Guidelines and Suggestions for those Starting a Hospice/Palliative Care Service, 3rd edition

Derek Doyle, OBE, MD

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Despite the tremendous engagement of the palliative care community, many patients in need do not have access to hospice and palliative care services.

It is tempting to see the enormous avoidable suffering of many patients with severe disease and at the late stages of life and, knowing that palliative care will be able to ease their suffering, rush into starting a palliative care service without planning. This can be disastrous. Spending time (even years) planning a palliative care service is always time well spent.

Governments have been urged to include palliative care as part of health policy; integrate palliative care training into the curricula of health professionals; ensure the availability and affordability of all essentials medicines. However, there is inequity and significant gap in provision of palliative care worldwide.

Most countries worldwide do not have palliative care policies or integrated palliative care services. Even in countries with an adequate standard of care and well-developed health care services, access to palliative care is greater in urban areas and for patient groups, such as cancer patients. Many people do not know what hospice/palliative care is, and what it is not; what its essential features are and how it can be provided.

This series of brief papers has been prepared for those interested in starting palliative care services in low- and middle-income countries where knowledge about and funding for palliative care is limited, allowing access to palliative care services for all those patients and their family members that would benefit from this care. 'Getting Started' has been produced by the IAHPC and it does not aim to implant a particular model of care worldwide but provide guidance and advice on how to start a service.

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