EAPC Atlas of Palliative Care in Europe 2019

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POPULATION AND METHODS Methods of the project B Definition of ‘Palliative Care development’ Development, in this context, refers to the processes, structures, policies and resources that support the delivery of palliative care. Palliative care development was organised according to the WHO public health strategy for palliative care, which includes service provision and implementation, policies, education, and medicine availability (see WHO framework). In addition, we provide information on a fifth dimension, palliative care vitality, which reflects the level of professional activity within the country. Who framework In order to effectively develop and integrate palliative care into health care systems, the WHO launched a Public Health Model. This model includes advice and guidelines to governments for implementing national palliative care based on four components: 1) appropriate policies, 2) adequate use of medicines, 3) education of health care workers and the public and 4) implementation of palliative care services at all levels of society. This process is always applied within the cultural context, disease demographics, socioeconomics and the health care system of a country. Development of the project This project was developed in six step or different phases (see figure). Methodology Flowchart Systematic review Two rounds Delphi Consensus Process Open-ended interviews with EAPC task force Leaders Indicators assessment process EAPC General Development Survey Development of general and specialised networks EAPC Specific Survey Complementary Search in Databases > INBC > EAPC > ESMO > SLOPUS > PUBMED EAPC General Development Study Complementary Studies > Public Health > Education Development and i ntegration of PC into > Paediatrics > Primary Care > LTCF > Volunteer > Cardiology Complementary Studies on > Vitality > Opioid consumption > Oncology 2019 EAPC ATLAS OF PC European Overview National-Level PC Development EAPC Atlas of Palliative Care in Europe 36
METHODS OF THE PROJECT B Step 1: Systematic review We conducted a systematic review to identify the most commonly used national-level indicators on palliative care development in cross-national studies. Articles included fulfilled the following inclusion criteria: mention (1) palliative care development, AND/OR; (2) palliative medicine development, AND/OR; (3) hospice and PC nursing development, AND; (4) use of indicators that allow cross-national comparison of at least two countries, AND; (5) report on national-level development or status, AND; and (6) published between January 1, 2008 and July 31, 2017. Peer-reviewed literature was searched using PubMed and CINAHL, and an additional search was conducted on Google Scholar and Google to assess grey literature. The following Mesh terms were used in the search: [(Palliative Care OR Hospice Care), (Development OR Provision OR Mapping), and (National OR International)]. Articles and reports found were assessed by title and abstract. National-level indicators were compiled and clustered by dimensions of the WHO Public Health Strategy, plus two additional categories: research and vitality (professional activity). Within clusters, each indicator was labelled with frequency of appearance and in the end 38 indicators were selected. The six most frequently used indicators were the number of palliative care services per population, the existence of a national palliative care plan, strategy, or programme, the existence of palliative medicine specialisation, the availability and allocation of funds for palliative care, the proportion of medical schools including PC in undergraduate curricula, and the consumption of opioids. While there were several indicators assessing development at the level of general health care provision, there was a clear lack of indicators assessing integration of palliative care into health systems. We refer to indicators on the development of paediatric palliative care, the provision of palliative care at long-term care facilities, at the primary care level, in malignant and non-communicable diseases and on the integration with volunteers (Arias-Casais, 2018). Step 2: Consensus process with the committee of international experts A group of international experts on palliative care development were invited to participate in a two-round modified RAND/UCLA Delphi consensus process to select the best indicators resulting from the review. Expert selection criteria included: a) experience with national-level indicators for palliative care, b) experience in palliative care development evaluation projects, and c) participation in palliative care networks or advocacy activities for at least four years. Forty-four experts were invited to participate, of which thirty assessed 45 indicators by relevance, measurability and feasibility (1-9). These three scores were used to calculate a Global Score (1-9). Indicators scoring >7 proceeded to the second round, in which experts assessed 34/45 indicators. Median, Confidence Interval (CI), Content Validity Index (I-CVI), and Disagreement Index were calculated. Indicators scoring a 95% CI ≥7 and an I-CVI ≥0.30 were selected. Twenty-four experts (see the International Committee of experts on indicators) representing five continents and several organisations completed the study. Twenty-five indicators showed a high content validity and level of agreement. They were thus selected as 25 of the best indicators to assess national-level palliative care development. Policy indicators included –among others- the existence of designated staff in the national Ministry of Health, the inclusion of palliative care services in the basic health package and in the primary care list of services. Education indicators focused on processes of official specialisation for physicians, inclusion of teaching at the undergraduate level and existence of palliative care professors. Use of medicines indicators consisted of opioid consumption, availability and prescription requirements whereas services indicators included mainly number and types of services for adults and children. Additional indicators for professional activity were identified (Arias-Casais, 2019). These indicators were used to create the 2019 EAPC Atlas of Palliative Care survey, which was sent to key informants in each country. Cover of Brief Manual on Health Indicators to Assess Global Palliative Care Development. EAPC Atlas of Palliative Care in Europe 37
Page 1 and 2: B EAPC Atlas of Palliative Care in
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Page 5 and 6: Abstract INTRODUCTION B Background
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COUNTRY INFORMATION How to read the
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Gross Domestic Product per capita (
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COUNTRY INFORMATION / ARMENIA 9,937
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COUNTRY INFORMATION / BELARUS 5,728
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COUNTRY INFORMATION / BELGIUM 43,32
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COUNTRY INFORMATION / CROATIA 13,38
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COUNTRY INFORMATION / CZECH REPUBLI
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COUNTRY INFORMATION / DENMARK 56,30
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COUNTRY INFORMATION / FINLAND 45,70
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COUNTRY INFORMATION / FRANCE 38,477
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COUNTRY INFORMATION / GEORGIA 4,057
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COUNTRY INFORMATION / GERMANY 44,47
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COUNTRY INFORMATION / GREECE 18,613
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COUNTRY INFORMATION / HUNGARY 14,22
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COUNTRY INFORMATION / IRELAND 69,33
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COUNTRY INFORMATION / KYRGYZTAN 1,2
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COUNTRY INFORMATION / LATVIA 15,594
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15,594 Gross Domestic Product per c
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COUNTRY INFORMATION / LUXEMBOURG 10
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COUNTRY INFORMATION / NETHERLANDS 4
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COUNTRY INFORMATION / TURKEY 10,546
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COUNTRY INFORMATION / UKRAINE 2,640
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COUNTRY INFORMATION / UZBEKISTAN 1,
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EAPC Atlas of Palliative Care in Europe 2019

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