One of the challenges in the implementation of palliative care has been a lack of consensus on what palliative care is, when it should be applied, to whom and by whom. The terms “palliative care” and “hospice care” have been used for many years, with different interpretations and several PC organizations have in turn, adopted their own definitions.
The current WHO definition for palliative care for adults was developed in 2002 and poses many challenges, limits palliative care to problems associated with life-threatening illnesses, rather than the need of patients with severe, chronic and complex conditions. The definition for children is even older (1998) and poses similar challenges.
In 2017, the Lancet Commission on Global Access to Palliative Care and Pain Relief published the report Alleviating the Access Abyss in Palliative Care and Pain Relief—An Imperative of Universal Health Coverage i and developed a framework to measure the global burden of serious health-related suffering (SHS), generating the evidence base to address this burden. The estimated SHS was based on 20 conditions or illnesses many of which are acute (such as malnutrition, low birth weight, hemorrhagic fevers, injuries, poisoning, etc.) and may be transitory if treated adequately and timely. This new approach by the Commission resulted in an even broader concept of PC and not surprisingly, the Commission recommended the WHO definition to be reviewed and revised to encompass health-system advances and low-income settings where medical professionals often have the difficult task of caring for patients without necessary medicines, equipment, or training.
Following the recommendation of the Lancet Commission and as an organization in formal relations with WHO, the IAHPC designed, developed and implemented a project to revise and adopt, based on consensus, a definition for palliative care.
The objective of this project was to develop, based on consensus, a PC definition that is focused on the relief of suffering that is timely and applicable to all patients regardless of the diagnosis, prognosis, geographic location, point of care and income level.
During 2018, the IAHPC developed a process based in three phases, including a large survey with over 400 IAHPC members from 88 countries. A paper with the description of the methodology has been submitted to a peer reviewed journal for dissemination.
The resulting definition consists of two sections and follows a similar structure to that of the WHO: a concise introductory statement and a list of components in bullet points. A third section was added after participants suggested adding a set of recommendations to governments.
i Knaul FM, Farmer PE, Krakauer EL, et al, on behalf of the Lancet Commission on Global Access to Palliative Care and Pain Relief Study Group. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. Lancet 2017; published online Oct 12. http://dx.doi.org/10.1016/S0140-6736(17)32513-8.