Recommendations from the European Association for Palliative Care
With the ongoing development of palliative care throughout Europe, decision makers are challenged not only to decide where and when palliative care services should be developed, but also how they should be equipped and configured. Adequate structural quality is a prerequisite for high quality of care. Administrative and political decision makers will aim for cost-effectiveness, and try to reduce costs by allocating a minimum of staff or reimbursement. Care providers will negotiate for adequate staff resources necessary for high quality of care. In this conflict both sides will seek guidance on structural quality.
The European Association for Palliative Care (EAPC) has put forward a White Paper on Standards and Norms for Hospice and Palliative Care in Europe. The White Paper includes recommendations for a common European terminology following a consensus process with the national palliative care and hospice associations. Representatives of 35 different national hospice and palliative care associations from 22 European countries have participated in the consensus procedure. Norms are defined on the basis of this consensual terminology. Guidance on norms and standards are necessary not only for health care professionals working in hospice and palliative care settings, but also for decision makers in health care who are responsible for adequate access to palliative care for patients.
In this paper, the EAPC presents norms on structural quality for the provision of palliative care with in- and outpatient services in different settings. This White Paper takes into account the different concepts and cultural background in the European countries and regions. This is acknowledged by the description of norms rather than the definition of standards. Whereas standards would imply an absolute limit below which quality palliative care is not possible (minimal standards), norms represent a consensus on quality goals that have to be aimed for (aspirational norms). If (or when) norms are achieved high quality can be safely expected.
The White Paper covers key elements of palliative care: definition and terminology of palliative care and hospice care, common values and philosophy of palliative care, levels of care, patient groups, needs assessment and requirements for different types of services and settings.
As an example the demand for inpatient palliative care units is described as 80-100 beds per million inhabitants, Palliative care units require a highly qualified, multidisciplinary team. The core team consists of doctors and nurses. The extended team comprises relevant associated professionals like psychologists, physiotherapists, social workers or chaplains. The demand for home palliative care teams is described as 10 services per million inhabitants. The core team of a home palliative care team is accessible for 24 hours per day and consists of 4 – 5 full-time professionals, comprising physicians and nurses with specialist training, a social worker and administrative staff.
The EAPC White Paper on Standards and Norms for Hospice and Palliative Care provides definitions, an overview of the philosophy of palliative care and recommendations for the number of services, staffing and service provision in different settings.
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