Palliative care for older people - World Health Organization ...

• the last days of life and death: the Liverpool CarePathway, or an equivalent tool, is recommended;• involving and supporting caregivers, with thefamily, including children, close friends and familycaregivers, recommended to be closely involved indecision-making and to have all the informationthey require;• education and training, with end-of-life carerecommended to be embedded in trainingcurricula at all levels and for all staff groups;• measurement and research, which requiresmeasuring the structure, process and outcomesof care; and• funding, with the government committing £88million in 2009/2010 and £198 million in2010/2011 to increase resources to implement thestrategy, but many of the improvements envisionedcan be achieved by using existing services better.The eastern part of the WHOEuropean RegionPalliative care services have developed somewhat incountries in the eastern part of the WHO EuropeanRegion following the political changes. Someimprovements have been achieved with the creationof the International Palliative Care Initiative withthe financial support of the Public Health Programof the Open Society Institute (12) and followingthe Council of Europe report on palliative care in2003 (13).Nevertheless, services are often unevenlydistributed, uncoordinated and poorly integratedacross wider health care systems. In the easternpart of the European Region, home care is themost common type of palliative care service,followed by inpatient palliative care, whereashospital teams, day care and nursing home teamsare much less frequent (13). Significant barriers tothe development of palliative care in these countries© Joan Tenohave been reported. These include: (1) financial andmaterial resources; (2) problems relating to theavailability of opioids; (3) lack of public awarenessand government recognition of palliative care as aspecialty; and (4) lack of palliative care educationand training programmes (14). A lack of financialand material resources has been reported as themost significant barrier. This has various causes,such as bureaucratic government systems, politicalinstability and pressing social problems.Mapping of hospice and palliative care servicesaround the world has found that such servicesare approaching integration in only four of thesecountries: Hungary, Poland, Romania and Slovenia(15). There are, however, some promising signs ofthe development of palliative care in the remainingcountries (Boxes 4.2–4.5).15