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Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report
Ist Teil von
The Lancet (British edition), 2018-04, Vol.391 (10128), p.1391-1454
Ort / Verlag
England: Elsevier Ltd
Erscheinungsjahr
2018
Link zum Volltext
Quelle
MEDLINE
Beschreibungen/Notizen
[...]unlike many other essential health interventions already identified as priorities, the need for palliative care and pain relief has been largely ignored, even for the most vulnerable populations, including children with terminal illnesses and those living through humanitarian crises, and even in the Sustainable Development Goals (SDGs).2 Yet palliative care and pain relief are essential elements of universal health coverage (UHC).Several barriers explain this neglect: the focus of existing measures of health outcomes—major drivers of policy and investment—on extending life and productivity with little weight given to health interventions that alleviate pain or increase dignity at the end of life;3 opiophobia, which refers to prejudice and misinformation about the appropriate medical use of opioids;4–6 the focus, in medicine, on cure and extending life and a concomitant neglect of caregiving and quality of life near death;7,8 limitations on patient advocacy due to the seriousness of illnesses; the focus on preventing non-medical use of internationally controlled substances without balancing the human right to access medicines to relieve pain;9–12 and the global neglect of non-communicable diseases, which account for much of the need for palliative care.13 Global health is devoid of the investments, interventions, and indicators that are essential to ensure universal access to safe, secure, and dignified care at the end of life or to the palliation of pain and suffering.With this Report, we aim to remedy these limitations by: (1) quantifying the heavy burden of serious health-related suffering (SHS) associated with a need for palliative care and pain relief (section 1); (2) identifying and costing an Essential Package Of Palliative Care And Pain Relief Health Services (the Essential Package) that would alleviate this burden (section 2); (3) measuring the unmet need for one of the most essential components of the package—inexpensive, immediate-release oral and injectable morphine (section 2); and (4) outlining national and global health-systems strategies to expand access14 to palliative care and pain relief as an integral facet of UHC by applying a balanced approach that ensures adequate attention to both the medical needs of all patients and the risk of non-medical use (section 3).12 Our findings and recommendations are summarised in five key messages (panel 1).With budget constraints, this will mean trade-offs against other health-system priorities, and we propose a framework for measuring the value to patients and families of alleviating SHS that would complement existing metrics like quality-adjusted life-years (QALYs) and enable balanced decision making.18 We also present mechanisms for accessing lowest prices through collective action, adopting human resource models based on competencies to lower cost, and extending coverage through more efficient delivery models.