a better quality of life

This article was exclusively written for The European Sting by Mr. Vinícius Almeida da Nóbrega, a first-year medical student at Federal University of Campina Grande, Brazil. He is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

There are several comorbidities and conditions that result in pain and suffering for people, including, for example, malignant neoplasms, dementia, renal failure, liver disease, injury and cerebrovascular diseases. Aggravating this scenario, global projection points to an increase in the number of deaths related to serious health-related suffering, especially in low and middle-income countries¹.

In this context, the importance of inserting palliative care is recognized to minimize the suffering triggered by certain health conditions by reducing pain, help in the control of symptoms, increase satisfaction with life, and act together to provide better quality of life for the patient, relatives and caregivers². In addition, it is important to highlight the need for early recognition of the indication of palliative care and the integration between health professionals and services, from primary care, so that palliative care is provided as expected within universal health coverage ^1;3.

A study that followed patients with severe neurodegenerative conditions found that the implementation of specialized palliative care improved the quality of life and relieved pain-related suffering, shortness of breath and sleep and bowel problems, without overloading the family or caregivers⁴. Other authors, analyzing a pediatric population with short life expectancy, found that palliative care at home was useful for the relief of symptoms and improvement of quality of life, decreasing the number of hospitalizations, besides reducing health costs.⁵

However, although the benefits of palliative care for patients and its importance in universal health coverage have been demonstrated, there are still obstacles that hinder its proper dissemination and execution.    Research analyzing the knowledge about palliative care of nursing home staff in six European countries found, for example, poor knowledge about pain management⁶, a situation that is probably aggravated in lower-income countries. In addition to the education problems already mentioned, another study adds other barriers to the implementation of palliative care, including cultural issues, difficulties in identifying referral for palliation, lack of trained human resources, as well as aspects related to problems in the health system and financial incentives for better performance in the palliative care scenario⁷.

Finally, given the above, the presence of palliative care within universal health coverage is essential and therefore should be defended and encouraged. With this objective, some actions can be carried out as measures to ensure a package of essential palliative care and pain relief health services, which includes the supply of medications, medical equipment, as well as professionals who assist in palliative care and promote reduction of physical or mental suffering of patients⁸. In addition, training of health professionals, encouraging the availability of low-cost drugs and developing funds for the promotion of palliative care are also attitudes that can contribute to improving access to palliative care⁹.

References

1. Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health. 2019 Jul;7(7):e883-e892.

2. Glare PA. Early implementation of palliative care can improve patient outcomes. J Natl Compr Canc Netw. 2013 Mar;11 Suppl 1:S3-9.

3. Munday D, Boyd K, Jeba J, Kimani K, Moine S, Grant L, Murray S. Defining primary palliative care for universal health coverage. Lancet. 2019 Aug 24;394(10199):621-622.

4. Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A et al. Specialist palliative care improves the quality of life in advanced neurodegenerative disorders: NE-PAL, a pilot randomised controlled study. BMJ Support Palliat Care. 2017 Jun;7(2):164-172.

5. Chong PH, De Castro Molina JA, Teo K, Tan WS. Paediatric palliative care improves patient outcomes and reduces healthcare costs: evaluation of a home-based program. BMC Palliat Care. 2018 Jan 3;17(1):11.

6. Smets T, Pivodic L, Piers R, Pasman HRW, Engels Y, Szczerbińska K et al. The palliative care knowledge of nursing home staff: The EU FP7 PACE cross-sectional survey in 322 nursing homes in six European countries. Palliat Med. 2018 Oct;32(9):1487-1497.

7. Aldridge MD, Hasselaar J, Garralda E, van der Eerden M, Stevenson D, McKendrick K, Centeno C, Meier DE. Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliat Med. 2016 Mar;30(3):224-39.

8. Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X et al. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet. 2018 Apr 7;391(10128):1391-1454.

9. Mon SW, Ozdemir S, Zu WWM, Win H, Maw MM, Win KC et al. End of life experiences of patients with advanced cancer in Myanmar: Results from the APPROACH study. Asia Pac J Clin Oncol. 2020 Dec;16(6):333-339.

About the author

Vinícius Almeida da Nóbrega is a first-year medical student at Federal University of Campina Grande, Brazil. He works with the International Federation of Medical Students’ Associations of Brazil (IFMSA – Brazil). Among its areas of interest are endocrinology, epidemiology and pneumology.