In 2021 I have had the honour of taking on roles in the name of two pioneering women with lasting legacies- Vice Dean (International) of the Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, and Director of the Cicely Saunders Institute (www.csi.kcl.ac.uk). They both strongly advocated for the role of research to improve outcomes for patients.
Cicely helped us to understand the needs of patients and families through the framework of physical, psychological, social and spiritual pain. Her multidisciplinary approach was pioneering – equally valuing good medical management of pain and symptoms alongside skilled psychosocial and spiritual care and support. Cicely set the challenge of us seeing each patient as an individual, important in their own right. Much has changed in the years since she founded St Christopher’s, but the challenge remains. How can we ensure that everyone facing life-limiting and life-threatening illness receives the care they need, at the right time?
The WHO Atlas of Palliative Care reported that 76% of adults and >97% of children who would benefit from palliative care live in low- and middle-income countries(1). Ehospice has been an incredibly effective tool to share and learn about challenges, inequalities, innovations and successes around the world. The WHO mortality data show the urgency of the task. By 2060 an estimated 48 million people (47% of all deaths globally) will die with serious health-related suffering, which represents an 87% increase from 2016. 83% of these deaths will occur in low-income and middle-income countries. Serious health-related suffering will increase in all regions, with the largest proportional rise in low-income countries (155% increase between 2016 and 2060). In absolute terms, it will be driven by rises in cancer deaths (16 million people, 109% increase between 2016 and 2060). The condition with the highest proportional increase in serious-related suffering will be dementia (6 million people, 264% increase between 2016 and 2060)(2, 3).
Universities have a crucial role in achieving the University Health Coverage goal of individuals and communities receiving the palliative care they need. First, they have an education function, ensuring that all health care professionals learn palliative care within their curricula, with locally relevant and up-to-date practices. There is also an urgent need for expanded access to postgraduate education in palliative care to develop leaders (in both education and practice). Second, research is needed to develop and evaluate models of care and interventions that will strengthen health systems, expanding coverage while maintaining quality across the health system.
Cross-national multidisciplinary partnerships are needed to foster academic departments. Strong university departments of palliative care in LMIC offer much to universities in high income countries through well-articulated partnerships(4). While universities in high income countries may have greater resources and a longer history in developing palliative care research methods, institutions in LMIC bring innovation, new approaches to widening access, and a strong commitment to research in developing local responses. Strong university departments working together internationally are key to delivering, disseminating and implementing palliative care for all.
- WHPCA/WHO. Global Atlas of Palliative Care. London: WHPCA/WHO; 2020.
- Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health. 2019;7(7):e883-e92.
- Sleeman KE, Gomes B, de Brito M, Shamieh O, Harding R. The burden of serious health-related suffering among cancer decedents: Global projections study to 2060. Palliat Med. 2020:269216320957561.
- Harding R, Namisango E, Radbruch L, Katabira ET. How to Establish Successful Research Partnerships in Global Health Palliative Care. J Pain Symptom Manage. 2016;53(2):2.