EAPC Atlas of Palliative Care in Europe 2019

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Authors INTRODUCTION B Natalia Arias-Casais University of Navarra Institute for Culture and Society (ICS) ATLANTES Research Program Pamplona (Navarra), Spain Eduardo Garralda University of Navarra Institute for Culture and Society (ICS) ATLANTES Research Program Pamplona (Navarra), Spain John Yohan Rhee Department of Medicine, Mount Sinai Hospital New York, NY, USA 10029 University of Navarra Institute for Culture and Society (ICS) ATLANTES Research Program Pamplona (Navarra), Spain Liliana de Lima International Association for Hospice and Palliative Care Houston TX, USA David Clark University of Glasgow, Dumfries Campus School of Interdisciplinar Studies Dumfries, Scotland, UK Jeroen Hasselaar Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre (Radboudumc) Nijmegen, Netherlands Julie Ling European Association for Palliative Care (EAPC) Daniela Mosoiu Hospice Casa Sperantei Brasov, Romania Carlos Centeno University of Navarra Institute for Culture and Society (ICS) ATLANTES Research Program Pamplona (Navarra), Spain Juan José Pons University of Navarra Department of Geography Pamplona (Navarra), Spain. EAPC Atlas of Palliative Care in Europe 5
Abstract INTRODUCTION B Background Every year 4,428,663 people die with serious health related suffering in Europe, with estimated 138,913 of them being children. Access to palliative care (PC) would greatly ease suffering of these patients. Last assessment of PC development across Europe was conducted in 2013 and therefore, our aim is to provide an updated analysis on the development and integration of PC across the Region. Methods We conducted a systematic review to identify the most commonly used national-level indicators on PC development. Policy, medicine-related, education and service provision indicators were idenified and rated by a committee of international experts in a two-round RAND/UCLA Delphi consensus process. Additional indicators exploring the integration of PC into different levels of care, diseases and disciplines were derived from interviews with the EAPC Task Force leaders on paediatrics, long-term care facilities, primary care, volunteering, public health and cardiology. All these indicators were sent through on-line surveys to qualified national experts in their field. Additional databases on opioids (International Narcotic Control Board), professional activity (EAPC databases), and PC integration into oncology (ESMO databases, Clinical.Trials. gov and Scopus) were consulted. disease registered in 10 countries. Furthermore, eight reference cardiology centres providing PC were also identified and the presence of PC trained staff in Long-Term Care Facilities is increasingly common (14/19 countries). Volunteers are active throughout Europe and eight countries report over 1000 registered PC volunteers while others even report the existence of volunteer-led hospices. The professisonal vitality of the discipline is demostrated by the rise of national PC associations in 41/51 countries. This Atlas presents a set of 51 country reports highlighting key data on national policies, use of medicines, education and PC services provision and does not offer secondary comparative analysis between countries. Conclusion PC health policies developed in recent years have promoted vigorous development across Europe. Preliminary data on the integration of PC into different fields are encouraging though inequalities between countries and sub-regions persist. Further comparative analysis exploring factors leading to uneven progress may inform strategies to provide PC for all people in need. Results We received response from 321 experts from 94% (51/54) of European countries. The survey identified 6,388 specialised services for adults (a median of 0.8 adult services per 100,000 inhabitants) and a variety of programmes specific to PC for Children in 38 countries: home care teams (n=385), hospital programmes (n=162) and hospices (n=133). Most countries have established legal frameworks for the provision of PC, with specific laws reported in eight countries and other laws or decree-laws present in 63% of the countries. Twenty-nine nations have a process of specialisation in Palliative Medicine for physicians and PC has been included in the undergraduate curricula of medical and nursing schools in 43% of the countries with variations in the number of teaching hours and clinical practice. Full professors have been reported in medical schools in 14 countries and in nursing schools in five. The average of opioid consumption is 107 mg morphine equivalent/ capita/year. The integration of PC into different fields is noticeable. Although only 12/34 countries have systems to identify patients in need of PC at the primary level, the majority of countries provide PC in the last month of life. PC is being integrated into oncology and clinical trials on early integration of PC in the course of the oncological EAPC Atlas of Palliative Care in Europe 7
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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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