Quality in palliative care: a critical note and a perspective

Prof Dr Wim J.A. van den Heuvel, Chairman of International Editorial Board of PALIAŢIA

The overall picture of palliative care is, that it is cost saving in almost all settings, although cost-effectiveness studies maybe criticized because of the variation in design and methods  (1). Given its costs-effectiveness many countries have developed palliative care, but the variation in the quality of palliative care is large (2). This variation has to do with the funding models in palliative care, but a successful model in one country may not be effective in another one (3). It seems that in many countries policy makers and involved palliative care professionals pick up those elements in building up a palliative care system, which fits them best. They seldom consider an overall view, which needs to include various dimensions, as is demonstrated by the quality of death index (2).

The principles of why and how palliative care never should be forgotten: ‘Palliative care is directed to maintenance of quality of life and to prevent and to relief suffering of those with a lifethreatening disease. It does not only concern the patient, but also the quality of life of family members and it deals with physical symptoms as well as with psychosocial and spiritual problems. Palliative care is delivered by vaious disciplines like nursing, medicine and social work’ (4).

The Quality of Death Index 2015 includes 80 countries worldwide, assessing the overall quality based on 5 dimensions, with a maximum score of quality of 100 (2). The highest scores (a score of > 80) are found in 9 countries (UK, Australia, New Zealand, Ireland, Belgium, Taiwan, Germany, the Netherlands and USA). 47 countries have a score below 50 and include in Europe Hungary, Russia, Slovakia, Greece, Bulgaria, Romania and Ukraine.

Of course, the quality of palliative care is not isolated from the way the health care system is organized in a country and the nation’s spending on health care and government policy on palliative care. Looking at that aspect, which is called the ‘health care environment’ dimension, 2 European countries score extremely low, i.e. Bulgaria and Romania. Looking at the dimension ‘quality of palliative care’, which means looking at the presence of painkillers, multidisciplinary teams, accommodations and bereavement services as well as using patients satisfaction surveys, the highest scores are for the UK, Sweden, Australia, New Zealand, France, Canada and Belgium (> 90), while in Europe Hungary, Bulgaria, Romania, Slovakia, Russia, Greece and Ukraine score < 40.

Despite these figures, there are recently indicators which may give an optimistic perspective about palliative care in Romania. For example, as reported before in PALIAŢIA, an unified, official regulation on how to organize palliative care in Romania is established (5). Part of it is the integration with regular health care services, including strengthening primary health care as noted in the last issue of PALIAŢIA.

Also this issue of PALIAŢIA offers perspectives because of the reviews, made and published by palliative care workers, which shows the interest to learn about recent developments abroad and the motivation to improve palliative care, based on evidence. The Editorial Board of PALIAŢIA welcomes all manuscripts, which contribute to stimulate the quality of palliative care. We all will benefit!

1. May P, Cassel JB. Economic outcomes in palliative and end-of-life care: current state of affairs. Ann Palliat Med 2018;7(Suppl 3):S244-S248.
2. The 2015 Quality of Death Index. Ranking palliative care across the world. The Economist Intelligence Unit; 2015.
3. Groeneveld EI, Cassel JB, Bausewein C. et al. Funding models in palliative care: Lessons from international experience. 2017; doi.org/10.1177/0269216316689015
4. Heuvel WJA van den, Olaroiu M. Palliative care in Romania: Needs and rights. Revista românǎ de bioeticǎ 2008;6(2):57-68.
5. Dumitrescu M. The first unified official regulation of how to organize palliative care in Romania. PALIATIA 2018: 11(2);10-1