In an impoverished rural district in Malawi, 76 percent of patients receiving palliative care needed social supports. A study in the United States found that 44 percent of patients with advanced cancer experienced spiritual pain. Data on prevalence of social and spiritual distress among these patients are scant. Dyspnea-shortness of breath-is especially common among people who die of COPD and heart failure and only slightly less common among those who die of malignant neoplasms and HIV/AIDS ( Moens, Higginson, and Harding 2014).ĭepressed mood and anxiety are quite common among patients with a variety of advanced life-threatening illnesses. A recent meta-analysis of pain prevalence studies, almost all from HICs, revealed that 75 percent of patients receiving anti-cancer treatment or with advanced, metastatic disease had pain, most of which was moderate or severe ( Doyle and others 2017 Van den Beuken-van Everdingen, Hochstenbach, and Joosten 2016). Pain is also common among those who die of heart disease, COPD, renal failure, neurologic disease, and dementia ( Moens, Higginson, and Harding 2014 Solano, Gomes, and Higginson 2006). On the basis of this characterization of the burden of suffering, we propose an EP of palliative care and pain control designed to do the following:Įxisting data, mostly from high-income countries (HICs), indicate that well over 50 percent of patients who die of malignant neoplasms and HIV/AIDS experience pain ( Foley and others 2006). We then estimated the types, prevalence, and duration of suffering resulting from each condition. To roughly estimate the need for palliative care, we identified the serious, complex, or life-limiting conditions listed in the International Classification of Diseases (ICD)-10 that most commonly result in physical, psychological, social, or spiritual suffering ( WHO 2015a). Thus, it was necessary to make a preliminary estimate of the burden of health-related suffering requiring palliative care. This chapter describes an essential package (EP) of palliative care services and treatments that could and should be accessible to everyone everywhere, as well as the sites or platforms where those services and treatments could be offered. Yet palliative care is rarely accessible in low- and middle-income countries (LMICs). For these reasons, it is recognized globally as an ethical responsibility of all health care systems and a necessary component of universal health coverage ( World Health Assembly 2014). Palliative care also can lower costs to health care systems ( Chalkidou and others 2014 DesRosiers and others 2014 Gomez-Batiste and others 2012 Jamison and others 2013 Knaul and others 2017 Summers 2016). Prolonged survival in some situations ( Connor and others 2007 Temel and others 2010).
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