Palliative Care in Spain

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The WPCA’s report: ‘Mapping levels of palliative care’ listed Spain as having achieved “preliminary integration” of palliative care.

Spain has a national palliative care association, the Sociedad Espanola de Cuidados Paliativos (SEPCAL),  founded in 1992 and which currently has 1800 members. The stated aims of the society are to consolidate ensure aid for research, and facilitate participation in conferences by Spanish palliative care professionals. The society also aims to build good relations with all scientific societies related to palliative care.

A directory of Spanish palliative care services is available on the SEPCAL website, although members suggest that this is due to be updated.

The Spanish Ministry of Health published a national plan on palliative care in 2007. This plan focuses on improving the quality of care at the end of life and ensures that access to palliative care is recognised as a legal- as well as a human right. The plan also includes bereavement care for families of patients.

A majority of patients accessing palliative care services in Spain have a cancer diagnosis. However, palliative care researchers have developed the NECPAL (Necesidades Paliativas; Palliative Needs) programme to identify non-cancer patients in need of palliative services.

According to the EAPC taskforce on the development of palliative care in Europe, Spain provides palliative care training for physicians, both in the form of a national program, and is not yet recognised as a medical or nursing speciality.

Some key challenges identified by those providing palliative care services in Spain are as follows:

  • Coverage of specialist services in many regions
  • Non-cancer chronic patients palliative approach in conventional services, although this is now addressed by Catalonia and Galicia with the NECPAL programme.
  • Implementing more actively psychosocial and spiritual care
  • The lack of a formal specialist training.

In a blog published in April last year on the EAPC website, Prof Xavier Gómez-Batiste, M Dulce Fontanals, Carles Blay and Jordi Roca-Casas, celebrated 25 years of palliative care in Spain, and announced the first Chair of Palliative Care in the country.

In Spain, palliative care services take the form of Hospital or Home support teams, palliative care units, or comprehensive networks. There is one dedicated “hospice” service, the CUDECA foundation in Malaga, based initially in the British experience of Hospices, and actually integrated as provider in the National Health care services in the region. 

There are major differences between regional palliative care provision, despite the existence of the National Strategy. The regions of Catalonia, Extremadura, Madrid, and Navarra, are among the best served with specialist palliative care services.

Palliative care was first introduced in Catalonia, and this province continues to lead the way in palliative care service provision, research and education.

The Catalan Institute of Oncology is listed as a World Health Organization Collaborating Centre (WHOCC) for palliative care, and hosts a palliative care demonstration project. The stated aims of this project are: “implementing specialist palliative care services, generating experience in this field, identifying areas for improvement, and introducing educative procedures (clinical and non-clinical).”

In Catalonia, palliative care service provision has been evaluated, and research has been undertaken to identify areas for improvement and to address inequities in service provision among districts.

To address the psychosocial and spiritual care, a Comprehensive Program for the psychosocial and spiritual care of patients with advanced conditions was developed, funded by the La Caixa Bank Foundation, and designed by the WHO Collaborating Centre for palliative care public health programmes. This program has implemented 29 full-time psychosocial and spiritual teams, with a total number of 126 full time professionals, giving support to 140 existing palliative care services. The program has attended more than 40 000 patients in 4 years and demonstrated effectiveness and satisfaction. The annual budget is 7 million Euros.

The NECPAL Programme is being implemented formally in Catalonia and in Galicia, with a growing number of initiatives. It is based in the British experience of the Gold Standards Framework, and consists in the early identification of chronic patients in need of palliative care approach in the conventional services. A prevalence study recently done show that the prevalence of these patients in the general population is around 1.6%, 24 by every general practitioner, around 30% (28-37%) in Hospitals, and 30-60% in Nursing Homes.

Despite challenges, palliative care is Spain has been demonstrated to be cost effective, and research indicates high levels of satisfaction with palliative care service provision by patients and family members.

Comments

  1. Rosie Moore

    I am urgently trying to locate a palliative care team in Seville for a best life long friend with end stage PSP, dysphagia and contradictory medications…potentially influencing poor swallow capacity…he is in Seville old town, 66 years old.
    I am a senior nurse in London specialist Palliative Care and he has NO soecialist support and end stage disease , he is living a horrific life with current NO SUPPORT and crazy drug regime..HELP

  2. Bruce

    I have sent several emails to Hospice facilities in Malaga, Spain, and received no replies. I am an American with Medicare insurance and wondered if this is covered in Spain.

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