NATIONAL PALLIATIVE CARE PROGRAMMES WHO CORE SELF- ASSESSMENT TOOL The Qualy Observatory WHO Collaborating Centre for Public Health Palliative Care Programmes Catalan Institute of Oncology (WHOCC-ICO) Tool September 2010 Instit ut Cat alà d'oncologia
Authors: Xavier Gómez-Batiste MD, PhD, Jose Espinosa MD 2011 The Qualy Observatory (OQ) WHO Collaborating Centre for Public Health Palliative Care Programmes (WHOCC-ICO). Legal Note: The documents & reports of The Qualy Observatory (OQ) / WHO Collaborating Centre for Public Health Palliative Care Programmes (WHOCC-ICO) can be reproduced as long as the goal of such reproduction is research and particular study. They can also be included in journals or scientific papers as long as the adequate acknowledgement is provided and the reproduction is not linked at all with any type of marketing activity. This document should be referenced as it follows: Gómez Batiste X, Espinosa J. National Palliative Care Programmes WHO Core Self-Assessment Tool available at: http://www.iconcologia.net 2/17
NATIONAL PALLIATIVE CARE PROGRAMMES WHO CORE SELF-ASSESSMENT TOOL ADAPTED VERSION FOR THE WORKSHOP ON DEVELOPING CAPACITY FOR PALLIATIVE CARE IN THE EUROPEAN REGION 20-21 September 2010, BARCELONA, SPAIN 1. AIMS AND RECOMMENDED METHODOLOGY 1. Thank you very much for your cooperation 2. This survey will help all of us to organize more efficiently the discussions at the meeting, as we will share the same format. 3. Additionally, it can help you in the systematization of your information. 4. To do the survey, we do recommend to involve an expert group including Planners at the Department of Health, Professionals, and Managers (National Palliative Care Associations, EAPC map data, and NGOs can also be very helpful) 5. You can use crude data or estimations 6. If we collect the information about the countries, it will be possible to write a joint descriptive paper bringing together the data. 2. IDENTIFICATION OF THE COUNTRY Official Name of the country Date 3/17
3. COUNTRY DESCRIPTION Population (total) Number and (%) of persons over 65 Life expectancy Health care districts or sectors (number) Acute Bed Hospital (number and total beds) Cancer services (Oncology, radiotherapy), or institutes (number) Geriatric services in acute hospitals (number) Mid term (Rehabilitation/mid length stay) facilities (number and beds) Nursing homes (Number and beds) Primary care teams or services Number of General practitioners ADDITIONAL COMMENTS TO SECTION III (SPECIALLY RELATED TO THE HEALTH CARE SYSTEM) 4/17
4. PALLIATIVE CARE PLAN 4.1. Plan existence NO NO, but there is a plan in preparation YES Does your country have a written and official (endorsed by the Ministry of Health) Palliative Care Plan? (Either exclusive or included in a broad plan document, like non-communicable disease control plan) Is there a formal Director or responsible for Palliative Care Plan at the Department of Health? If your answer to the above was NO, but there is a plan in preparation, please skip the following questions and go to Section V If your answer to the above was YES, please answer the following questions: Official Palliative Care Plan: please attach document or provide the link 4.2. Plan timeliness When was the most recent written Pal Care Plan created? What is the timeframe of the plan? YEAR (S) I f the plan was done over 5 years ago, does the country intend to develop a new one? NO YES 5/17
4.3. Plan Scope National (whole country) Sub-National (one or more states/provinces/regions of the country) Cancer / non-cancer / geriatric What is the scope of the official Palliative Care Plan? 4.4. Stakeholders involvement in the planning process Classify the involvement or participation of Stakeholders in the cancer control planning process INVOLVEMENT Not Low Medium High Stakeholders in the planning process represent a balance among consumers, government providers, and private sectors government sectors. Representatives in the planning process included experts in public health, cancer prevention, early detection, treatment, palliative care and information systems Leaders from state and community organizations were included in the planning process 6/17
4.5. Critical sections of the plan For the next questions on the plan please rate the elements mentioned or included in the plan according to the following score: 0 (not developed at all) Item is NOT mentioned or included in the plan. 1 (low) The plan mentions the item, but no detail is given. 2 (medium) 3 (fully developed) The plan addresses the item to some extent. An item scored 2" is a middle-of-the-road score for an item. The plan does a good, solid job in addressing the item which is generally adequate or close to ideal. Does the written Palliative Care Plan include? 0 1 2 3 Aims, principles, mission, and vision Assessment of needs: cancer and no cancer Goals and measurable short, medium and long-term objectives Plan of action to meet the objectives based on evidence, affordability, coverage, and equity Integration of activities to existing chronic disease and other related programmes (Cancer, Geriatrics, Chronic, Health Plan) Opioid availability and accessibility (Decree, Order, or Law) Standards of specialist services Directory of palliative care services Definition of the model of care Definition of the model(s) of organisation (in settings or districts) Standards of general services (primary care, other) Financing model Specific budget Law, Decree, or Order Education and training Plan Priority research areas to support the implementation of the plan Development of an information system for monitoring and evaluating the priorities Clear process and outcome indicators for monitoring an evaluation Budget / Costing of the action plan and resources needed for its implementation 7/17
4.6. Needs Assessment (Cancer/No Cancer) (Estimation or Crude Figures) - Look at the papers from MacNamara, Higginson and the WHOCC-ICO Syllabus - In European countries, 60-75% of population die by a chronic evolutive condition after a progressive course Total figure Per million % of total Global mortality (per million and total figure) Mortality by all chronic illnesses (see the SYLLABUS and papers McNamara, usually 60-75% or more in most EU countries)) (per million and total figure) Mortality by cancer Mortality by non-cancer chronic illnesses with a limited life prognosis ADDITIONAL COMMENTS TO SECTION IV 8/17
5. ONGOING PALLIATIVE CARE SERVICES / ACTIVITIES RELATED TO PC PLAN 5.1 Development status of ongoing services or activities - All data from crude data or estimations of 2009 - See definitions in the syllabus What is the status of the services addressing people's needs for each component of the PALLIATIVE CARE PLAN? Estimations or crude figures SPECIALIST SERVICES Hospital Support Teams Home Care Support teams Units in Acute bed hospitals Units in cancer centres Units in other resources Independent Hospices (number) Total number of palliative care beds Number of Paediatric PC services Number of Geriatric PC Services Total Number of Specialist Services Total number of full time Doctors Total number of full time Nurses Total Number of other professionals (Psychologists / Soc workers / Physiotherapists / Occupational Therapists / Chaplains / Volunteers, etc) COVERAGE Total number of advanced/terminal cancer patients attended by specialist services Total number of advanced/terminal non-cancer patients attended by specialist services % of cancer terminal patients attended by specialist services % of non-cancer terminal patients attended by specialist services % of districts having at least one Palliative care service available 9/17
OTHER ASPECTS Measures in conventional services: Primary care, Hospital services, nursing homes (describe) EDUCATION AND TRAINING Palliative Care or Medicine are recognized as specialty Palliative Care Curriculum defined (yes/no) Number of Physicians with advanced training Number of Nurses with advanced training Number of Physicians with advanced training Number of Palliative Care training activities / year: Basic, Intermediate, Advanced Number and % of Medicine Faculties having PC pregraduate training Number and % of Nursing schools having PC pregraduate training ADDITIONAL COMMENTS TO SECTION V.1 10/17
5.2 Opioid Availability and Accessibility OPIOID CONSUMPTION / ACCESIBILITY / AVAILABILITY Oral morphine Parenteral morphine Oral Methadone Parenteral methadone Phentanyl patches Phentanyl oral mucose (breakthrough pain) Oxydocone Hydromorphone Other strong opioids Prescription forms availability Length or duration of the prescription forms in days Yes/ Not available Avail able in Hospi tals Availab le in the commu nity (GPs) Consu mption (DDD) / million / year Cost of 1 day in Euros (average equivalent doses of 100 mg morphine) ADDITIONAL COMMENTS TO SECTION V.2 11/17
6. QUALITATIVE ASSESSMENT OF YOUR PLAN 6.1. Methodology: - Use a simple SWOT (Strong points, Areas for Improvement) analysis by dimensions by agreement of the group - List 1 to 3 strong points and 3 areas for improvement in every Dimension - Areas for improvement come from weaknesses DIMENSIONS Leadership Palliative care services Coverage cancer Coverage non-cancer Opioid availability Standards Education and training Funding Evaluation Other Other STRONG POINTS AREAS FOR IMPROVEMENT 12/17
6.2. Difficulties, Barriers, Resistances - Share this approach with the group DIFFICULTIES AND BARRIERS 1. 2. 3. 4. 5. 7. NEEDS AND EXPECTATIONS FROM WHO AND WHO COLLABORATING CENTERS 7.1. Needs and Expectations of Support from WHO And WHO Collaborating Centres - What would help you more to develop your programs? - What do you expect from the WHO regional Office and WHO Collaborating Centres or other organisations? 1. 2. 3. 4. 5. 6. 7. 8. 13/17
7.2 Proposals for 2 years (According to needs and expectations) 1. 2. 3. 4. 5. 6. 7. 8. ADDITIONAL COMMENTS TO SECTION VIII 14/17
8. PRINCIPAL AUTHOR AND CO-AUTHORS - Please provide the contact information of the authors and co authors participating in the core self- assessment 8.1. Methodology - How did you complete the assessment? Group of experts Team at the DoH Advisory committee Others Additional Comments: 8.2. Principal author (person in charge of the coordination of answering the questionnaire) Principal author Last name: Position/Title: Organization Address City Country Postal code Phone (country code) Fax (country code) E mail First name: 8.3. Principal Co-authors that collaborated in this assessment (team members). - Use one table for each one Co-author A Last name: : Position/Title: Organization Address City Country Postal code Phone (country code) Fax (country code) E mail First name: 15/17
Co-author B Last name: Position/Title: Organization Address City Country Postal code Phone (country code) Fax (country code) E mail First name: Co-author C Last name: Position/Title: Organization Address City Country Postal code Phone (country code) Fax (country code) E mail First name: Co-author D Last name: Position/Title: Organization Address City Country Postal code Phone (country code) Fax (country code) E mail First name: 16/17
9. REFERENCES Please, make a list of additional references describing the situation in your country 17/17