EAPC Atlas of Palliative Care in Europe 2019
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. Per land is de stand van zaken van de (kinder)palliatieve zorg weergegeven.
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.
Per land is de stand van zaken van de (kinder)palliatieve zorg weergegeven.
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Chapter 10. Integration <strong>of</strong> <strong>Palliative</strong><br />
<strong>Care</strong> <strong>in</strong>to Cardiology<br />
EUROPEAN CONTEXT<br />
B<br />
TECHNICAL DATA<br />
ON THE <strong>2019</strong> <strong>EAPC</strong><br />
SURVEY ON PALLIATIVE<br />
CARE INTO CARDIOLOGY<br />
Population: 54 countries <strong>of</strong> the<br />
<strong>Europe</strong> WHO region and Lichtenste<strong>in</strong>.<br />
Survey Details<br />
Areas explored: 5 <strong>in</strong>dicators<br />
on PC provision <strong>in</strong> Cardiology<br />
services, <strong>in</strong>clusion <strong>of</strong> PC topics<br />
<strong>in</strong> Cardiology congresses (and<br />
vice versa), meet<strong>in</strong>gs between<br />
experts from the national cardiology<br />
and PC associations, and<br />
publications on PC provision <strong>in</strong><br />
cardiology services.<br />
Questionnaire: on-l<strong>in</strong>e survey,<br />
12 questions, time answered <strong>in</strong><br />
(average) 16 m<strong>in</strong>utes.<br />
Participants: 14 national experts<br />
<strong>in</strong> <strong>Palliative</strong> <strong>Care</strong> and Cardiology.<br />
Pr<strong>of</strong>ile <strong>of</strong> experts (affiliation):<br />
8 from Cardiology Departments<br />
(5 Cardiology departments, 3<br />
Cardiology Associations), 5 from<br />
PC centres (4 from PC services, 1<br />
from PC Association) and 1 from<br />
University .<br />
Coverage: 12/54 countries<br />
(22%): with one respondent<br />
9/12 (75%) countries, with two<br />
respondents 3/12 (25%)<br />
Data collection: 12/2018 to<br />
3/<strong>2019</strong> (4 months)<br />
Project Management: ATLAN-<br />
TES Research Group, Institute for<br />
Culture and Society, University<br />
<strong>of</strong> Navarra, Pamplona (Navarra),<br />
Spa<strong>in</strong> .<br />
Scientific Advice: Manuel<br />
Martínez Sellés (Spa<strong>in</strong>)<br />
y Pablo Díez Villanueva (Spa<strong>in</strong>).<br />
Promotor: <strong>Europe</strong>an Association<br />
for <strong>Palliative</strong> <strong>Care</strong> (<strong>EAPC</strong>).<br />
HEART failure patients may have generic palliative care needs and<br />
THEREFORE there exists an <strong>in</strong>creas<strong>in</strong>g conviction that <strong>in</strong> order to<br />
enhance care for patients with advanced heart diseases, PALLIATIVE<br />
<strong>Care</strong> should become a usual component.<br />
Nowadays accord<strong>in</strong>g to the <strong>EAPC</strong><br />
dedicated Taskforce on Heart Failure<br />
and the Heart Failure Association<br />
<strong>of</strong> the <strong>Europe</strong>an Society <strong>of</strong><br />
Cardiology, just a few people with advanced<br />
heart failure and those approach<strong>in</strong>g end <strong>of</strong><br />
life, as well as their families, receive appropriate<br />
PC support (1,2). Further exist<strong>in</strong>g <strong>in</strong>formation<br />
show that large gaps exist <strong>in</strong> address<strong>in</strong>g<br />
symptom burden and PC needs <strong>of</strong> cardiac<br />
patients ( 3,4, 5).<br />
In consequence, this chapter will <strong>in</strong>tend to provide<br />
a view on the degree to which <strong>Palliative</strong><br />
<strong>Care</strong> is <strong>in</strong>tegrated <strong>in</strong>to Cardiology <strong>in</strong> 12 <strong>Europe</strong>an<br />
countries (Albania, Czech Republic, Denmark,<br />
Germany, Ireland, Italy, Portugal, Spa<strong>in</strong>,<br />
Sweden, Switzerland, The Netherlands and the<br />
United K<strong>in</strong>gdom) by look<strong>in</strong>g at the very provision<br />
<strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> cardiology services<br />
but also at the level pr<strong>of</strong>essional collaboration<br />
between discipl<strong>in</strong>es. In 42 <strong>Europe</strong>an countries<br />
the research team was unable to identify a reference<br />
person for PC <strong>in</strong> Cardiology.<br />
PC Provision <strong>in</strong> Cardiology Services<br />
In <strong>Europe</strong>, the provision <strong>of</strong> palliative care for<br />
cardiac patients rema<strong>in</strong>s scarce, and solely<br />
eight countries report the existence <strong>of</strong> pioneer<strong>in</strong>g<br />
cardiology services provid<strong>in</strong>g <strong>Palliative</strong><br />
<strong>Care</strong>. All these countries (Czech Republic, Denmark,<br />
Ireland, Portugal, Spa<strong>in</strong>, Sweden, The<br />
Netherlands and the United K<strong>in</strong>gdom) identify<br />
at least an <strong>in</strong>tegrated service where <strong>of</strong>ten<br />
seems to have dedicated protocols for <strong>Palliative</strong><br />
<strong>Care</strong> delivery (Denmark, Italy, Spa<strong>in</strong>, Netherlands<br />
and United K<strong>in</strong>gdom).<br />
The frequency with which cardiology services<br />
and PC pr<strong>of</strong>essionals collaborate is occasional.<br />
A higher ratio has been identified <strong>in</strong> Spa<strong>in</strong><br />
and Italy, where good experiences <strong>in</strong> different<br />
Eduardo Garralda, Manuel Martínez Selllés, Pablo Díez Villanueva.<br />
centres mediated by the oncology experience<br />
(Italy) or a close relationship with <strong>in</strong>tra-hospital<br />
PC teams (Spa<strong>in</strong>), exist.<br />
PC topics <strong>in</strong>clusion <strong>in</strong> National<br />
Cardiology Congresses<br />
and vice versa<br />
<strong>Palliative</strong> care topics have been <strong>in</strong>cluded at<br />
least <strong>in</strong> the last three years <strong>in</strong> 11 <strong>Europe</strong>an<br />
countries (11/12). The extent to which this is<br />
a common issue varies from country to country.<br />
The Czech Republic reports the <strong>in</strong>clusion <strong>of</strong> a<br />
session on Advanced heart failure and palliative<br />
care with four lectures with<strong>in</strong> as an extraord<strong>in</strong>ary<br />
and new achievement, whereas Spa<strong>in</strong><br />
for <strong>in</strong>stance, report hav<strong>in</strong>g PC topics <strong>in</strong>cluded<br />
every year. Similarly, 10 countries (10/12)<br />
report the <strong>in</strong>clusion <strong>of</strong> cardiology topics <strong>in</strong> the<br />
National <strong>Palliative</strong> <strong>Care</strong> Congresses <strong>in</strong> the last<br />
three years though <strong>in</strong> the perception <strong>of</strong> some<br />
respondents <strong>in</strong>clusion <strong>of</strong> Cardiology topics <strong>in</strong><br />
PC Congresses is somehow more difficult than<br />
the other way round. Only Italy and Spa<strong>in</strong> report<br />
the existence <strong>of</strong> periodical meet<strong>in</strong>gs between<br />
experts from the national cardiology and PC<br />
association.<br />
Publications regard<strong>in</strong>g PC<br />
provision <strong>in</strong> Cardiology Services<br />
Seven countries report the existence <strong>of</strong> publications<br />
regard<strong>in</strong>g palliative care provision<br />
<strong>in</strong> cardiology services. The National experts<br />
reported diverse amount <strong>of</strong> scientific publications<br />
per country, rang<strong>in</strong>g from seven <strong>in</strong> Spa<strong>in</strong>,<br />
three <strong>in</strong> the United K<strong>in</strong>gdom, two <strong>in</strong> Italy, and<br />
at least one <strong>in</strong> the Czech Republic, Denmark,<br />
Portugal, and the Netherlands (a sample <strong>of</strong><br />
some <strong>of</strong> these articles can be seen <strong>in</strong> the bibliographic<br />
references´ section).<br />
<strong>EAPC</strong> <strong>Atlas</strong> <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> <strong>Europe</strong><br />
85