The global need for palliative care will continue to grow as a result of the rising burden of non-communicable diseases and ageing populations.
- Each year, an estimated 40 million people are in need of palliative care, 78% of them people live in low- and middle-income countries. Worldwide 14% and in India only 1% people who need palliative care currently receive it.
- Palliative Care is, thus, an important but overlooked aspect of public health. It improves the quality of life of patients and their families who are facing problems associated with life-threatening illness, whether physical, psychosocial or spiritual.
- It involves taking care of issues beyond physical symptoms. Palliative care uses a team approach to support patients and their caregivers, that works together with the patient’s other doctors to provide an extra layer of support, facilitating a continnum of care. This helps patients live as actively as possible irrespective of the outcome.
- Palliative care is appropriate at any age and any stage in a serious illness and can be provided along with curative treatment.
- Palliative care is applicable across a wide range of diseases such as cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%) and diabetes (4.6%). Many other conditions may require palliative care, including kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies and drug-resistant tuberculosis.
- Worldwide 14% and in India only 1% people who need palliative care currently receive it.
- Pain is one of the most frequent and serious symptoms experienced by patients in need of palliative care. Opioid analgesics are essential for treating pain and other common distressing physical symptoms, including breathlessness. Controlling such symptoms at an early stage is an ethical duty in order to relieve suffering and respect the dignity of people. Overly restrictive regulations for morphine and other essential controlled palliative medicines deny access to adequate pain relief and palliative care.
- Lack of training and awareness of palliative care among health professionals is a major barrier to improving access.
- Early palliative care reduces unnecessary hospital admissions and the use of health services.
- Palliative care is explicitly recognised under the human right to health. It should be provided through person-centred and integrated health services that pay special attention to the specific needs and preferences of individuals.
This growth has occurred primarily in response to the increasing number of people living with serious and chronic illnesses and to the caregiving realities faced by their families. But palliative care has also been embraced for the simple reason it gives patients and families control and choice over their own care. The strong partnership of patient, family and the palliative care team ensures that treatment goals are established and coordinated and full communication is maintained in what is often a long, complex course of serious illness.
Since the early 1980s, the need for palliative care for cancer patients has been progressively acknowledged worldwide. More recently, there is increased awareness of the need for palliative care for other chronic diseases or conditions such as HIV/AIDS, congestive heart failure, cerebrovascular disease, neurodegenerative disorders, chronic respiratory diseases, drug-resistant tuberculosis, and diseases of older people.
However, there remains a huge unmet need for palliative care for these chronic life-limiting health problems in most parts of the country.
- The National health policy does not often include palliative care.
- Training in palliative care for health professionals is often limited or non-existent.
- Peoples’ access to opioid pain relief is inadequate and fails to meet international conventions on access to essential medicines.
- Lack of awareness among policy-makers, health professionals and the public about what palliative care is, and the benefits it can offer patients and health systems
- Cultural and social barriers that exist about death and dying.
- Misconceptions about palliative care, such as that it is only for patients with cancer, or for the last weeks of life.
- Misconceptions that improving access to opioid analgesia will lead to increased substance abuse.