Factors related to good death in the Eastern Mediterranean Region: a systematic review

Background: Considerations for palliative care and quality of death has significantly increased over the past 10 years in the Eastern Mediterranean Region (EMR). Recent trends in ageing and increasing chronic disease burden have drawn attention to the need to pay attention to the concept of good death and related factors from the perspective of the local population. Aims: To assess the factors related to good death in the EMR. Methods: We searched PubMed, Embase, Scopus, Web of Science, and ProQuest on 22 October 2021 for English language articles, with no time limit, using keywords “quality of death”, “good death”, “quality of dying”, “good dying”, “Middle Eastern”, and countries in the Region. The quality of articles was evaluated using the Hawker criterion and based on the PRISMA guidelines. From the thematic analysis, the factors influencing good death were extracted. EndNote X8 software was used for data management. Results: The search yielded 55 articles, and 14 were included in the study, with a total of 3589 participants. Factors related to good death were classified into 2 main categories: patient preferences and end-of-life care. The former was divided into 4 groups: symptom management, psychological support, social support, and spiritual care. The second category included 2 subcategories: death control and patient autonomy, and end-of-life care. Conclusion: Although patients’ beliefs about good death are personal, unique, and different, perception about good death in the EMR depends on the extent to which patients’ preferences are met and end-of-life care is provided. More research on good death is recommended in the context of Islamic countries in EMR, and to empower patients and their families to better manage the dying process and create educational programmes.

Планирование и оказание услуг паллиативной помощи: пособие для руководителей программ

В 2014 г. первая в истории глобальная резолюция по паллиативной помощи, WHA67.19, призвала ВОЗ и государства-члены улучшать доступ к паллиативной помощи как одному из основных компонентов системы здравоохранения, уделяя особое внимание первичной медико-санитарной помощи и оказанию помощи на уровне местных сообществ и на дому. В Глобальном плане действий ВОЗ по профилактике неинфекционных заболеваний и борьбе с ними на 2013–2020 гг. паллиативная помощь прямо признается частью комплекса услуг, оказание которых необходимо при неинфекционных заболеваниях. Государства-члены обратились к ВОЗ с просьбой разработать научно обоснованные рекомендации по интеграции паллиативной помощи в национальные системы здравоохранения в отношении разных групп заболеваний и уровней помощи.Этот документ является практическим пособием по планированию и внедрению услуг паллиативной помощи, интегрированных в существующие службы здравоохранения, на национальном или субнациональном уровне. Он был разработан прежде всего для руководителей программ в области здравоохранения на национальном, местном или районном уровнях, независимо от того, отвечают ли они за программы по неинфекционным заболеваниям, инфекционным болезням, службы здравоохранения или за другие технические области, в которых паллиативная помощь играет важную роль. Цель пособия состоит в изложении широкого ряда вариантов и отправных точек для создания и укрепления служб паллиативной помощи. В каждом разделе по возможности подробно изложен пошаговый подход с акцентом на методах работы, приемлемых для стран с низким и средним уровнем дохода.

Palliative care for older people: better practices

Populations around the world are ageing, and more people are living with the effects of serious chronic illness towards the end of life. Meeting their needs presents a public health challenge. This publication aims to provide examples of better palliative care practices for older people to help those involved in planning and supporting care-oriented services most appropriately and effectively. Examples have been identified from literature searches and from an international call for examples through various organizations, including the European Association of Palliative Care and the European Union Geriatric Medicine Society. Some examples consider how to improve aspects within the whole health system; specific smaller examples consider how to improve palliative care education, support in the community, in hospitals or for specific groups of people, such as people in nursing homes and people with dementia and their families. Some examples await rigorous evaluation of effectiveness, and more research is needed in this field, especially the cost–effectiveness and generalizability of these initiatives. This publication takes both an individual person and a health systems approach, focusing on examples from or relevant to the WHO European Region. The publication is intended for policy-makers, decision-makers, planners and multidisciplinary professionals concerned with the care and quality of life of older people.