Palliative care in low- and medium-resource countries.
Low- and medium-resource countries are facing a significant increase in the incidence of noncommunicable diseases such as cancer. Unfortunately, the majority of patients with cancer present with advanced disease, and disease-directed treatment may be unlikely to be effective and/or not available. Globally, there will be a growing need for palliative care services. There has been significant progress in the provision and integration of palliative care into the health care policy and systems. Nonetheless, palliative care services vary significantly between regions of the world and also between countries in the same region. Some common barriers to care include the lack of a trained workforce to provide palliative care, lack of availability of opioids or the restriction of their use, cultural attitudes of physicians and patients, and also funding. Despite these challenges, there are examples of low- and medium-resource countries that are providing excellent palliative care that is being integrated into the health care system and the cancer care continuum. This article provides an overview of the progress in providing palliative care in low- and medium-resource countries. In addition, more specific information is provided on palliative care in low-resource countries in Latin America, Asia, and Africa. Finally, a more personal perspective is presented on the development of palliative care in Ethiopia, as an example.
A portion of this manuscript will be incorporated into a chapter in an upcoming book on global cancer care, Editors, Kenneth Miller, MD, and Miklos Simon, MD, Praeger Press. From *The Johns Hopkins University/Sinai Hospital of Baltimore Internal Medicine Residency Program, Baltimore, MD; †Friends of Hospice Ethiopia (formerly PHEALPS [Partnership of Hospice Ethiopia & ASIH L˚ngbro Park, Sweden]); ‡Sinai Hospital of Baltimore, Palliative Care Program, Baltimore, MD.
Arnab
A
Basu
Barbro Norrström
BN
Mittag-Leffler
Kenneth
K
Miller
D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards; D003906:Developing Countries; D006295:Health Resources / Q000592:standards / Q000600:supply & distribution*; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D011203:Poverty