A recent study examining the feasibility of further developing palliative care in the Republic of Greece was publicly released in Greece on 18 May.
This initiative is the first step in a three-stage project to further organize and implement a national strategy for palliative care development in Greece.
The Stavros Niarchos Foundation (SNF), in cooperation with palliative care leaders and the Greece Ministry of Health (MoH), initiated the process through the Worldwide Hospice Palliative Care Alliance to address the lack of progress on palliative care in the country.
“Palliative care has a long history in Greece, yet it has not developed along with other high income countries in the European Union,” said Dr. Stephen R Connor, Executive Director, Worldwide Hospice Palliative Care Alliance, who supported the work of the Committee as principal investigator of the study.
The feasibility study is a first step to examine the need for palliative care in Greece, to assess the capacity to deliver palliative care in the country, and to put forward recommendations for overcoming barriers to palliative care development.
The reported addressed all the policy makers in Greece, including the prime minister’s office, the parliament, the ministries of health, labor, education, finance and interior; academics; scientists; public health officials; NGOs and other civil society organizations.
In this report, the need for palliative care has been estimated at 120,000 to 135,000 patients and their families per year. This translates to approximately 15,000 patients per day.
At present, there are five programs delivering specialized palliative care in the country. Together, they are serving about 2,400 patients per year. In addition, there are oncology and pain clinics in hospitals offering pain relief.
In order to close the gap in access to palliative care in Greece it will require actions such as changing existing laws that have not been implemented and could interfere with correct palliative care development. This includes:
- educating a workforce of over 4,000 health professionals and many currently practicing prescribers;
- changing some current health budget flows to invest more in home based care;
- clarifying regulations on controlled substance prescribing and monitoring;
- creating a registry of patients receiving palliative care;
- developing standards of palliative care operation and clinical guidelines for provision of care;
- including primary care providers in palliative care delivery and setting up new palliative care interdisciplinary teams throughout the country for both adults and children.
The report identifies 20 major problems to be addressed and offers 42 recommendations to improve the provision of palliative care in Greece.
Addressing the need
Approximately 37% of the need for palliative care in Greece is for cancer patients and 63% for other conditions such as cardiovascular disease, chronic obstructive pulmonary disease, drug resistant TB, HIV, diabetes, cirrhosis, kidney disease, dementias, and other complex chronic conditions.
Over 95% of patients could receive care in their home setting and only about 3.5% in inpatient facilities at any given time. A projection of 500 inpatient beds for palliative care has been made. To meet the entire current need would require about 300 home-based care teams each serving 50 patients per day and would likely take decades to achieve.
At present the total need for inpatient palliative care beds is estimated at 500 beds while only 9 dedicated inpatient beds are currently available. This represents less than 0,5 % of the ultimate need.
Children also need palliative care services both during the neonatal period as well as through childhood and adolescence. They are affected by congenital and other chronic life-limiting or life-threatening conditions.
“It is important to understand that these are estimates of the current need in a perfect world where everyone gets palliative care. In no country is the full need for palliative care being met.
For example, in the 45 years that palliative care has been developing in the USA only about 75% of the current need is met. In Greece, it will likely take many years to meet the majority of the need for palliative care and planning must take this into account,” said Dr. Connor.
The gap between the need for and capacity to deliver palliative care in Greece is very wide. The need for palliative care support for those nearing the end of life alone is about 62,000 people annually. Current capacity to deliver palliative care is less than 4% of the decedent need and less than 2% of the total need. While hospice and palliative care is primarily an outpatient and home-based care service there is some need for inpatient care as well, usually for brief periods for severe symptom management.
This report is an attempt to examine the current status of palliative care in Greece and to explore the feasibility of bridging the gap in lack of access to palliative care. The current structures for providing needed palliative care are not effective in bridging this gap. Much more work is needed to do the extensive planning that is needed to accomplish this task.