title: Comprehensive and Integrated Palliative Care for People With Advanced Chronic Conditions: An Update From Several European Initiatives and Recommendations for Policy.
abstract: The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer. There is a great need to identify these patients and integrate an early palliative approach according to their individual needs in all settings, as suggested by the World Health Organization. Several tools have recently been developed in different European regions to identify patients with chronic conditions who might benefit from palliative care. Similarly, several models of integrated palliative care have been developed, some with a public health approach to promote access to all in need. We describe the characteristics of these initiatives and suggest how to develop a comprehensive and integrated palliative approach in primary and hospital care and to design public health and community-oriented practices to assess and respond to the needs in the whole population. Additionally, we report ethical challenges and prognostic issues raised and emphasize the need for research to test the various tools and models to generate evidence about the benefits of these approaches to patients, their families, and to the health system.
authors.affiliation: The "Qualy" Observatory/WHO Collaborating Center for Palliative Care Public Health Programs, Catalan Institute of Oncology, Barcelona, Spain; Chair in Palliative Care, University of Vic, Barcelona, Spain. Electronic address: xgomez@iconcologia.net.
authors.forename: Xavier
authors.initials: X
authors.lastname: Gómez-Batiste
authors.affiliation: Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray
authors.affiliation: End of Life Care, University of Birmingham, Birmingham, UK.
authors.forename: Keri
authors.initials: K
authors.lastname: Thomas
authors.affiliation: Chair in Palliative Care, University of Vic, Barcelona, Spain; Chronic Care Program, Catalan Department of Health, Government of Catalonia, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Blay
authors.affiliation: Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Boyd
authors.affiliation: Education and Health Practices Laboratory, University Paris 13, Sorbonne Paris Cité, Bobigny, France; Health Simulation CenterSimUSanté®, Amiens University Hospital, Amiens, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Moine
authors.affiliation: Education and Health Practices Laboratory, University Paris 13, Sorbonne Paris Cité, Bobigny, France; Health Simulation CenterSimUSanté®, Amiens University Hospital, Amiens, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Gignon
authors.affiliation: Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Van den Eynden
authors.affiliation: Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Leysen
authors.affiliation: Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Wens
authors.affiliation: Department of Anaesthesiology, Pain, Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Marianne
authors.initials: M
authors.lastname: Dees
authors.affiliation: Palliative Care Unit, IRCCS Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Costantini
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D005060:Europe; D006291:Health Policy; D006801:Humans; D010166:Palliative Care / Q000941:ethics / Q000331:legislation & jurisprudence
keywords: Palliative approach; chronic care; comprehensive care; integrated care; palliative care; public health planning