European Healthcare Research Articles

The Impact of Population Ageing and COVID-19 on Healthcare Systems and Management in European Countries

The European healthcare landscape is undergoing significant changes due to the twin pressures of an aging population and the COVID-19 pandemic

Acute care bundles should be used for patients with intracerebral haemorrhage: An expert consensus statement.

Intracerebral haemorrhage (ICH) is the most devastating form of stroke and a major cause of disability. Clinical trials of individual therapies have failed to definitively establish a specific beneficial treatment. However, clinical trials of introducing care bundles, with multiple therapies provided in parallel, appear to clearly reduce morbidity and mortality. Currently, not enough patients receive these interventions in the acute phase. We convened an expert group to discuss best practices in ICH and to develop recommendations for bundled care that can be delivered in all settings that treat acute ICH, with a focus on European healthcare systems. In this consensus paper, we argue for widespread implementation of formalised care bundles in ICH, including specific metrics for time to treatment and criteria for the consideration of neurosurgical therapy. There is an extraordinary opportunity to improve clinical care and clinical outcomes in this devastating disease. Substantial evidence already exists for a range of therapies that can and should be implemented now.

Implementation of pre-emptive testing of a pharmacogenomic panel in clinical practice: Where do we stand?

Adverse drug reactions (ADRs) account for a large proportion of hospitalizations among adults and are more common in multimorbid patients, worsening clinical outcomes and burdening healthcare resources. Over the past decade, pharmacogenomics has been developed as a practical tool for optimizing treatment outcomes by mitigating the risk of ADRs. Some single-gene reactive tests are already used in clinical practice, including the DPYD test for fluoropyrimidines, which demonstrates how integrating pharmacogenomic data into routine care can improve patient safety in a cost-effective manner. The evolution from reactive single-gene testing to comprehensive pre-emptive genotyping panels holds great potential for refining drug prescribing practices. Several implementation projects have been conducted to test the feasibility of applying different genetic panels in clinical practice. Recently, the results of a large prospective randomized trial in Europe (the PREPARE study by Ubiquitous Pharmacogenomics consortium) have provided the first evidence that prospective application of a pre-emptive pharmacogenomic test panel in clinical practice, in seven European healthcare systems, is feasible and yielded a 30% reduction in the risk of developing clinically relevant toxicities. Nevertheless, some important questions remain unanswered and will hopefully be addressed by future dedicated studies. These issues include the cost-effectiveness of applying a pre-emptive genotyping panel, the role of multiple co-medications, the transferability of currently tested pharmacogenetic guidelines among patients of non-European origin and the impact of rare pharmacogenetic variants that are not detected by currently used genotyping approaches.

The role of veterinarians in zoonosis prevention: Advising families of immunocompromised children with pets

BackgroundPet ownership is widespread, offering numerous benefits to individuals and families. However, the risk of zoonotic diseases must be carefully considered, especially for immunosuppressed patients. Knowledge gaps in preventive measures for zoonoses have been identified, underscoring the vital role of veterinarians in addressing this issue. ObjectivesThis study aimed to assess the knowledge and recommendations of veterinarians regarding pet ownership by immunocompromised individuals. Additionally, we compared these insights with responses from European healthcare professionals specializing in pediatric transplant recipients. MethodsWe conducted an observational, cross-sectional study involving small animal veterinarians in Spain. An online survey was administered to gather information on veterinarians' knowledge of zoonoses and their recommendations for immunocompromised pet owners. ResultsA survey of 514 individuals was collected from experienced veterinarians mainly working in primary care clinics. Surprisingly, 63% of respondents did not routinely inquire about the presence of immunocompromised individuals among pet owners, although 54% offered specific recommendations for this group. Most respondents adhered to deworming guidelines for pets owned by immunocompromised individuals and demonstrated sound practices in Leishmania and Leptospira prevention, as well as the avoidance of raw food. However, gaps were noted concerning Bordetella bronchiseptica vaccination. Notably, veterinarians outperformed medical professionals in their knowledge of zoonotic cases and identification of zoonotic microorganisms. The presence of specific recommendations in veterinary clinics was viewed positively by nearly all respondents. ConclusionsOur findings indicate that veterinarians possess a superior understanding of zoonotic pathogens and exhibit greater proficiency in diagnosing zoonoses compared with physicians. They stay well-informed about recommendations outlined in established guidelines and are more likely to provide written recommendations in their clinics than physicians. Nevertheless, knowledge gaps among veterinarians emphasize the need for enhanced communication between medical and veterinary professionals. Reinforcing the “One Health” concept is imperative, with veterinarians playing a pivotal role in this collaborative effort.

Personalized Medicine Era: Exploring the Multifaceted Application of Biomarkers in Chronic Disease Management

The paper investigates the dynamic landscape of personalized medicine in European healthcare, focusing on the multifaceted application of biomarkers in chronic disease management from 2013 to 2023. Beginning with an exploration of the concept of personalized medicine, the study underscores the pivotal role of biomarkers in tailoring medical interventions to individual patient characteristics. The research methodology incorporates a systematic literature review, primary research studies, and case analyses to provide a comprehensive overview. Exemplary applications in oncology, cardiovascular diseases, and diabetes illuminate the transformative impact of biomarkers on treatment outcomes. The paper also navigates challenges such as data privacy, ethical considerations, and disparities in access, while highlighting opportunities for further research and improvement. Through collaborative efforts between healthcare professionals, researchers, and industry partners, personalized medicine emerges as a promising paradigm in reshaping the landscape of chronic disease management in Europe.

Healthcare Professionals’ Experiences of Recovery-Oriented Collaboration Between Mental Health Centres and Municipalities: A Qualitative Study

Collaboration within mental health centres and with municipalities in Western European healthcare has presented challenges due to structural and cultural disparities. The Danish healthcare system faces obstacles that impact mental healthcare services, particularly in cross-sectorial cooperation. Our aim was to investigate healthcare professionals’ experiences of recovery-oriented collaboration within a mental healthcare setting across hospitals and municipalities to gather a deeper understanding of this issue. Twenty-four employees were purposively sampled from mental health centres in Copenhagen and focus group interviews were conducted to explore their perceptions of working together. Inductive content analysis was used to analyse the data and identify themes and categories. The participants emphasised challenges in communication and coordination to improve collaboration within across the two sectors. This study can contribute to a greater understanding of collaboration between mental health centres and municipalities. It aims to inspire improvements in communication, coordination, and the optimisation of mental health service delivery across sectors.

Knowledge, Attitudes, and Practices of European Healthcare Professionals towards Hepatitis A and Hepatitis B Vaccination in at-Risk Adults.

Despite the occurrence of several hepatitis A (hepA) and hepatitis B (hepB) outbreaks in Europe in the last few decades, not all European countries have implemented hepA and hepB vaccinations in their national immunization programs, especially for adults at risk for hepA and/or hepB infection, such as men who have sex with men or patients with chronic liver disease. Currently, little is known on the attitudes of European healthcare professionals (HCPs) towards hepA and hepB vaccinations for at-risk adults. We conducted an online survey among HCPs in Germany, Spain, and the United Kingdom to assess their awareness of and adherence to their national hepA and hepB vaccination guidelines for at-risk adults. Among the 698 HCPs who took the survey, most (91.1%) were familiar with their national vaccination recommendations and always followed them or followed them most of the time when advising or prescribing hepA or hepB vaccines. Major and moderate barriers for recommending or administering such vaccines were the non-disclosure of risk factors by the patient (53.0-57.6%) and the patient's lack of motivation or knowledge about the risk of the disease (50.3-52.9%). These results may help inform strategies to improve and accelerate hepA and hepB vaccination in European at-risk adults.

The experience of racism against migrants in healthcare in Europe: a scoping review

Abstract Background Racial discrimination is frequently mentioned as a social determinant of migrants’ health. However, in the European context, racial discrimination and its impact on migrants’ access to healthcare is under-researched. This scoping review makes a first step toward filling this void by mapping the literature on racism against migrants in healthcare in Europe and identifying evidence gaps. Methods Following PRISMA guidelines, four databases were searched for empirical, peer-reviewed studies on manifestations, experiences, or impacts of racism against migrants in healthcare settings in European countries, published in English between 1992 and 2022. Out of 2365 articles screened, 43 were included in the data extraction. A quality assessment and narrative synthesis were performed. Results Our synthesis of the extant evidence identifies three interrelated ways in which racism manifests in and impacts migrants’ healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. However, our analysis demonstrates that for many country and healthcare contexts, research on racism in healthcare is lacking. Most studies apply an explorative qualitative research design, while the comparability and generalizability of research results are low. Furthermore, there is a near-exclusive research focus on racism at the interpersonal level, with little data on institutional and structural levels. Conclusions The review pinpoints limitations and lacunae in the current body of knowledge; namely a lack of evidence for many country and healthcare contexts, a dearth of generalizable results, and a near-exclusive focus on racism on the interpersonal level as compared to structural levels. At the same time, its findings underscore how racism reinforces inequities in healthcare and health outcomes. It thus highlights the need for systematic research on racism in healthcare in Europe. Key messages • Racism against migrants in healthcare reinforces health inequities through anti-migration bias, health(care)-related prejudice, and differential medical treatment. • Research on racism in healthcare in European countries is scarce; especially systematic and generalizable evidence and evidence on racism on structural levels is lacking.

Migrant workers in European informal health care settings

Abstract Care for the elderly in Europe increasingly depends on migrant carers, both in institutionalised and informal care settings. For the latter, the vulnerability of migrant carers working in private households has been described in several studies. Austria is a EU member state that made attempts to legalise the grey labour market of home care by several legislative changes, providing a framework of regulations to foster inclusion of migrant care workers into schemes of social protection. It can serve as an example how attempts of inclusion also make room for in-built mechanisms of exclusion, and how public health issues are related to economic considerations of a “care market”, with migrant workers as important, yet rather voiceless, stakeholders.

Voluntary private health insurance and management of frailty in European Health Systems: a longitudinal analysis

Abstract Frailty is a major health concern associated with aging. It is a state of multisystem physiological decline and inability to maintain homeostasis, gradually leading to an increased risk of multiple adverse outcomes, such as falls, hospitalizations, and death. The prevalence of frailty in community-dwelling older Europeans (65 years and older) varies between 5.8% and 27.3%; in addition, between 34.6% and 50.9% are classified as ‘pre-frail’. In the face of the rapid population ageing occurring in Western societies, frailty is set to reach epidemic proportions over the next few decades. Although most European health care system offer essential treatment free of charge, voluntary private health insurances (VPHI) are becoming more common. Their coverage can be complementary or supplementary including access, faster treatment, waiting list avoidance, and out-of-pocket refund. A growing body of evidence is showing that there is erosion of the universal health coverage in European Health Systems and accessing VPHI might impact quality of care, especially for complex conditions i.e. Frailty. Using European data from the 2013 to 2011 we will assess trends of VPHI in individuals 65 years and older and whether accessing VPHI impacts frailty management and quality of life for elderly Europeans who are frail. These findings will help assessing quality of frailty management in European Health Systems and identify possible inequalities in accessing health services.

Sentiment towards vaccinations in healthcare workers of five European countries after the pandemic

Abstract Background Health care workers (HCWs) are a trusted source of vaccine information for patients and communities. Our aim is to evaluate the impact of the COVID-19 pandemic on European HCWs’ sentiment towards vaccination (STV), focusing on COVID-19 and influenza. Methods We designed a multilingual Knowledge-Attitudes-Practice web-survey with 4-point Likert items addressed to HCWs in 11 countries and spread through national Public Health Associations. We present a preliminary analysis of responses from France (n = 206), Germany (n = 376), Italy (n = 394), Spain (n = 549) and the United Kingdom (n = 172, UK). Results The completion rate is 81% (1,374/1,697). Respondents are mostly female (66%), with a median age of 45, mainly employed as physicians (44%). HCWs agree on the effectiveness (92%), safety (89%) and necessity (91%) of vaccinations in general, but many think that their side effects are downplayed by pharmaceutical companies (46%) and health authorities (39%). The majority received 3+ doses of COVID-19 vaccines (72%) and agree that these vaccines are effective (88%) and have a favorable benefit-risk ratio (83%). However, many have concerns about their administration in pregnancy (76%). Most HCWs agree with mandatory COVID-19 vaccine for their category (59%) and are ready to accept a further COVID-19 booster vaccination if recommended (72%). The majority agree that the pandemic increased their attention to update their vaccination schedule (62%) and their confidence in vaccines safety (53%). Accordingly, only 50% received regular influenza vaccination prior to the pandemic, whereas 67% got vaccinated in the last season and 65% plan to do so in the next one. Overall, STV is more positive in Italy and Spain, less marked in Italy has the lowest scores in Germany. Conclusions Despite persisting doubts about COVID-19 vaccines and differences among countries, the sentiment towards vaccinations in European HCWs is generally positive and has improved after the pandemic. Key messages • European healthcare workers have generally positive sentiment towards vaccination, including COVID-19 and influenza, despite concerns about side effects and about administration during pregnancy. • The COVID-19 pandemic increased European HCWs’ attention to update their vaccination schedules, with the majority agreeing on the effectiveness, safety, and necessity of vaccinations in general.

The Future of HSR Program Evaluation: A European Perspective

Abstract There is a long tradition of program evaluation in public health, due to the influence of medical approaches and the development of evidence-based medicine. Health services research have thus provided substantial evidence and built itself partially on the evaluation of organizational innovations over time in various international healthcare settings. What is new here? What is the future of HSR from an evaluation perspective? Since the turn of the century, two main shifts in the resources and methods available to public health researchers could provide a significant leap for HSR research in Europe, and in France especially. First, more data are being produced and made available to researchers. Most healthcare systems in Europe have implemented DRGs and for doing so, information systems have been developed incidentally. This led to the routine production of data initially used for payment schemes, that are now increasingly being used for research. Although this is similar to what happened in the US, the main difference with European healthcare systems lies in the generalized approach of the welfare system to the whole population. Second, evaluation methods recently evolved towards the framework of what is known as “realist evaluation” based on the causal analysis of programs or public policies while incorporating contextual effects and a theoretical perspective to explain rather than merely measure the effect - or lack thereof. To conclude, we shall argue that the future of HSR program evaluation may bring together researchers, health professionals and policymakers to discuss, explore, experiment and implement innovative actions in healthcare to address the challenges to come.

European value-based healthcare benchmarking: moving from theory to practice.

Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. In the VOICE community-a European healthcare centre cluster intending to address VBHC from theory to practice-information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions.

20 years of declining hospital length-of-stay in different European healthcare models and systems

Abstract Background Hospital length of stay (LOS) is an important indicator of healthcare systems’ performance. Several factors are closely related to LOS, which is characterized by high heterogeneity among countries. This study aims to investigate the 20-year time-trends of LOS and their association with different healthcare systems’ and reimbursement models among 25 European countries. Methods We conducted a 20-year time-trend analysis (2000-2019) using a Weighted Least Squares model for panel data to investigate the association between LOS, healthcare systems’ models (National Health Service, NHS, National Health Insurance, NHI, Social Health Insurance, SHI, and Etatist Social Health Insurance, ESH), reimbursement schemes (Prospective Global Budget, PGB, Diagnosis Related Groups, DRG, and Procedure Service Payment, PSP), and several control variables. Data were extracted from the Eurostat and GBD study databases. Results The analysis showed a generalized reduction of LOS across the 25 countries, ranging from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to the reference category (NHS) (b=−0.6327, p < 0.05). Both DRG (b = 1.2399, p < 0.05) and PSP (b = 1.1677, p < 0.05) reimbursement models were positively associated with LOS when compared to PGB. Conclusions Our results confirmed the downward trend of LOS in the last 20 years among European countries, highlighting the strong influence of the healthcare system model. The results of this study offer insight into the factors influencing healthcare utilization and can inform the design of more efficient and sustainable healthcare systems. Key messages • This study investigated the relationship between HS models, financing, regulation, service provision, reimbursement schemes, and LOS, across 25 European countries in the last 20 years. • This study found a dominant influence of the HS models on LOS. SHI models were associated with shorter LOS compared to National Health Systems, after accounting for several factors.

Fellow travellers in transformative times: a reflection on 21 years membership of the European Health Policy Group.

It must have been early 2000, around the start of the new Millennium. I was working as a junior lecturer/researcher at the then Institute for Health Care Policy and Management at Erasmus University in Rotterdam, the Netherlands. Still barely familiar with Dutch health care as a policy system, let alone with European health care policy systems I decided that it would be a good idea to attend a seminar of the recently established European Health Policy Group. I had heard good stories about this new multidisciplinary group, founded by Elias Mossialos and Adam Oliver. My PhD thesis supervisor, Tom van der Grinten, also went there, as did some of my colleagues from the Department of Health Economics and Health Insurance, people like Erik Schut and Wynand van de Ven for example. They were close colleagues of me, although our respective disciplines from which we studied health care policy were different.

INDIVIDUAL ARTICLE: NECOM 3: A Practical Algorithm for the Management of Radiation Therapy-Related Acute Radiation Dermatitis.

In the Nordic European countries in 2020, cancer diagnoses accounted for 175,925 patients. About 50% of cancer patients receive radiation therapy (RT), which may lead to radiation dermatitis (RD). Notably, patients with breast, head, neck, and anal cancers may be prone to developing RD. However, few algorithms exist for the prevention and treatment of RD. The Nordic European Cutaneous Oncodermatology Management (NECOM) project aims to improve cancer patient outcomes by offering tools to prevent and treat cancer therapy-related cutaneous adverse events (cAEs). The first 2 NECOM papers presented various cAEs and skincare regimens involving hygiene, moisturization, sun protection, and camouflage products for preventing and managing cAEs. The NECOM 3 practical algorithm for preventing and managing acute RD (ARD) is intended to promote healthy skin and reduce RT-related ARD, improving cancer patient outcomes.  Results: The NECOM advisors discussed the results of a systematic literature review and obtained consensus on the evidence and opinion-based practical algorithm for ARD to support all stakeholders in the Nordic European healthcare setting. The algorithm starts with skin-preserving therapy, followed by skin condition assessment and patient-specific interventions based on the grade of RD present.  Conclusion: ARD may lead to symptoms of pruritus and pain, decreased QoL and morbidity, and treatment interruptions. Patient education on the prevention of RD and treatment recommendations given in the NECOM 3 algorithm may help prevent and manage RD and improve the overall care of patients receiving RT. J Drugs Dermatol. 2023;22:11(Suppl 2):s3-s10.

Racism against racialized migrants in healthcare in Europe: a scoping review

BackgroundRacism is frequently mentioned as a social determinant of migrants’ health and a barrier to health services. However, in the European context, racism and its impact on racialized migrants’ access to healthcare is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racial and ethnic discrimination against racialized migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research on this topic.MethodsFollowing PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report findings on manifestations, experiences and/or impacts of racial or ethnic discrimination against racialized migrants in a healthcare setting in a European country. They were summarized by study characteristics (geographical scope, study design, research question and measures) and research findings were synthesized.ResultsOut of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 38 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most studies apply an explorative qualitative research design; comparability and generalizability of research results are low. Our analysis furthermore shows a near-exclusive research focus on racism on the interpersonal level as compared to institutional and structural levels. Our synthesis of study results identifies three interrelated ways in which racism manifests in and impacts migrants’ healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment.ConclusionsOur review underscores how racism reinforces inequities in healthcare access and quality for racialized migrants. It also highlights the need for more research on racism in Europe across a greater scope of country contexts, healthcare settings and migrant/racialized categories in order to understand specific forms of racism and capture race as a context-contingent social construct. It is critical that future research includes the consideration of individual-level racism as embedded in racism on institutional and structural levels. Methods and insights from other disciplines may help to critically examine concepts in light of underlying historical, sociopolitical and socioeconomic processes and structures, and to improve methods for researching racialization and racism in healthcare.

The Role of Patients’ Advocacy Groups to Reduce Headache Pain in the European Union: from the Italian Case History to the European Migraine Action Plan

From the “patients’ right to avoid unnecessary suffering and pain” to the “Charter of Rights of the Cephalalgic Patient”, over the years the role of the civic & patients’ organisations to reduce headache pain in the European Union is increased: this research article explores the experiences of individuals affected by migraines and headaches, highlighting challenges, rights, and the need for improved healthcare support. Based on an extensive civic survey conducted at the national level by the Italian NGO Cittadinanzattiva, the study reveals the profound impact of headaches on people's lives, emphasising the lack of disability recognition and difficulties in accessing quality care. Through compelling testimonies, the article underscores the emotional, psychological, and physical burden of these conditions, and describes an innovative artificial intelligence-based tool called “EMI”. Together with many actors, since decades Cittadinanzattiva has been engaged in the fight against chronic pain for decades, both at the national and European levels. In this regard, what attention will the new MEPs (Members of the European Parliament) and the new leadership of the EU Commission DG Santé (Directorate-General for Health and Food Safety) dedicate to this issue in the wake of the upcoming European elections in 2024? From various quarters, there is a call for a European Migraine Action Plan aimed at finally placing this issue on the agenda of European political institutions, promoting a more inclusive and patient-centered vision within the European healthcare landscape, where the pain of those suffering from migraines and headaches is no longer invisible or unheard.

Interpreter services for immigrants in European healthcare systems: a systematic review of access barriers and facilitators.

Language barriers have been identified as a key access barrier to healthcare services for immigrants. The aim of this study was twofold: to investigate immigrants' and healthcare professionals' experiences with barriers and facilitators of interpreter services, and to examine the influence of barriers to interpreter services on the quality of care from immigrant and healthcare professional perspectives. We searched PubMed, Embase, The Cochrane Library, Scopus, SocINDEX and PsycINFO, resulting in 1425 studies. A total of 21 original quantitative, qualitative and mixed methods studies published between 1996 and 2021 were assessed as eligible for inclusion. Identified barriers included: lack of immediately available interpreter services, cost, lack of knowledge about availability, and attitude towards interpreter services. Facilitators included: a high number of interpreters in the requested language, awareness among healthcare professionals and patients of the patient's rights to interpreters, and a positive attitude towards use of interpreter services. Regarding quality of care, language barriers created safety risks for the patients, made patients feel unsafe, or delayed patient contact with the healthcare system. Immigrant patients and healthcare professionals experience barriers in using interpreter services due to restrictive policies regarding user fees and limitations to entitlement to interpreters, a limited number of qualified interpreters and lack of knowledge. Medical encounters with unaddressed language barriers can put patients at risk and reduce quality of care for immigrants, which calls for strengthening formal and informal access to interpreters.

Legal and Medical Aspects of the End of Human Life from the Perspective of Palliative Medicine Related to Cardiac Surgery

Abstract Despite the impressive developments in modern medicine, the healthcare system is still associated with human death. Medicine has made great strides in the treatment of many diseases. The procedures are particularly advanced in, e.g., cardiac surgery, vascular surgery, and other fields. However, despite these efforts, not all patients are cured, and the use of aggressive treatment often contributes to their suffering. This does not mean that patients should be left unattended at the end of their lives.. Palliative medicine deals with patients coming to the end of their lives, concentrating on alleviating suffering and improving quality of life. It is a medical speciality focused on a wide range of interventions, including symptom management, communication, and psychosocial and spiritual support for patients. Patients undergoing highly qualified procedures, for whom causal treatment is not possible, should have the right to such care before death. However, according to medical practice and national legal regulations, it is not always possible to provide this care, despite the anticipated death. This article presents the legal and medical aspects of the end of life from the point of view of the European and Polish healthcare systems.