Palliative care updates in Eastern Europe and Central Asia - Tom Lynch

In May 2002, the first ever systematic empirical study of hospice and palliative care related activities in 28 former communist countries in Eastern Europe and Central Asia was completed (Clark and Wright, 2003). Funded by the Open Society Institute, New York, the project reviewed the background to current service initiatives, gave detailed information on levels of provision, explored achievements and successes, and highlighted barriers to further progress as well as suggesting ways in which these might be overcome. The project was the first step in providing the quantitative and qualitative data needed to frame palliative care as a serious public health issue for the countries of Central and Eastern Europe (CEE) and the Commonwealth of Independent States (CIS). The review findings were disseminated via several publications and converted into individual country reports that were uploaded onto the IOELC website for free access in the public domain – the first country reports to be published on the web by the Observatory.

Since 2003, reports on the countries in question have been partially updated, and in the case of Russia extensive revisions have been made. In May 2004, eight of the original 28 countries joined the European Union; an event of enormous significance for palliative care in terms of access to funds and European directives. In addition, Bulgaria and Romania are acceding countries due to join the European Union in 2007, whilst Croatia and Macedonia are both candidate countries. This current project will produce revisions and updates in each of the 28 countries in order to maintain the current rigor and validity of our reports. The project is working in close collaboration with the European Association for Palliative Care Task Force on the Development of Palliative Care in Europe, of which Tom Lynch and David Clark are members.

EAPC Atlas of Palliative Care in Europe ** New
The European Association for Palliative Care has published the EAPC Atlas of Palliative Care in Europe. Announced the first day of the EAPC Conference in Budapest, Hungary on 7th June 2007, the atlas includes a country by country overview of the delivery of hospice and palliative care in different settings. There are two versions available: Atlas book and a CD. Anyone wishing to order the Atlas can do so by contacting Carlos Centeno in the first instance.

Aim of the project:

To provide a rigorously analytic picture about the current state of hospice and palliative care provision in Central and Eastern Europe and Commonwealth of Independent States that fully considers political, social, and healthcare policy and related factors.

Objectives of the project:

The major priority in updating the country reports is the broad dissemination of an ‘evidence base’ of clear and accessible research-based information concerning the current provision of hospice and palliative care in this vast and complex region. It is hoped that the updated country reports will continue to have a positive impact on future planning and innovation in a number of areas: to act as a resource for current and future policy and service development that may assist commissioners of services to integrate palliative care into national health plans; to serve as an important source of ideas for incorporating palliative care into medical and nursing education; to raise public awareness of palliative care in those countries where end of life care innovation is still in its infancy and the majority of the population is underserved by this aspect of care; to serve as a national resource for palliative care development and further hospice and palliative care activities in the region; to enable clinicians from outside the region who are engaged in partnerships with hospices and palliative care units within Central and Eastern Europe and Commonwealth of Independent States to place their own activities in a wider milieu; to direct researchers in this field towards potential new lines of enquiry.

Methods and analysis

The updated country reports aim to map the existence of services country by country using a common template which facilitates cross-national and regional comparison and enables a comparative analysis of countries and contexts to be generated. Each country report draws on several research traditions in the social and health sciences to illuminate: the provision of palliative care services; the history and development of palliative care; the public health context; and ethical issues relevant to that particular country. The reports undertake a social and cultural analysis of end of life issues in the region and are compiled using a multi-methodological approach; quantitative and qualitative, including statistical information, narrative accounts, photographs, and historical and ethical perspectives. Ethnographic interviews are conducted wherever possible in each country with key healthcare professionals and other related individuals and groups involved in service provision to examine the perspectives and experiences of those involved in hospice and palliative care. Public health and policy data relating to hospice and palliative care services are also critically examined.

Research partners

This work has been funded through a grant from the Open Society Institute International Palliative Care Initiative, (IPCI), who have provided core support for the ongoing collation and publication of country reports on palliative care development in Central and Eastern Europe and Commonwealth of Independent States as part of their overarching aim to incorporate palliative care into national health care plans, policies, legislation, delivery systems, health care professional education and public education.

Progress to date:

Updated reports have been produced so far for:

Azerbaijan
Hungary
Kazakhstan
Kyrgyzstan
Romania
Tajikistan
Turkmenistan
Uzbekistan

Reference

Clark, D., and Wright, M. 2003. Transitions in End of Life Care: Hospice and Related Developments in Eastern Europe and Central Asia. Buckingham: Open University Press.