Promoting Palliative Care to Patients in Developing Countries-Global Perspectives and Future Recommendations.

Background: Despite a plethora of evidence available on the benefits of palliative care (PC), it is estimated that only about 14% of those living in low- to middle-income countries (LMIC) or developing countries have access to PC. Objective: To globally examine PC expert perspectives regarding PC infrastructure and resources within each country, drug and opioid availability to provide PC, and workforce and educational issues. Design: Descriptive, open-ended survey seeking first-hand qualitative perspectives. Setting/Subjects: PC experts from 21 developing countries representing 5 continents around the world. Measurements: Qualitative narratives and discussions with PC experts. Results: The summaries inform four key recommendations for future progress of PC in developing countries: (1) PC infrastructure should increase accessibility to both urban and rural areas; (2) increasing medication and nonpharmacologic approaches for symptoms is essential; (3) interdisciplinary education should continue to expand and include scholarships, PC certifications, and advanced education; and 4) future research with developing countries is desperately needed to advance care and progress. Conclusions: Considerable PC progress has been accomplished; however, significant gaps remain. This report can be used to discuss PC capacity building within a country. It could serve as an important document while negotiating with authorities and Ministries of Health about expanding PC infrastructure, especially in rural areas. Finally, PC champions can use this report to advocate for increased opioid availability to promote comfort; in particular, increased availability of oral opioids is essential, so that patients can die comfortably at home.