Comprehensive and Integrated Palliative Care for People With Advanced Chronic Conditions: An Update From Several European Initiatives and Recommendations for Policy

Xavier Gómez-Batiste, Scott A. Murray, Keri Thomas, Carles Blay, Kirsty Boyd, Sebastien Moine, Maxime Gignon, Bart Van den Eynden, Bert Leysen, Johan Wens, Yvonne Engels, Marianne Dees, Massimo Costantini

Research output: Contribution to journalArticlepeer-review

Abstract

The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer. There is a great need to identify these patients and integrate an early palliative approach according to their individual needs in all settings, as suggested by the World Health Organization. Several tools have recently been developed in different European regions to identify patients with chronic conditions who might benefit from palliative care. Similarly, several models of integrated palliative care have been developed, some with a public health approach to promote access to all in need. We describe the characteristics of these initiatives and suggest how to develop a comprehensive and integrated palliative approach in primary and hospital care and to design public health and community-oriented practices to assess and respond to the needs in the whole population. Additionally, we report ethical challenges and prognostic issues raised and emphasize the need for research to test the various tools and models to generate evidence about the benefits of these approaches to patients, their families, and to the health system.

Original languageEnglish
Pages (from-to)509-517
Number of pages9
JournalJournal of Pain and Symptom Management
Volume53
Issue number3
DOIs
Publication statusPublished - Mar 1 2017

Keywords

  • chronic care
  • comprehensive care
  • integrated care
  • Palliative approach
  • palliative care
  • public health planning

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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