Stephen Connor

• PhD
• Executive Director at Worldwide Hospice Palliative Care Alliance

Background The Lancet Commission on global access to palliative care and pain relief introduced the concept of serious health-related suffering (SHS) to measure the worldwide dearth of palliative care. This Article provides an extended analysis of SHS from 1990 to 2021 and the corresponding global palliative care need.

Context Estimates of serious health-related suffering (SHS) demonstrate immense unmet need for palliative care, predominately in low- and middle-income countries (LMICs). Because opioids are essential medicines in palliative care (PC), measuring their availability can be used to evaluate the capacity of health systems to meet need. Objectives Pres...

In Ethiopia, there is a great need for culturally relevant, sustainable palliative care. Profound poverty and limited health care resources magnify the impact of disease in Ethiopia, one of the poorest countries in the world. The impacts of high burden of disease and poor access to health care include physical suffering, and detrimental economic ef...

At the International Gynecologic Cancer Society (IGCS) Global Meeting in 2023 held in Seoul, South Korea, we held a Presidential Plenary Session focusing on palliative care ( https://www.youtube.com/watch?v=TBDIoQ50xgI ). We hereby reaffirm the significance of this session, express the Palliative Care Declaration made by the IGCS, and describe our...

Context Inequities and gaps in palliative care access are a serious impediment to health systems especially in low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palli...

Inequities and gaps in palliative care access are a serious impediment to health systems especially low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care...

People whose family member(s) friend(s) have died from COVID-19 or other causes have been deeply affected by the physical and social restrictions imposed during the pandemic. These limitations have affected end-of-life care and support for the bereaved. The purpose of this review is to identify: the published studies of evaluated programs about int...

Background: Approximately 40 million people in need of palliative care worldwide, while 80% of them live in low- and middle-income countries. Kazakhstan, a low-to middle-income country with a reforming healthcare system, is committed to improving quality and accessibility of care for its 100,000 terminal patients in need of palliative care. Policy...

Cancer, a leading cause of mortality worldwide, is often diagnosed at late stages in low-and middle-income countries, resulting in preventable suffering. When added to standard oncological care, palliative care may improve the quality of life (QOL) of these patients. A longitudinal observational study was conducted from January 2020 to December 202...

Objectives: On 3-4 October 2022, the Memorial Sloan Kettering Cancer Center Supportive Care Service and Department of Psychiatry and Behavioral Sciences hosted the Third Annual United States (US) Celebration of World Hospice and Palliative Care Day (WHPCD). The purpose of this article is to reflect on the event within the broader context of the in...

The 7th International African Palliative Care Conference and the 4th African Ministers of Health Meeting were held in Kampala from the 24th to 26th August 2022. The theme of the conference - Palliative Care in a Pandemic - reflected the reality of palliative care provision on the continent, and the experience of patients and providers over the past...

Palliative care, which aims to provide comprehensive, interdisciplinary, holistic care to children, adolescents and adults with life-threatening, and ultimately life-limiting conditions, is a discipline that has emerged as an integral component of healthcare systems throughout the world. Although the value of life-affirming palliative care (PC) has...

Context: Between 2000 and 2020 Open Society Foundations was one of very few funders that supported global palliative care development and advocacy. Objectives: To describe progress made in three priority areas-the integration of palliative care into public health systems, access to controlled medicines, and pediatric palliative care-during those...

Objective On October 5–6, 2021, the Memorial Sloan Kettering Cancer Center Supportive Care Service and Department of Psychiatry and Behavioral Sciences hosted the 2nd Annual United States (US) Celebration of World Hospice and Palliative Care Day (WHPCD). The purpose of this article is to describe the event within the broader context of the internat...

Data and information on all aspects of death, dying, & bereavement

This chapter provides a global overview of palliative and supportive care with an emphasis on cancer in lower income and middle-income regions and countries as defined by the World Bank (1). This is done in recognition of long-standing local and indigenous traditions of caring for those who suffer and with awareness of how formal palliative care as...

Aims The study aimed to explore the quality and impact of care provided through an innovative palliative care project to improve the quality of life of older people in an urban informal settlement in Bangladesh. Methods Center for Palliative Care (CPC) at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, in collaboration with the Worldwi...

Context Few efforts have attempted to quantify how well countries deliver end-of-life (EOL) care. Objectives To score, grade, and rank countries (and Hong Kong and Taiwan) on the quality of EOL care based on assessments from country experts using a novel preference-based scoring algorithm. Methods We fielded a survey to country experts around the...

This study aimed to explore the quality and impact of care provided through an innovative palliative care project to improve the quality of life of older people in an urban informal settlement in Bangladesh

This chapter describes all aspects of policy, including definitions, who is it that sets policy, how policy is made, how policy is implemented, the elements of effective policies, the differences between policies and regulations, the policies that are important for palliative care, global versus national policy differences, and barriers to the crea...

This chapter describes all we currently know about the history of palliative care for children and the epidemiological data we have on need for and delivery of care.

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extr...

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience var...

PURPOSE To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration. METHODS We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified De...

Objective On October 10, 2020, the Memorial Sloan Kettering Cancer Center Supportive Care Service hosted their first-ever United States (US) World Hospice and Palliative Care Day (WHPCD) Celebration. The purpose of this article is to describe the US inaugural event in alignment with the broader goals of WHPCD and provide lessons learned in anticipa...

Treating dyspnea in patients with idiopathic pulmonary fibrosis is a challenge. The foreign experience of using low doses of opioids to relieve dyspnea in patients with progressing diseases is controversial among Russian specialists. The presented clinical case is an 83-year-old patient with idiopathic pulmonary fibrosis in the terminal stage and r...

The COVID-19 pandemic poses an unprecedented health crisis in all socio-economic regions across the globe. While the pandemic has had a profound impact on access to and delivery of health care by all services, it has been particularly disruptive for the care of patients with life-threatening noncommunicable diseases (NCDs) such as the treatment of...

Background: The growing interest in tracking the global development of palliative care provision is not matched by research on the development of palliative care services specifically for children. Yet it is estimated that worldwide, 21 million children annually could benefit from the provision of palliative care. We report on a global study of chi...

The Global Atlas of Palliative Care, 2nd Edition (2020) paints a picture of palliative care Worldwide. This important reference book is published by the Worldwide Hospice Palliative Care Alliance in cooperation with the World Health Organization. Need for palliative care, barriers to palliative care, levels of palliative care development, resources...

Palliative care development follows a public health model developed by the WHO that emphasizes policy, education, medication availability, and implementation.21 There are many barriers to achieving each of these components.

Responding to the enormous unmet need for palliative care has been very challenging. In the over 50 years since the opening of St. Christopher’s Hospice in the United Kingdom there has been a slow but steady growth in programmes that serve the needs of those with life-threatening illness. There are now approximately 25,000 hospice or palliative car...

Resources for palliative care development are limited worldwide. In spite of this, considerable private efforts, goodwill and community support have sustained and helped build palliative care worldwide. In this chapter the educational, financial, and human resources devoted to meeting the need for palliative care will be discussed along with some e...

Executive Summary Worldwide, over 56.8 million people are estimated to require palliative care every year including 31.1 million prior to and 25.7 million near the end of life. The majority (67.1%) are adults over 50 years old and at least 7% are children. The majority (54.2%) are non-decedents who need palliative care prior to their last year of l...

This introductory chapter covers the definition of palliative care, why palliative care is a human right, and the World Health Assembly Resolution on Palliative Care.

Context: Palliative care is an emerging health care service essential for every health care system. Information on the current status of palliative care service delivery is needed in order to understand the gap between need for palliative care and current capacity to deliver. Objectives: To estimate the number of providers delivering palliative...

Background: Public policy has been a foundational component of the World Health Organization public health model for palliative care development since 1990. There is, however, limited evidence on the existence and character of palliative care policy at the country level. Objective: To identify, report on, and map the presence of national palliative...

Background: The growing interest in tracking the global development of palliative care provision is not matched by research on the development of palliative care services specifically for children. Yet it is estimated that worldwide, 21 million children annually could benefit from the provision of palliative care. We report on a global study of chi...

Background: The growing interest in tracking the global development of palliative care provision is not matched by research on the development of palliative care services specifically for children. Yet it is estimated that worldwide, 21 million children annually could benefit from the provision of palliative care. We report on a global study of chi...

Background The International Association for Hospice and Palliative Care (IAHPC) developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. Aim The objective of this paper is to presen...

The need for and accessibility to children’s palliative care (CPC) varies globally, with differences seen between countries and regions.

In this chapter we explore the overall definition and concept of global palliative care development, the assessment of need for palliative care, national levels of palliative care development, progress in achieving the public health model of palliative care including policy development, educational development, access to essential medicines, implem...

In May 2019, we, as representatives of the three global palliative care organizations, [International Association for Hospice and Palliative Care (IAHPC), International Children’s’ Palliative Care Network (ICPCN) and Worldwide Hospice Palliative Care Alliance (WHPCA)] met in Berlin to discuss how to work more closely together to convey the same mes...

Context: Palliative care is gaining ground globally and is endorsed in high level policy commitments, but service provision, supporting policies, education and funding are incommensurate with rapidly growing need. Objectives: To describe current levels of global palliative care development and report on changes since 2006. Methods: An online s...

Background : Despite growing interest from policy makers, researchers and activists, there is still little science to underpin the global development of palliative care. This study presents the methods deployed in the creation of a ‘world map’ of palliative care development. Building on two previous iterations, with improved rigour and taking into...

Background : Despite growing interest from policy makers, researchers and activists in the global development of palliative care, there is still little science to underpin it. This study presents the methods deployed in the creation of a ‘world map’ of palliative care development. Building on two previous iterations, with improved rigour and taking...

Understanding the growth and development of palliative care worldwide poses significant challenges. In this chapter we explore the overall definition an concept of global palliative care development, the assessment of need for palliative care, national levels of palliative care development, progress in achieving the public health model of palliativ...

The central principle of “balance” represents the dual obligation of governments to establish a system of control that ensures the adequate availability of controlled substances for medical and scientific purposes while simultaneously preventing their nonmedical use, diversion, and trafficking, two primary goals of the international control system....

Background: Validated and reproducible means to systematically improve pain documentation and outcomes in home-based hospice populations are generally lacking. This paper describes a novel, electronic medical record (EMR)-embedded pain monitoring and management program for home-based hospice patients. Measures: Pain relief was measured by patien...

This book is a guide for Ministries of Health around the world to determine and implement their national healthcare priorities. I am one of the many authors of Chapter 12 "Palliative Care and Pain Control" pp 235-246 The whole book is included. The editor of this book are: Jamison, D. T., H. Gelband, S. Horton, P. Jha, R. Laxminarayan, C. N. Mock,a...

The Worldwide Hospice Palliative Care Alliance (WHPCA) is an international non-governmental organization registered as a charity in England and Wales that was established in 2008 following a series of international gatherings that highlighted the important need for palliative care to be included in global policy and health planning. The vision of t...

In 2014, 1.5 million people died of tuberculosis (TB) worldwide including 400,000 co-infected with HIV. TB remains a major cause of death and suffering globally, in spite of the fact that it is supposed to be a curable disease. Drug resistant forms of TB have developed as a result of poor treatment compliance including multi-drug and extreme drug r...

In the last seven years, considerable progress has been made in palliative care (PC) in Armenia, but many problems remain unresolved. Policies developed include completion of a national needs assessment, a recognized working group on PC formed, national standards approved, a concept paper on PC approved, resolutions on PC as a specialized service a...

The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed t...

Palliative care began in Kyrgyzstan in 2005 as a pilot home-based care program in Osh Cancer Center and was supported by a small group of nurses and one physician from Scotland. In 2010, the Soros Foundation-Kyrgyzstan and the Open Society Foundation's International Palliative Care Initiative began supporting work on palliative care policy, legisla...

Sixty percent of cancer patients are diagnosed with advanced stages of disease and those diagnosed in early stages face challenges to receive adequate treatment. Palliative care has had significant developments in recent years in Albania because of a close partnership with the Ministry of Health, local nonprofit organizations, and the Open Society...

The third edition of Hospice and Palliative Care is the essential guide to the hospice and palliative care movement both within the United States and around the world. Chapters provide mental-health and medical professionals with a comprehensive overview of the hospice practice as well as discussions of challenges and the future direction of the ho...

A comprehensive guide to help in building integrated palliative care programs and services with a public health perspective, written by most of the members of the Technical Advisory Group ant the WHO HQ.

KEY POINTS O The relief of suffering is the main goal of palliative care. O The comprehensive and integrated model of palliative care is based on the needs and characteristics of persons with advanced chronic conditions and limited life prognosis. O Multidimensional needs including physical, emotional, spiritual, family, social, economic, and ethic...

KEY POINTS O Definition: A specialized palliative care service is a health care resource devoted specifically to attending to the complex needs of patients with progressive, chronic life-limiting conditions and their families and to give support to other services. It is composed of a competent interdisciplinary team with advanced training, and clea...

KEY POINTS O Estimating the cost of palliative care is an essential part of planning for its implementation. O Palliative care can provide value in health care by reducing unnecessary costs associated with hospitalization and with futile assessment and treatments. O Home and community-based services are emphasized over building inpatient palliative...

KEY POINTS O A thorough review of existing laws and regulations impacting the provision of palliative care is needed. O Modifications to law or regulation, where necessary, should be carried out. O National standards for operating a palliative care program or service are needed. O Measurement of palliative care is necessary and supports quality ass...

KEY POINTS O Palliative care can be provided at all levels and in all settings of the health care system. O There are different levels of palliative care complexity, from general actions of palliative approach in all settings to referral services or comprehensive / integrated networks in a district. O Generic criteria of universal access consist of...

KEY POINTS O Ethical practice in palliative care is guided by ethical principles. O Delivering good ethical practice requires well-developed skills in:-Communication,-Provision of respectful, people-centred care,-Supporting dignity, spirituality, hope, and autonomy,-With attention to advance care planning,-Based on the identification of values, pre...

‘‘Jerome’’ has stage 4 cancer and multiple co-morbidities. During his fourth hospital admission within 6 months, he said to his wife ‘‘Marilyn,’’ ‘‘I don’t want to be in the hospital anymore. They can’t fix me. Let’s go home.’’ Jerome was discharged and enrolled in home hospice care. On February 6, 2015, Jerome’s hospice nurse made a routine home v...

This chapter describes palliative care public health programs as the systematic (comprehensive, combined, multi-level, & step-wise) measures taken to improve quality of care for defined target patients and their families, within a defined, population-based context (national, regional, or district level)

The opening chapter of the book on integrating palliative care into health systems. This book was written by members of the WHO Technical Advisory Group (TAG) on Palliative Care and this chapter describes the work on the TAG following the passage of the resolution on palliative care by the World Health Assembly.

This chapter explains the processes for determining the need for palliative care in a country or any context.

KEY POINTS Palliative care is the comprehensive and integrated care of persons with advanced chronic conditions and limited life prognosis and their families. O The target patients for a palliative care approach can be defined in terms of a cluster of symptoms or factors, including the presence of a chronic advanced disease or condition, a limited...

Context: The need for children's palliative care (CPC) globally is unknown. In order to understand the scope of the need and to advocate to meet it, more accurate estimates are needed. Objectives: To create an accurate global estimate of the worldwide need for CPC based on a representative sample of countries from all regions of the world and al...

The International Psycho-Oncology Society (IPOS) Human Rights Task Force has been working since 2008 to raise awareness and support, for the relevance of psychosocial cancer care as a human rights issue. In 2014 the “Lisbon Declaration: Psychosocial Cancer Care as a Universal Human Right” was fully endorsed by IPOS. Subsequently, the IPOS Standard...

Hospice developed in the United States in the 1970s as a way to address unmet needs for end-of-life care: support for pain and symptom management provided in the location and manner that the patient and family prefer. In Europe and Australia, hospice is available from the time of diagnosis of an advanced life-limiting illness onward, but in the Uni...

Background: An estimated 6,000 to 18,000 additional hospice and palliative medicine (HPM) physicians are needed in the United States. A source could be the military graduate medical education system where 15% of U.S. medical residents are trained. A community-based hospice and palliative care organization created a one-week rotation for military r...

Background/rationale: This report describes a quality improvement continuing medical education activity designed to enhance the recognition and treatment of residents with Alzheimer's disease (AD) or other dementias in skilled-nursing facilities (SNFs). Methods: Charts were compared in 6 areas prior to and following (stages A and C) a live, facu...

This is a chapter on hospice and home care in the book "Psycho-Oncology.

This chapter describes major developments in the growth of hospice and palliative care globally over nearly 50 years. The foundational work of St. Christopher's Hospice, key leaders and organizations such as Elizabeth Kubler-Ross, the International Work Group on Death, Dying & Bereavement, the International Association of Hospice and Palliative Car...

Most cancers occur in developing countries, with 60 % of cancer cases and 70 % of cancer deaths occurring in Africa, Asia and Central and South America, where the disease is increasingly a public health concerngiven the regions’ populous nature and often deficient preventive and curative oncological approaches and treatment access. Palliative care...

This chapter describes the status of various global palliative care initiatives

Hospice care continues to be viewed in may countries as an inpatient setting for the care of those at life's end. Increasingly hospice care is now viewed as palliative care provided to people in the place they call home.

This landmark title is the key resource for nurses working in the field of palliative care. Edited by renowned nursing experts, and written by a dynamic team of internationally known authorities in nursing and palliative medicine, the Oxford Textbook of Palliative Nursing covers the gamut of principles of care from the time of initial diagnosis of...

Context Outpatient nonhospice palliative care has been shown to provide many benefits to patients facing advanced illness, but such services remain uncommon in the U.S. Little is known about the association between clinic-based outpatient palliative care consultation and the timing of hospice enrollment. Objectives To determine whether there are d...

Background: It is important to ensure that minimum standards for palliative care based on available resources are clearly defined and achieved. Aims: (1) Creation of minimum National Standards for Palliative Care for India. (2) Development of a tool for self-evaluation of palliative care organizations. (3) Evaluation of the tool in India. In 2006,...

ObjectiveA major goal of palliative care is to provide comfort, and pain is one of the most common causes of treatable suffering in patients with advanced disease. Opioids are indispensable for pain management in palliative care and can usually be provided by the oral route, which is safe, effective, and of lowest cost in most cases. As patients ne...

Background: Dyspnea significantly impacts quality of life and is one of the most common symptoms in advanced illness. Systemically-administered opioids and benzodiazepines have been the most studied and utilized pharmacologic treatments for refractory dyspnea. Less attention has been given to the use of these medications and others when nebulized....