Although cancer cure rates continue to rise respectably, cancers worldwide are the leading cause of disease-related deaths and morbidities. According to the most recent statistics, 8.2 million deaths annually across the globe are cancer-related. Although cancer-related deaths span every country, continent, and age group, less developed countries account for 65% of these deaths. In particular, Africa, Asia, and Central and South America suffer disproportionately high rates of cancer-related deaths.1–4 Dying of cancer calls for a unified and global approach that, just like cancer, reaches across all geographic borders and all ages. The commitment to reduce the burdens of cancer-related deaths is apparent in position statements and resolutions from the World Health Organization, the Worldwide Palliative Care Alliance, and the United Nations,5,6 but when palliative and end-of-life care was strongly recommended to be one of the United Nation’s Sustainable Development Goals for 2015 to 2030, this priority did not make the final list.7 We need global champions, but who they could be is not immediately clear.
Most certainly, the interest in a global approach to end-of-life care is reflected in position statements from a number of international organizations and professional associations and in the priority care or research lists generated by small groups involving a limited number of individuals from 3 or more countries.8,9 But this level of interest and effort has not become a global initiative, program, or movement. There are no international laws that include end-of-life care as part of a healthcare system, and there are no tested international clinical guidelines and no globally approved best practices. Of most concern, there may be no political will to legislate the right of all persons to the highest-quality end-of-life care.10
But what would a global champion do? What would be better for individuals dying a cancer death, their families, and their governments? A global champion would commit to establishing a unified and worldwide plan that would include a shared vision, conceptual model and business plan, consensus priorities for care and the corresponding research and quality improvement strategies, and a common lexicon for use in administration, policy setting, education, care, research, and quality improvement efforts. Monitoring the implementation of the consensus priorities and a formal evaluation plan would also be a part of this unified approach.
The advantages of this approach seem to be almost infinite; accuracy of relevant data would be immediately enhanced by the use of shared conceptual definitions and metrics; new knowledge would result from the natural comparisons and contrasts in response to care interventions that a global approach innately makes possible; evidence to support the integration of end-of-life care into healthcare policies; and opportunities to apply and rapidly evaluate policies and care strategies designed to reduce the burden of dying on patients and families, healthcare systems, and governments would yield the basis of global best practices. New standards of education could be created and implemented that would allow cross-border achievement of end-of-life-care credentials. Interactions among individuals at the levels of policy making, funding, caregiving, education, and research would be facilitated in ways that dwarfs what has been attempted to this point in time.
The advantages are stunning; attention given to dying consistently translates into benefits for the living. We need to ask potential global champions: what is keeping you?
Our very best,
Pamela S. Hinds, PhD, RN, FAAN
Editor-in-Chief, Cancer Nursing™
Deborah A. Lafond, DNP, PPCNP-BC, CPON, CHPPN
PANDA Palliative Care Team,
Division of Hospitalist Medicine
Children’s National Health System
3. Corless IB, Limbo R, Bousso RS, Rochon K. End-of-life care in a global health context. In: Breakey S, Corless IB, Meedzan NL, Nicholas PK, eds. Global Health Nursing in the 21rst Century
. 2015: 307–325.
4. Downing J, Powell RA, Marston J, et al. Children’s palliative care in low and middle income countries. Arch Dis Child
. 2015; 0: 1–6.
5. Connor SR, Bermedo MCS, eds. Global Atlas of Palliative Care at the End of Life. Worldwide Palliative Care Alliance, 2014
. Accessed September 14, 2015.
8. Hagen NA, Addington-Hall J, Sharpe M, Richardson A, Cleeland CS. The Birmingham International Workshop on supportive, palliative, and end-of-life care research. Cancer
. 2006; 107( 4): 874–881.
9. Evans CJ, Benalia H, Preston NJ, et al. The selection and use of outcome measures in palliative and end-of-life care research: the MORECare International Consensus Workshop. J Pain Symptom Manage
. 2013; 46( 6): 925–937.
10. Schenker Y, Arnold R. The next era of palliative care. JAMA
. 2015; 314( 15): 1565–1566.