Obstacle | Summary | Opportunities to address it |
---|---|---|
Ethos | Primacy of life saving efforts in humanitarian action deflects attention from objectives of alleviating suffering and promoting dignity | ● Increased reflection and engagement in humanitarian organizations ● Emphasizing all three goals of humanitarian action ● Accepting potential for integration of curative and palliative approaches ● Raise awareness of the unaddressed health-related suffering |
Priority Setting | In situations of crisis where resources are scarce and needs are high, it may be difficult to justify directing resources to palliative care | ● Emphasize that most palliative care interventions are not costly ● Partner with local community and lay caregivers ● Question when care being provided may be futile or unduly burdensome ● Ensure suffering and dignity are addressed for all patients as a matter of equity ● Prioritize those resources dedicated to palliative care to address needs of patients with most imminent and severe needs |
Funding | Palliative care is unlikely to be effective for garnering funding from the public or large donors, a perception which may lead to not including it in programs | ● Challenge perceptions of humanitarians as ‘heroic life-savers’ as it problematically narrows the scope of humanitarian action ● Test the assumptions that palliative care efforts would not be seen favorably by donors ● Learn from successful examples within and beyond the humanitarian sector (e.g hospice movement) ● Identify relevant accountability metrics for palliative care |
Guidance and expertise | There are few organizational polices and clinical standards related to palliative care in humanitarian settings, and few organizations have developed expertise or implemented training in this area | ● Develop policies, standards and clinical guidelines, and training for palliative care in humanitarian aid organizations ● Share resources among organizations ● Identify health professionals with palliative care expertise who can act as resources for the organization, and real time supports for teams |
Access to medications | It is very difficult to access pain medications, especially opioids, in many countries due to legal restrictions, logistical issues, and misperceptions. | ● Advocate for standard access to opioids and other pain and symptom medications, especially removal of legal barriers ● Plan and integrate medications into medical supply chain and logistics ● Address misperceptions regarding opioids |
Cultural specificity | Humanitarian organizations and their staff coming from other settings will have difficulty accessing or understanding local cultural, spiritual and social dimensions of death and dying | ● All humanitarians should reflect on their own cultural values, and engage with humility and respect ● Consult and collaborate with translators, local health professionals, and lay care providers to provide culturally and religiously sensitive palliative care |
Equity | Providing palliative care to displaced persons may lead to concerns for equity if this care is not available to host communities | ● Work with local communities to better understand and address their concerns ● Design programs in ways that explicitly address issues of equitable access to care ● Draw attention to the equity concerns of not providing palliation to those who require it, whether from refugee or host communities. |
Continuity of care | Even if humanitarians initiated palliative care, continuity would be difficult if this approach does not exist in the local health system | ● Thoroughly explore and support existing local palliative care provision ● Contribute to capacity building where needed, including training local lay people and health providers |
Security | In some settings, security concerns may arise if when health professionals propose palliative care for a patient it is perceived by others as not providing the best care possible. | ● Carefully and continuously assess security risks ● Ensure that health professionals are trained to evaluate such issues ● Explore ways as a team to still provide palliative care while not undermining team safety |
Terminology | Some humanitarian and local health professionals and policymakers may resist the term ‘palliative care’ but be open to the clinical approach if not labeled in this way | ● Consider how terms are understood and interpreted by different groups ● Seek to clarify meanings and adapt vocabulary used to the particular context |