Primary Palliative Care: Thematic issue underlines an urgent need

In September the journal Palliative Medicine published a thematic issue: Primary Palliative Care. Scott A. Murray, a former board member of the IAHPC, and IAHPC Research Advisor Tania Pastrana, guest editors of the issue, prepared this Q&A. They added that, "This entire project has been a rewarding learning experience. We are now organizing webinars to further disseminate the insights from this special issue."

1. What is primary palliative care?

SM: This refers to palliative care provided by primary health care workers. This includes doctors, nurses, and other health care workers in community settings. One goal of palliative care advocates is to integrate palliative care into primary care, so as to reach patients earlier and ensure that it is more accessible to a wider population of those in need. As the demand for palliative care grows along with the aging global population as well as a rise in chronic illness, bringing palliative care into primary settings becomes critical.

2. Why this particular issue, and why now?

TP: Primary palliative care is essential to meet the increasing needs of patients, particularly those in low- and middle-income countries (LMICs). In an editorial I wrote with Dan Munday and Scott Murray for this special issue, we reflect on the rapidly growing number of people experiencing serious health-related suffering, especially where access to specialist palliative care is limited. 

International agencies, such as the World Health Organization, support the integration of palliative care into primary care. Primary care workers are in an ideal position to provide early palliative interventions, offer continuous care, and manage chronic diseases while collaborating with specialists. This approach is key to achieving universal health coverage and addressing health-related suffering globally.

3. Who are the contributors? 

SM: This special issue includes a rich and diverse group of contributors. For example, Anna Peeler, from King's College London, joined with researchers from Malawi and South Africa to conduct a scoping review on palliative care integration in LMICs. José Pereira provided insights on models of integrated care in Canada. Contributions from Portugal, China, Uganda, and Australia represent a wide range of perspectives. This global perspective adds great value to the issue. 

4. What type of contributions are included?

SM: The issue includes a mix of systematic reviews, original research articles, and practical case studies. For example, Mhoira Leng’s study on palliative care integration in refugee settings in Uganda offers insights into how palliative care can be implemented under such challenging conditions. Sarah Mitchell and her team conducted a realist inquiry involving workshops in Great Britain to explore how primary and palliative care integration can improve equity. Other articles feature innovative approaches, such as using electronic symptom monitoring in home-based palliative care, as explored by Suning Mao and her team from China. Other studies showed how less is more in palliative care.

We selected the Leng article for a European Association for Palliative Care (EAPC) blog because it highlights the tremendous potential of primary palliative care even in fragile, conflict affected, and vulnerable settings with significant refugee populations.

5. How long did the issue take, and were all contributions peer-reviewed?

TP: This special issue took nearly two years to complete. Catherine Walshe, the editor-in-chief of Palliative Medicine, reached out to me in October 2022, as I chair the EAPC's reference group for primary palliative care. I invited Scott Murray, funder of the reference group and pioneer in this field, to join me in this enterprise. In weekly meetings, often from various locations, we met to review nearly 100 submissions. All contributions underwent a rigorous peer-review process, with input from the journal’s editorial board. 

6. What do the contributors and editors hope to achieve with this special issue?

SM: Our hope is that this issue encourages global development and expanded research of primary palliative care. By sharing these diverse models and experiences, we aim to inspire health care professionals, policymakers, and educators to integrate palliative care into primary care settings. 

This integration is not just important for improving access: it is also necessary in order to address health inequalities, especially in underserved areas. In our editorial, we also suggest a research agenda for the future for readers to consider. 

Ultimately, we want this issue to be a stepping stone toward making early palliative and supportive care accessible for all who need it, regardless of where they live or their financial situation.

Editor's notes: Professor Murray has a podcast on the editorial. Also, both Scott and Tania welcome your feedback on the thematic issue.

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