Conclusions: Palliative care—the need for a public health approach

Abstract Background Palliative care is recognised as a public health issue with the need for earlier integration in the wider healthcare system. However, research indicates that it continues to be accessed late in the course of an illness, public understanding of palliative care is limited, and common misconceptions prevail. Strategies to address this are needed in order to reduce barriers to palliative care delivery and improve access. Methods An explanatory sequential mixed methods study, comprising a cross-sectional survey and interviews was undertaken. Sociodemographic characteristics, public awareness, knowledge and perceptions of palliative care were examined and strategies to raise awareness and overcome barriers within a public health framework were identified. Survey data were analysed using SPSS v25 with factor analysis and non-parametric statistics and qualitative data were analysed using thematic analysis. Results A total of 1201 participants completed the survey (58.3% female, mean age 61 years) and 25 took part in interviews. A fifth of participants (20.1%) had previously heard about palliative care and had an accurate understanding of the term. Being female, higher educated, married, and older, increased respondents’ levels of awareness. The three most commonly held misconceptions included: Palliative care is exclusively for people who are in the last 6 months of life (55.4% answered incorrectly); A goal of palliative care is to address any psychological issues brought up by serious illness (42.2% answered incorrectly); and a goal of palliative care is to improve a person’s ability to participate in daily activities (39.6% answered incorrectly). Talking about palliative and end of life care was advocated but societal taboos restricted this occurring with exposure limited to personal experience. Conclusions Current knowledge gaps and misconceptions derived from limited ad hoc personal experiences and fear of engaging in taboo conversations may deter people from accessing integrated palliative care services early in a disease trajectory. The results indicate the need for public education programmes that move beyond merely raising awareness but provide key messages within a public health approach, which may change attitudes to palliative care thus ultimately improving end of life outcomes.

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Young adults understanding and readiness to engage with palliative care: extending the reach of palliative care through a public health approach: a qualitative study

BMC Palliative Care ◽

10.1186/s12904-021-00808-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Anita Mallon ◽

Felicity Hasson ◽

Karen Casson ◽

Paul Slater ◽

Sonja McIlfatrick

Keyword(s):

Public Health ◽

Palliative Care ◽

Young Adults ◽

Death And Dying ◽

Population Based ◽

Public Health Approach ◽

Structured Interviews ◽

Comfort Care ◽

Positive Attitudes ◽

Framework Approach

Abstract Background Moving palliative care from a solely clinical focus to a more population based and community orientated approach is the hallmark of a much advocated public health approach to palliative care. Young adults are a vital cohort of the public, yet their understanding of palliative care has not been investigated. This study aimed to explore young adults’ understanding of palliative care and identify factors that influence their engagement. Methods A purposive sample of young adults (n = 24) aged 18–29 years were recruited from one UK University. Semi-structured interviews were undertaken face to face or via telephone or Skype between November 2017 and February 2018. Thematic analysis using a framework approach and underpinned by a socioecological perspective was used to analyse the interviews. Results Three thematic categories were identified relating to intrapersonal and interpersonal influences, cultural and social influences and organisational and public policy influences. Palliative care was understood as supportive comfort care, delivered in the absence of cure, associated with the end of life and specifically focused on death and dying. Negative attitudes related to the context of care, which represented a static and hopeless situation. Whilst some reported positive attitudes, potential engagement was seen to be governed by a lack of knowledge and protective cultural norms. In terms of demonstrating readiness to engage with palliative care, participants requested clear information and suggested a normalising of palliative care through the education system. Conclusion Young adults in this study were ready to find out more about palliative care and identified social media as a platform upon which to engage this population. However, their perception of a society that views palliative care as a subject for those directly affected, creates a barrier to engagement. This study identified the ingredients of a public health message and mediums for disseminating the message. However, findings also suggest that a cultural shift is required to recognise the potential of engaging young adults in health issues that cross the life span, empowering them not only as individuals but as vital members of community and society.

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A Public Health Approach to Integrate Palliative Care into a Country’s Health-Care System: Guidance as Provided by the WHO

Textbook of Palliative Care ◽

10.1007/978-3-319-31738-0_122-1 ◽

2018 ◽

pp. 1-20

Author(s):

Arno Maetens ◽

Joachim Cohen ◽

Richard Harding

Keyword(s):

Public Health ◽

Health Care ◽

Palliative Care ◽

Health Care System ◽

Public Health Approach ◽

Care System

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The public health approach to palliative care: sharing practice on a global level

Expert Review of Pharmacoeconomics & Outcomes Research ◽

10.1586/erp.11.18 ◽

2011 ◽

Vol 11 (3) ◽

pp. 265-266 ◽

Cited By ~ 1

Author(s):

Libby Sallnow ◽

Farzana Khan ◽

Nezam Uddin

Keyword(s):

Public Health ◽

Palliative Care ◽

Public Health Approach ◽

Global Level ◽

The Public

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Patient-centred supportive and palliative care

10.1093/med/9780199550173.003.0014 ◽

2013 ◽

Author(s):

Genevieve Thompson ◽

Carla Ens ◽

Harvey Chochinov

Keyword(s):

Public Health ◽

Health Care ◽

Palliative Care ◽

Care Delivery ◽

Cancer Control ◽

Public Health Approach ◽

Low Resource Settings ◽

The Public ◽

Low Resource

Chapter 14 expands on the role of palliative care within the framework of cancer control. In addition, the public health approach outlined by the WHO, including appropriate policy, adequate drug availability, education, and palliative care delivery at all levels of health care, will be discussed. Finally, the challenges in adapting these principles into high and low resource settings will be described.

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A Public Health Approach to Palliative Care in the Canadian Context

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119892591 ◽

2019 ◽

Vol 37 (7) ◽

pp. 492-496 ◽

Cited By ~ 1

Author(s):

Giovanna Sirianni

Keyword(s):

Public Health ◽

Palliative Care ◽

Care Delivery ◽

World Health ◽

Public Health Approach ◽

Multiple Streams ◽

Multiple Streams Framework ◽

Canadian Context ◽

Health Organization

Palliative care helps improve the quality of life of individuals facing life-limiting illness throughout the course of their disease. In Canada, delivery and access to palliative care has been fraught with challenges including differential availability of services based on geography, funding, language, and socioeconomic status. Many groups, including the World Health Organization, have advocated for a public health approach to palliative care as an antidote to fragmented service delivery. Multiple scholars, academics, and public health advocates have suggested that a public health approach to palliative care can help with issues of access, equity, and cost. Through the lens of Kingdon’s Multiple Streams Framework, this commentary will explore potential reasons why a public health approach to palliative care has not been adopted in the Canadian context and why this is an opportune time to consider this policy innovation. The Compassionate Communities concept is discussed as a potential solution to a public health approach to palliative care delivery.

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