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Report
10th Congress of the EAPC
Budapest, Hungary, 7-9 June 2007
The
Budapest Commitments – a framework for palliative care
development
A
joint initiative by:
-
European Association for Palliative Care (EAPC),
- International
Association for Hospice and Palliative Care (IAHPC) and
- Worldwide
Palliative Care Alliance (WPCA)
Background
Palliative care is an approach that improves the quality of
life of patients and their families facing the problems associated
with life-threatening illness, through the prevention and
relief of suffering by means of early identification and impeccable
assessment and treatment of pain and other problems, physical,
psychosocial and spiritual. This definition of the World Health
Organisation (WHO) (http://www.who.int/cancer/palliative/definition/en/,
accessed on 27.02.2007) shows the full scope that palliative
care providers have to cover.
However, in most services the provision of palliative care
is far from optimal and in many countries and regions in and
out of Europe, the development of palliative care is hindered
by barriers and obstacles. In spite of tremendous engagement
of palliative care specialists and volunteers, countless patients
at the end of life suffer from treatable pain, anxiety and
other symptoms, social isolation and existential solitude.
Results from a recent survey on development of Palliative
Care in Europe show vast differences in the state of development
among European countries (Centeno C. EAPC Task Force on the
Development of Palliative Care in Europe. European Journal
of Palliative Care 2006; 13: 149-151).
Even in countries with an adequate standard of care, access
to palliative care is greater in urban areas and for selected
patient groups such as cancer patients, while limited to patients
in rural areas or with non-cancer diagnoses. Whereas the middle-aged
adult with cancer has a good chance for a full scope of hospice
and palliative care services, paediatric palliative care remains
a challenge in most European countries. The provision of care
for the elderly, especially in nursing homes, is far from
adequate even in resource-rich countries, and the extension
from end-of-life care for cancer patients to palliative care
for the elderly is a major challenge that we are now facing.
The strategy
To help individuals and national palliative care organizations
develop effective strategies to meet these needs, the EAPC
in close collaboration with the International Association
for Hospice and Palliative Care (IAHPC) and the Worldwide
Alliance for Palliative Care (WPCA) decided to launch a two-year
campaign for and with the national associations to develop
strategies at the country level. This campaign will include
commitments to accomplish goals within a proposed framework.
All the regional associations (African Palliative Care Association
(APCA), American Academy of Hospice and Palliative Medicine
(AAHPM), Asia Pacific Hospice and Palliative Care Network
(APHN), Eastern and Central Europe Palliative Task Force (ECEPT),
Latin American Association of Palliative Care (ALCP)) as well
as the National Hospice and Palliative Care Organization (NHPCO)
from USA, Palliative Care Australia (PCA) and the International
Observatory on End of Life Care (IOELC) have been invited
to participate in the process and in the development of the
framework.
The
framework
This initiative is based on a strategy which includes using
a framework that will help identify and establish development
goals in five major areas: Drug
availability; Policy; Education; Quality and Research.
Within
this framework, national associations for palliative care
will be invited to choose commitments from a list of proposals
or draft their own among these five areas. The commitments
should be based on measurable indicators.
The framework will proceed
in three phases:
Empowerment
During the spring 2007, the initiators of the Budapest Commitments
will contact the national associations and present the outline
of the campaign. The associations will be invited to join
the campaign and propose specific commitments tailored to
meet their palliative care needs in the five main areas. This
involvement ensures peer support for the framework from the
national associations, propelling the Budapest Commitments
forward by the bottom-up approach.
Commitment
During and after the 10th congress of the EAPC in Budapest
(7th – 9th June 2007, www.eapcnet.org/budapest2007/welcome.html)
the national associations will be asked to define commitments
that they will aim to achieve in the next two years.
- Budapest,
June 6th, 2007: An initial meeting took place prior to the
10th EAPC Congress, with representatives of the supporting
organizations and national and regional palliative care
associations. The five main areas within the framework (policy,
drugs, quality, education and research) will be presented
and discussions on commitments will follow. Several of the
sessions throughout the congress will cover these aspects
of development.
- Budapest,
June 8th, 2007: Meeting of the EAPC Task force on National
Associations, with representatives of the National Associations
during which additional discussions were held.
-
Budapest, June 9th, 2007: The summary of the project were
presented in an open workshop as well as the commitments
proposed by each association.
In order to focus activities towards the chosen commitments
and thus increase the chances of success, each association
should define their priorities and choose a limited number
of commitments (not more than five, recommendation: three
commitments). The commitments
will be announced through the EAPC, IAHPC and Hospice Information
Services bulletins and newsletters as well as websites.
National associations not able to join the discussions
in Budapest will be invited to participate in the campaign
and submit comments and commitments via the websites after
the Budapest conference.
Advocacy
The commitments will require the national associations’
efforts and participation in political and social activities.
It is recognized that in order to be successful national associations
will need to undertake a considerable and regular amount of
advocacy over the next two years. The EAPC Task Force for
National Associations will actively seek to provide support
in this process.
A review of the commitments and the status of accomplished
objectives will be carried out in time for the next Research
Forum of the EAPC in Trondheim, 2008. Barriers and challenges
will be identified in those cases in which the commitments
were unmet and new strategies and solutions will be identified
and proposed in order to accomplish the goals.
The results of the commitment and the advocacy work will be
presented at the next EAPC congress in Vienna in 2009.
The
commitment proposals
Examples for commitments in five areas are listed below. They
may serve as models for specific commitments aligned to individual
national associations’ priorities, thus making this
list the core of a commitments list to be developed by the
national associations.
Drug
availability
- To ensure availability and access to all the palliative
care essential medicines of the IAHPC list available in the
country (or close substitute) (De Lima L (2007) International
Association for Hospice and Palliative Care list of essential
medicines for palliative care. Ann Oncol 18(2): 395-9).
- To have more than 2 potent opioids available with at least
an immediate onset and a modified release application form
and at least an oral and a parenteral (subcutaneous) application
form.
- To increase the rational use of opioids as reported by the
INCB consumption reports (http://www.incb.org/incb/en/annual_report.html,
accessed on 14.04.2007)o provide percentage of increase that
is targeted until 2009.)
Policy
| -
To produce a report on the state of development and necessary
next steps to be presented to the national authorities. |
-
provide information when and how the report shall
be presented
|
| -
To produce a guideline for basic palliative care endorsed
by the national association (alternatively: by the medical
board, or by the ministry of health) |
-
provide details on the scope of the guidelines
|
| -
To establish the right for compassionate care leave for
family members wishing to care for their diseased relative |
| -
To have palliative care included in the national cancer
and HIV/AIDS programs |
| -
To establish reimbursement policies for physicians and
nurses |
| -
To identify and eliminate barriers in the laws and regulations
which interfere with the rational use of controlled medications,
based on the WHO Achieving Balance Guidelines (http://www.medsch.wisc.edu/painpolicy/publicat/00whoabi/00whoabi.pdf,
accessed on 14.04.2007) |
-
provide information on laws and regulations that have
to be addressed
|
Education
| -
To have palliative care inserted in the curriculum for
medical/nursing students (and other professionals) |
-
provide content/knowledge and number of lessons that
are mandatory for students
|
| -
To implement specialist training with the medical board-
To implement specialist training with the medical board |
-
provide detailed designation of speciality /sub speciality
|
| -
To implement specialist training for nurses |
| -
To implement academic training |
-
provide detailed description of academic grade
|
| -
To establish a certification process to recognize palliative
care competence |
-
provide description of the authority supporting the
certification process
|
Quality
| -
To define standards of care |
- provide
details of standards and of standard development process
|
| -
To introduce a standard documentation system for palliative
care services |
-
provide information about the implementation process
|
| -
To establish a quality assurance project, using benchmarking
or audit-cycles |
| -
To get a definition of high quality palliative care |
Research
| -
To incorporate the proposals presented in the Venice Declaration
to support the development of research in palliative care |
- provide
description of the proposals selected for incorporation
|
| -
To initiate a research forum or a working group on research
as a platform for future projects and training of researchers |
| -
To produce a national agenda on palliative care research |
- provide
details of research topics
|
| -
To establish funding or an award to promote research activities
in the country |
| -
To increase the publishing of papers in peer reviewed
journals on issues relevant to palliative care |
- provide
percentage of increase that is targeted until 2009
|
The
Budapest Commitments – a worldwide campaign
The
Budapest Commitments will help develop a framework that will
be applicable in all regions of the world and can be modified
to meet the needs of countries, according to their socio economic,
cultural, geographical and epidemiological conditions. Priorities
and resources vary vastly between the different regions of
the world, and this has to be taken into consideration for
the formulation of the commitments in the individual countries.
Developing
countries may have to choose smaller goals for their commitments,
but they will be able to identify goals and commit themselves
accordingly. Developing countries may even show the developed
part of the world how to make best use of limited resources,
and might set new standards for realistic and down-to-earth
work plans.
It is worthwhile to spread the campaign around the world,
in close cooperation with the pan-national associations.
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