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Major differences in palliative care provision across the globe

University of Leeds

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A major review of palliative care services around the world has highlighted huge inconsistencies in provision, with patients in some countries receiving a fraction of the support provided elsewhere.

More than 11 million cases have been reviewed at the University of Leeds' Academic Unit of Palliative Care, which found length of care for people with life limiting and terminal conditions varies acutely across different countries - and within the countries themselves.

The researchers found:

  • In the UK, cancer patients are referred to palliative care earlier than patients with other life limiting conditions, despite the need being the same among both groups

  • In the United States, patients receive on average 10 days' fewer palliative care than in non-US countries

  • The shortest average duration of care was six days in Australia, while the longest was 69 days in Canada

Palliative care is internationally defined as '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'. Its function is to support patients and their families with needs that arise during a serious illness, months or potentially years before death.

It has been found to be most effective if introduced at least three to four months before a patient's death, when it can improve their quality of life and reduce financial costs.

But previous studies carried out into the duration of palliative care in countries around the world revealed a wide variation in length of care.

The multi-disciplinary research team led by Leeds conducted a systematic review and meta-analysis of 169 studies from 23 countries, involving 11,996,479 patients.

They found the global average length of care from initiation to the patient's death was 18.9 days. When US data was removed, the average length increased to 29 days.

Cancer patients received care for an average of 15 days, but non-cancer patients received only six days' care.

Duration of care also varied depending on the location, from 19 days in a specialist palliative care unit; 20 at home or in the community, and six days on a general hospital ward.

And countries with very high levels of development provided on average 18.91 days of care, compared with 43 days for countries at all other levels of development.

Dr Matthew Allsop, University Academic Fellow from the Leeds Institute of Health Sciences, who co-authored the paper, said: "This study highlights a major challenge to human health worldwide.

"Our work highlights a stark shortfall in the duration of palliative care being provided internationally, with clear variation reported across countries. There is no data from low- and middle-income countries to understand at what point patients are accessing care before death - it is in these countries that provision of palliative care is most lacking.

"Increased funding is essential to develop capacity, but so too is research - to determine when people are accessing palliative care and how existing services can be improved."

The work included researchers from Hull York Medical School, and the Department of Public Health and Primary Care, Ghent University, Belgium. It was supported by National Institute for Health Research infrastructure at Leeds.

Nine UK studies were included in the analysis, covering 50,021 patients. Care lasts on average 48 days in the UK, but this varies depending on the setting. Specialist palliative care lasts nine days, whereas in the community or at home the duration is 41 days.

Some 85% of studies covering 97% of participants were from the USA, with three studies featuring more than one million participants each. Sub analysis of this data was performed, comparing it with non-US countries. The researchers found the average length of care in the US was 18.9 days - but 10 days fewer than outside it.

The report suggests this could be explained by USA models of care that restrict hospice care to patients with prognoses of fewer than six months, and have financial implications for patients.

Meanwhile, in middle income countries, the duration of palliative care was often much longer. In Brazil, the average duration was 190 days; Egypt was 66 days and Thailand 33 days. The data came from smaller samples and further research is needed to understand these findings.

Dr Allsop said: "Death affects us all. The global burden of serious health-related suffering requiring palliative care is projected to almost double by 2060 - most people either receive no palliative care, or not the amount necessary to achieve maximum benefit.

"There is a clear and significant gap between current and ideal practice, which impacts on the benefit of palliative care for patients and health care services.

"Globally palliative care needs to be highlighted as an essential component of healthcare with efforts needed to increase capacity and access to support for patients and their families."

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Further information

Duration of palliative care before death in international routine practice: A systematic review and meta-analysis was published on 26 November in BMC Medicine.

For media enquiries contact University of Leeds press officer Lauren Ballinger via l.ballinger@leeds.ac.uk.

The University of Leeds

The University of Leeds is one of the largest higher education institutions in the UK, with more than 38,000 students from more than 150 different countries, and a member of the Russell Group of research-intensive universities. The University plays a significant role in the Turing, Rosalind Franklin and Royce Institutes.

We are a top ten university for research and impact power in the UK, according to the 2014 Research Excellence Framework, and are in the top 100 of the QS World University Rankings 2021.

The University was awarded a Gold rating by the Government's Teaching Excellence Framework in 2017, recognising its 'consistently outstanding' teaching and learning provision. Twenty-six of our academics have been awarded National Teaching Fellowships - more than any other institution in England, Northern Ireland and Wales - reflecting the excellence of our teaching. http://www.leeds.ac.uk

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National Institute for Health Research (NIHR)

The study was supported by NIHR infrastructure at Leeds. NIHR is the nation's largest funder of health and care research. The NIHR:

Funds, supports and delivers high quality research that benefits the NHS, public health and social care

Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research

Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future

Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services

Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.

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