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      Redefining Palliative Care—A New Consensus-Based Definition

      research-article
      , MD, , MHA, , MD, , MD, , MD, , MD, , MD, , MD, PhD, , BSc, MCPh, , MD, PhD, , MME, , MD, , MD, , MD, , PhD, , MD, , PhD, , MD, PhD, , MD, , MD, , PhD, , MD, , PhD, , MD, PhD, , PhD, , BSc, , MD, , MD, PhD, , PhD, , MD, , MD, , MD, , MBChB, Dip Obs, , MD, , MD PhD, , MD, , PhD, , MD, PhD
      Journal of pain and symptom management
      Definition of palliative care, consensus, Delphi method, quality of life, relief of suffering, low or middle income countries

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          Abstract

          Context.

          The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief.

          Objective.

          The main objective of this article is to present the research behind the new definition.

          Methods.

          The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition.

          Results.

          The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC.

          Conclusion.

          Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.

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          Most cited references19

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          Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review.

          The Delphi technique is widely used for the development of guidance in palliative care, having impact on decisions with relevance for patient care.
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            Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report

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              The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions

              Summary Background Serious life-threatening and life-limiting illnesses place an enormous burden on society and health systems. Understanding how this burden will evolve in the future is essential to inform policies that alleviate suffering and prevent health system weakening. We aimed to project the global burden of serious health-related suffering requiring palliative care until 2060 by world regions, age groups, and health conditions. Methods We projected the future burden of serious health-related suffering as defined by the Lancet Commission on Palliative Care and Pain Relief, by combining WHO mortality projections (2016–60) with estimates of physical and psychological symptom prevalence in 20 conditions most often associated with symptoms requiring palliative care. Projections were described in terms of absolute numbers and proportional change compared with the 2016 baseline data. Results were stratified by World Bank income regions and WHO geographical regions. Findings 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 26 million people in 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). Globally, serious health-related suffering will increase most rapidly among people aged 70 years or older (183% 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). Interpretation The burden of serious health-related suffering will almost double by 2060, with the fastest increases occurring in low-income countries, among older people, and people with dementia. Immediate global action to integrate palliative care into health systems is an ethical and economic imperative. Funding Research Challenge Fund, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London.
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                Author and article information

                Contributors
                Journal
                8605836
                4849
                J Pain Symptom Manage
                J Pain Symptom Manage
                Journal of pain and symptom management
                0885-3924
                1873-6513
                26 April 2021
                06 May 2020
                October 2020
                05 May 2021
                : 60
                : 4
                : 754-764
                Affiliations
                Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
                International Association for Hospice and Palliative Care, Houston, Texas
                University of Miami Institute for Advanced Study of the Americas, Coral Gables, Florida, USA
                San Nicolash, Argentina
                Kenian Hospice and Palliative Care Association, Nairobi, Kenya
                Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
                Wits Centre for Palliative Care, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
                Department of Palliative Rehabilitation and Integrative Medicine, MD Anderson Cancer Center Houston, Houston, Texas, USA
                School of Pharmacy, University of Panama, Panama City, Panama
                Private Practice, Rio de Janeiro, Brazil
                New York, New York, USA
                Pain and Palliative Care Unit, Kenyatta National Hospital, Nairobi, Kenya
                Department of Palliative Medicine, Clinica Universidad de Navarra, Navarra, Spain
                Department of Medicine, IU Simon Cancer Center, IU School of Medicine, Indianapolis, Indiana, USA
                Worldwide Hospice Palliative Care Alliance, London, United Kingdom
                General Practice and Basic Skills Department, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
                International Children’s Palliative Care Network, Cape town, South Africa
                New York, New York, USA
                Division of Palliative Medicine at the National Cancer Centre Singapore, Singapore
                Clínica de Linfomas and LMA Cuidados Paliativos and Terapia Metronómica, King’s College London, London, United Kingdom
                Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Centre for Global Health Palliative Care, King’s College London, London, United Kingdom
                Palliative Care Department, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
                Institut universitaire de formation et de recherche en soins, Universite de Lausanne, Lausanne, Switzerland
                Department of Palliative Care, Makerere University, Kampala, Uganda
                African Association for Palliative Care, University Parisse, Kampala, Uganda
                International Children’s Palliative Care Network, Cape town, South Africa
                Health Education and Practices Laboratory, University Parisse, Villetaneuse, France
                Palliative and Supportive Care Program at the American University of Beirut Medical Center, Palliative and Supportive Care Program at the American University of Beirut Medical Center
                International Association for Hospice and Palliative Care, Houston, Texas
                George Washington University’s Institute for Spirituality and Health, Washington, District of Columbia, USA
                Trivandrum Institute of Palliative Sciences, Trivandrum, Kerala, India
                Hope Institute Hospital, Kingston, Jamaica
                Australasian Palliative Link International, Melbourne, Australia
                Mehac Foundation, Kochi, Kerala, India
                Sir Michael Sobell House, Oxford University Hospital, Oxford, United Kingdom
                Melbourne, Australia
                College of Nursing Catholic, University of Korea, Seoul, South Korea
                Department of Palliative Medicine, University Hospital Aachen, Aachen, Germany
                Author notes
                Address correspondence to: Lukas Radbruch, MD, Department of Palliative Medicine, University Hospital Bonn, 53127 Bonn, Germany. Lukas.radbruch@ 123456malteser.org
                Article
                NIHMS1694235
                10.1016/j.jpainsymman.2020.04.027
                8096724
                32387576
                da91f7e4-79f0-49ee-87f8-dbd993bdec67

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                definition of palliative care,consensus,delphi method,quality of life,relief of suffering,low or middle income countries

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