title: Barriers to the development of palliative care in the countries of Central and Eastern Europe and the Commonwealth of Independent States.
abstract: During the years of communist rule in the countries of Central and Eastern Europe (CEE) and the Commonwealth of Independent States (CIS), there were few significant palliative care developments. Since the political changes of the 1990s, however, there has been a steady development of palliative care services in this region. In 2005, the European Association for Palliative Care Task Force for the Development of Palliative Care in Europe undertook a qualitative survey among boards of national associations to identify barriers to the development of palliative care in CEE and CIS. By July 2006, 44 of 52 (85%) European countries had responded to the survey, but we report here on the specific results from 22 of 27 (81%) countries in CEE and CIS. Data were analyzed thematically by geographic region and by the degree of development of palliative care in each country. Four significant barriers to the development of palliative care were identified: 1) financial and material resources; 2) problems relating to opioid availability; 3) lack of public awareness and government recognition of palliative care as a field of specialization; and 4) lack of palliative care education and training programs. Despite huge variations in the levels of provision across the countries of CEE and the CIS, data collected in the qualitative survey reveal that the development of palliative care in many countries continues to remain uneven, uncoordinated, and poorly integrated across wider health care systems, mainly as a result of inadequate investment and limited palliative care service capacity.
authors.affiliation: International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster, UK. t.lynch2@lancaster.ac.uk
authors.forename: Thomas
authors.initials: T
authors.lastname: Lynch
authors.forename: David
authors.initials: D
authors.lastname: Clark
authors.forename: Carlos
authors.initials: C
authors.lastname: Centeno
authors.forename: Javier
authors.initials: J
authors.lastname: Rocafort
authors.forename: Luis Alberto
authors.initials: LA
authors.lastname: Flores
authors.forename: Anthony
authors.initials: A
authors.lastname: Greenwood
authors.forename: David
authors.initials: D
authors.lastname: Praill
authors.forename: Simon
authors.initials: S
authors.lastname: Brasch
authors.forename: Amelia
authors.initials: A
authors.lastname: Giordano
authors.forename: Liliana
authors.initials: L
authors.lastname: De Lima
authors.forename: Michael
authors.initials: M
authors.lastname: Wright
mesh_terms: D000701:Analgesics, Opioid / Q000600:supply & distribution; D005060:Europe; D005061:Europe, Eastern; D019538:Health Care Surveys; D017051:Hospice Care / Q000706:statistics & numerical data; D010166:Palliative Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid