Understanding access to palliative care for cancer patients in Europe: a vignette approach

Abstract

Abstract Background Palliative care encompasses all treatment and care options available for people with serious illness, such as incurable, life-threatening cancer. The goal of palliative care is to improve and maintain quality of life for both patients and their families. It focuses on the assessment and management of pain and other symptoms, addressing caregiver needs, and coordination of care. It requires early identification and coordinated treatment of problems in the physical, functional psychological, social or spiritual dimension. Methods A palliative care vignette was developed reflecting typical patient characteristics and a recommended patient pathway for advanced lung cancer: chemotherapy to shrink tumors and alleviate symptoms, opioids for pain, benzodiazepines for breathlessness and anxiety, laxatives for constipation due to opioid use, psychosocial assessment followed by psychotherapy and/or antidepressants, and counselling for family carers. Experts in 12 countries were asked to complete a survey on service coverage, cost sharing, physical access (availability) and other barriers to access. Results The presentation will report on findings from a cross-country perspective for each of the categories mentioned above (work is currently ongoing). Individual country examples will be used to highlight outliers and draw policy lessons for the future. Conclusions Palliative care has received considerable socio-political support in recent years, due primarily to epidemiological developments. Depending on severity, life expectancy and the patients' personal circumstances, it can be delivered in a variety of settings, including private residences, assisted living facilities, acute and long-term care hospitals, hospice residences, correctional facilities, and homeless shelters. As a result, access barriers might be particularly complex to identify and overcome. Cross-country learning can be an important catalyst for future improvements.