Estimating the need for palliative care at the population level: A cross-national study in 12 countries.
To implement the appropriate services and develop adequate interventions, detailed estimates of the needs for palliative care in the population are needed.



To estimate the proportion of decedents potentially in need of palliative care across 12 European and non-European countries.



This is a cross-sectional study using death certificate data.



All adults (⩾18 years) who died in 2008 in Belgium, Czech Republic, France, Hungary, Italy, Spain (Andalusia, 2010), Sweden, Canada, the United States (2007), Korea, Mexico, and New Zealand ( N = 4,908,114). Underlying causes of death were used to apply three estimation methods developed by Rosenwax et al., the French National Observatory on End-of-Life Care, and Murtagh et al., respectively.



The proportion of individuals who died from diseases that indicate palliative care needs at the end of life ranged from 38% to 74%. We found important cross-country variation: the population potentially in need of palliative care was lower in Mexico (24%-58%) than in the United States (41%-76%) and varied from 31%-83% in Hungary to 42%-79% in Spain. Irrespective of the estimation methods, female sex and higher age were independently associated with the likelihood of being in need of palliative care near the end of life. Home and nursing home were the two places of deaths with the highest prevalence of palliative care needs.



These estimations of the size of the population potentially in need of palliative care provide robust indications of the challenge countries are facing if they want to seriously address palliative care needs at the population level.
1 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.|2 French National Observatory on End-of-Life Care, Paris, France.
Lucas
L
Morin
2 French National Observatory on End-of-Life Care, Paris, France.
Régis
R
Aubry
3 Italian National Insitute of Statistics, Rome, Italy.
Luisa
L
Frova
4 HammondCare and University of Sydney, Greenwich, NSW, Australia.
Roderick
R
MacLeod
5 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Donna M
DM
Wilson
6 Center for Palliative Care, Prague, Czech Republic.
Martin
M
Loucka
7 University of Pécs Medical School, Pécs, Hungary.
Agnes
A
Csikos
8 Regional Ministry of Equality, Health and Social Policies in Andalusia, Seville, Spain.
Miguel
M
Ruiz-Ramos
9 McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Marylou
M
Cardenas-Turanzas
10 Dongduk Women's University, Seoul, Korea.
YongJoo
Y
Rhee
11 Gerontology and Geriatrics, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.
Joan
J
Teno
12 Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.|13 Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
Joakim
J
Öhlén
14 Department of Medical Oncology, University Hospital Ghent, Ghent, Belgium.|15 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
Luc
L
Deliens
15 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
Dirk
D
Houttekier
15 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
Joachim
J
Cohen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000706:statistics & numerical data*; D012372:ROC Curve; D013727:Terminal Care / Q000706:statistics & numerical data; D055815:Young Adult
Palliative care; cause of death; end-of-life care; needs assessment