Global Consensus-Based Essential and Expanded Packages for Palliative Care and Pain Relief for Adults and Children: A Delphi Study

Journal of Pain and Symptom Management, vol. 70, pp. 627–637.e3

Abstract

BACKGROUND: In 2018, the Lancet Commission on Global Access to Palliative Care and Pain Relief introduced the concept of serious health-related suffering (SHS) to quantify the need for palliative care and proposed an essential package of palliative care and pain relief (PCPR) to address it. However, this package did not account for complex and specialized needs, and its global implementation has been limited. OBJECTIVES: We conducted a multistage, modified Delphi study to update and expand the initial Essential Package for children and adults METHODS: Two international panels -adult and pediatric- representing diverse geographical regions and income levels participated in two Delphi rounds. External validation was conducted by global experts in palliative care. RESULTS: Retention rates for the Delphi rounds were 79.5% for adults and 64.0% for children. Consensus was achieved on the updated Essential Packages for both adults and children, with minor modifications. Expanded Packages were developed, including additional medications, equipment, and human resources to address broader needs. The study also revealed persistent inequities in medicine availability, particularly in low- and middle-income countries, and limited awareness of the Lancet Commission's Essential Package among health professionals. CONCLUSION: These globally validated Essential and Expanded Packages for adults and children offer a practical adaptable framework to guide national health strategies, strengthen palliative care services, and reduce SHS. Their adoption can meaningfully contribute to achieving Universal Health Coverage.

Authors 8

1. Tania Pastrana corresponding Aachen Department of Palliative Medicine

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Palliative Medicine (T.P.), Uniklinik RWTH Aachen, Aachen, North Rhine-Westphalia, Germany; International Association for Hospice and Palliative Care (T.P., L.L., L.R.), Houston, Texas, USA. Electronic address: tpastrana@ukaachen.de

   Department of Palliative Medicine, Uniklinik RWTH Aachen, Germany. Electronic address: tpastrana@ukaachen.de

2. Liliana De Lima
   Affiliation as printed

   International Association for Hospice and Palliative Care (T.P., L.L., L.R.), Houston, Texas, USA

   International Association for Hospice and Palliative Care, Houston, Texas, USA

3. Verónica Dussel

   Massachusetts General Hospital

   Affiliation as printed

   Pediatric Palliative Care Research and Innovation Lab (V.D.), MassGeneral for Children, Boston, Massachusetts, USA

   Pediatric Palliative Care Research and Innovation Lab, MassGeneral for Children, Boston, MA, US

4. Xiaoxiao Jiang Kwete
   Affiliation as printed

   Yangzhou Philosophy and Social Science Research and Communication Center (X.K.), Yangzhou, Jiangsu Province, China

   Yangzhou Philosophy and Social Science Research and Communication Center, Yangzhou, China

5. Julia D Downing

   University of Edinburgh

   Affiliation as printed

   International Children's Palliative Care Network (J.D.), Bristol, England, UK; Global Health Academy, Usher Institute (J.D. L.G.), University of Edinburgh, Scotland, UK

   International Children's Palliative Care Network. Bristol, UK and Durban, South Africa; Global Health Academy, Usher Institute, University of Edinburgh, Scotland

6. Liz Grant

   University of Edinburgh

   Affiliation as printed

   Global Health Academy, Usher Institute (J.D. L.G.), University of Edinburgh, Scotland, UK

   Global Health Academy, Usher Institute, University of Edinburgh, Scotland

7. Afsan Bhadelia

   Purdue University West Lafayette

   Affiliation as printed

   Department of Public Health (A.B.), College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA

   Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA

8. Lukas Radbruch

   University of Bonn

   Affiliation as printed

   International Association for Hospice and Palliative Care (T.P., L.L., L.R.), Houston, Texas, USA; University of Bonn (L.R.), Bonn, North Rhine-Westphalia, Germany

   International Association for Hospice and Palliative Care, Houston, Texas, USA; University of Bonn, Bonn, Germany