New WHO Guidance (1) Palliative care the solid facts (2) Better palliative care for older people

1
New WHO Guidance(1) Palliative care the solid
facts(2) Better palliative care for older people

• Irene J Higginson
• www.kcl.ac.uk/palliative

2

• Intended audience, rationale, process of
  development
• Content of two booklets
• (1) Palliative care the solid facts,
• (2) Better palliative care for older people
• Next steps
• Invite discussion of dissemination and what
  useful in your countries

3
Acknowledgements

• Floriani Foundation
• The Open Society Institute Network Public Health
  Programme
• The European Association of Palliative Care
• Kings College London
• The European Institute of Oncology (WHO
  collaborating centre)

4
Acknowledgements WH0 expert group

• Janet Askham
• Elizabeth Davies (ed)
• Marilene Filbet
• Charles-Henri Rapin
• Kathleen M Foley
• Giovanni Gambassi
• Irene Higginson (ed)
• Claude Jasmin
• Stein Kaasa

• Lalit Kalra
• Karl Lorenz
• Joanne Lynn
• Martin McKee
• Miel Ribbe
• Jordi Roca
• Joan Teno
• Vittorio Ventafridda

5
Who is the guidance for?

• policy makers
• governments
• health care planners
• Professionals, voluntary, families - will be
  able to USE the guidance to advocate for
  palliative care

6
Process of development of guidance

• Telephone conference calls
• Meeting in Lago Orta, Italy
• Meeting at EAPC conference in the Hague
• Consultation, comment, EAPC, individuals,
  organisations (wide)
• Evidence review as part of WHO HEN document
• Formal WHO review

THANK YOU
7
Drafting, contributions, re-drafting, images, WHO
technical editor
8
Why two booklets?

• Initial goal - to provide guidance on palliative
  care for older people
• But how would we best reach policy makers?
• Be part of a series - THE SOLID FACTS which WHO
  Europe Office aims at policy makers
• But do policy makers know what palliative care
  is?
• Different people responsible for older and
  general
• 2 booklets - independent but interconnected

9
Content of guidance

• Short statements, key facts, pictures, figures
• Definitions
• Examples of good practice
• Recommendations
• Europe (relevant) focus (initially)
• There are many gaps in our knowledge, but it is a
  first step ideally would be updated

10
Palliative care The Solid Facts overview

• 1. Changing populations
• 2.   Emerging needs towards the end of life
• 3.   Palliative care
• 4.   Rights and options
• 5.   Effective palliative care
• 6.   Vulnerable groups
• 7.   Improving services
• 8.   Educating professionals
• 9.   Educating the public
• 10. Research and development

11
Palliative care The Solid Facts highlights
implications for policy

• 1.      Policy-makers must invest in providing
  publicly funded palliative care services as a
  core part of health care and not as an add-on
  extra.
• 2.      Policy-makers must take steps nationally
  to ensure that unmet needs for care are
  identified for all common serious diseases,
  including cancer, ischaemic heart disease,
  cerebrovascular disease, chronic obstructive
  respiratory disease, end-stage liver and kidney
  disease, infectious diseases and dementia.
• 3.      Policies must also recognize the work of
  families and caregivers and support them to help
  care for the patient. Might include assistance
  similar to that often granted to those with
  maternity and paternity responsibilities.

12
Palliative care The Solid Facts highlights
implications for policy

• 1.      Public health policy must acknowledge
  peoples right to high-quality palliative care
  and to make decisions about it, whatever the
  nature of the disease they suffer from. These
  rights should be enshrined in health and social
  care legislation.
• 2.      Policy-makers should monitor the wishes
  of seriously ill people concerning place of care
  and death.
• 3.      Policy-makers should routinely monitor
  place of death as one interim measure of success
  of the system of palliative care provided.
• 4. Policy-makers should encourage the
  health services to inquire of people their
  preference for place of care and death. Meeting
  individual preferences should be the ultimate
  measure of success.

13
Better palliative care for older people overview

• 1.  Why palliative care for older people is a
  public health priority
• 2.  Palliative care the needs and rights of
  older people and their families
• 3.  Evidence of underassessment and
  undertreatment
• 4.  Evidence of effective care solutions
• 5.  The challenge for health policy- and
  decision-makers
• 6.  Recommendations 

14
Highlights - Predicted proportions of people over
65 years in 2020
2000 2020
15
Highlights - Why is ageing important?

• Populations are ageing this is fastest in
  developing countries
• People reaching 65 live on average 12 22 more
  years
• Japan and France have highest life expectancies
• Proportion of those 80 years and over increasing
  fastest, already 4 this age in Germany, UK,
  France, Japan

16
Highlights - Why is ageing important?

• Most people who die are elderly
• Shift from acute to chronic causes of death
• New technologies and expectations
• Changing family, culture, ethnic patterns
• Likely reduction in available workforce

17
Highlights - From what will we die in 2020
worldwide?
Disorder Predicted ranking 2020 Previous ranking 1990
Ischaemic heart disease 1 1
Cerebrovascular disease (including stroke) 2 2
Chronic obstructive pulmonary disease 3 6
Lower respiratory infections 4 3
Lung, trachea and bronchial cancer 5 10
18
Highlights - palliative care inequities?

• Those dying in old age are more often missed by
  palliative care services
• because of
• nature of illness
• setting of care
• wishes of patients and families
• differences in treatment
• possible ageism?

19
(No Transcript)
20
Highlights - Where do patients die by country
21
Highlights - Illness in older people multiple
pathology

• Multiple problems, varying severity
• Minor problems may have greater psychological
  impact
• Cumulative effect may be much greater than any
  individual disease
• Additional problems of acute illness, physical or
  mental impairment, economic distress, social
  isolation

22
Next steps

• Document with printer
• Approval of proofs and photos by WHO (and me)
• Printing
• Launch - ? Nov / Dec (or early 2004)
• Dissemination and use
• Template of format / photos available from
  European Office - for translation and re-printing
  in other languages by those who wish

23
Questions

• Dissemination
• Launches involving ministry are planned in some
  countries, e.g. Italy
• What would be best way of disseminating for you
• Printing
• How many copies would you like, and where are
  best repositories of copies e.g. Mary
  Callaway's living room