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Skip to 0 minutes and 9 seconds People are interested in how palliative care is becoming more and more established across the world. A number of key reports have documented this, notably the Economist Intelligence Unit in 2015. As well as this, Professor Carlos Centeno was instrumental in the development of the European Association of Palliative Care Atlas of Palliative Care in Europe. We were fortunate to speak to Carlos of the ATLANTES Research Group of the University of Navarra about this important document. We started by asking him why and how he created it. The idea of to create the European Atlas of Palliative Care, it comes to me since 10 years ago or more.

Skip to 0 minutes and 57 seconds We want to show in very clear vision, what was the situation of palliative care around the countries. And the idea of put all the countries together to do a simple analysis to see how the different countries are, it’s powerful for many people. Carlos goes on to identify how he came up with the design to collect data for the Atlas. This is the key point of the Atlas, to find the information, to find the data. And to find that out 53 countries with around 850 million inhabitants it was difficult. We designed a method to find information that received information from at least three main sources. The first one it was the literature.

Skip to 2 minutes and 2 seconds From some countries the information was a lot and for others information was lacking. The second source of information, and perhaps the main source of information, it was the expert in the country. We invite to the National Association and asked names of people that can explain the situation of palliative care movement in the country. And also we asked the National Association their participation doing a peer review process after receiving the data. And the third source is our own data, because we have data from the last Atlas of Palliative Care that was done five years ago.

Skip to 2 minutes and 54 seconds And also we have in the head office of the European Association, we have several other data from, for instance, the number of people that is attending the conference of APC, or data of the number of associations that are in the countries. And so on. In the Atlas this time, we only focus on specialised palliative care. That means in-patient hospice, home care teams, hospital service, and also mixed teams. Because some teams work in the community but also in hospital in some countries. And this time, for the first time, we address also the issue of palliative care for children. Paediatric service. It’s the first time that any Atlas addressed this point.

Skip to 3 minutes and 50 seconds As well as looking at the provision of palliative care, they wanted to know about the education of people involved in delivering palliative care. What information about education. Two levels of education. The basic one about teaching in the university at the undergraduate level. And the more advanced educational level about the process of specialisation of the certification for palliative care physicians working full time in that field. A key aspect about the delivery of palliative care is how involved governments are in its provision. This can be shown through policy documents, and also by making appropriate drugs available.

Skip to 4 minutes and 35 seconds In this field we understand that we want to know if a country has a law about palliative care, and also if the country has a national strategy for palliative care. And the last one, the last point, is the drug availability. It’s, as you know, for the control of symptoms, one indicator of high quality is the use of opioids– and that is a strong pain killer– the use of opioids for the control of pain in cancer and non-cancer patients in both kinds of person. This is the information that we have in the Atlas. Four domains. Services, education, policies, and drug availability. Based upon his findings, we asked him which countries performed best. We think that this is a difficult question.

Skip to 5 minutes and 33 seconds To talk about who is best and who is worse always is a little bit difficult. Because there are many domains. And one country can be the best one in one domain and another one could be worse than another. In general, I started to tell this, in general, West countries are higher, with higher development than countries of Central and Eastern Europe. There are big differences between the two sides of Europe. In West Europe, the highest number of service per inhabitant are in the United Kingdom, the Netherlands, Belgium, Sweden. And in the East countries we have countries that are at the top level. Poland for instance, or Romania has good development of palliative care service and so on.

Skip to 6 minutes and 44 seconds Then, if we look at the number of services this is the reality. They sometimes found certain countries had incorporated palliative care into national directives or indeed as a legal requirement or policies better than others. Austria, France, Ireland, Italy, Poland are the best in Europe in this moment. They are basing it on national laws, plan, or strategies or standards for palliative care. Regarding education, that is another point that is important. Regarding education, Norway, United Kingdom, Israel, were the best performers per number of medical faculties teaching palliative medicine, and for the assistance of Chairs and Professors. These kinds of reports are completed on a regular basis, and they give us an opportunity to compare findings with previous years.

Skip to 7 minutes and 47 seconds Some countries have improved more than others. In recent years, we have the information of the two Atlases between 2005 and 2013, and for that reason we can compare. And it’s nice to see that several countries improved more than others. Perhaps Portugal is one of the countries that improved more recently. But also the Netherlands is a country with a big development of palliative care service. Not only in home care but also hospital and so on. Netherlands have improved the most in the last times. And Malta, one small country, Malta also is going better than before. Whilst there have been major improvements, there are still some major barriers to palliative care. Two main barriers are important for the integration of palliative care.

Skip to 8 minutes and 45 seconds In the study that we did with leaders of palliative care in the countries, these two are first, the lack of education in the universities for the future doctors and nurses. And second, the lack of specialised training for physicians working in palliative care. The translation of this is in many countries we don’t have enough palliative care physicians or palliative care nurses. Yet at the same time he could see real opportunities in palliative care as it develops as a speciality across Europe. Talking about main opportunities, in many countries are seeing that something is changing at the policy level in the Minister of Health in the regulatory framework. This is seen as the biggest opportunity now in Europe.

Skip to 9 minutes and 50 seconds In other countries they are seeing also opportunities in education. You can ask what happened? You said before that was the main barrier. It’s the main barrier is some parts of Europe, but in the countries that have started education in the universities, the leaders are seeing that as the big opportunity for their future. It’s interesting to see in our study that education is a barrier, when you say lack of education, but also is the big opportunity for Europe today.

Barriers to integrating palliative care in Europe

Palliative care is continuing to develop across the world. There are, however, a number of barriers to these developments.

The film you are about to watch features a discussion with Professor Carlos Centeno of the ATLANTES research group at the University of Navarra in Spain.

Carlos was instrumental in the development of the Atlas of Palliative Care in Europe (see below for the link to the full text). You will hear from Carlos about the creation of the Atlas, along with the barriers to integrating palliative care in Europe.

As you watch this film, consider what you think some of the barriers are to palliative care in your own country based on your own experiences. Your notes will be useful for the activity which follows the film.

Additional reading

For those of you who are interested, you can find some optional reading in the downloads section below.

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Palliative Care: Making it Work

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