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A WHO guide for planners, implementers and managers
Need for research and quality 
improvement
Ministries of health and health care planners can estimate the palliative care needs in their countries or 
regions with existing documents such as the WHO Global atlas of palliative care at the end of life and 
the report of the Lancet Commission on palliative care and pain relief 
(1,11). However, accurate locally 
generated data are more helpful to precisely characterize the health requirements of a given population 
and to inform health care planning. Reliable data can provide information about the principal health 
challenges facing a population and about treatment outcomes, making it easier for health systems to 
prioritize investment of scarce resources. To optimize the benefit of palliative care integrated into PHC, it is 
useful to understand the suffering of the target populations by means of a palliative care situation analysis. 
It also is important to understand local attitudes to infirmity, suffering, dying and death. In addition, 
it is important to measure the safety, effectiveness, value, and acceptability of palliative care once it is 
implemented.
Situation analysis
Data on needs, values and beliefs of patients in the community
To design palliative care services that provide optimum benefit for a specific population, the most common 
and most severe types of suffering should be studied. When no such data exist on the target population, 
palliative care situation analyses can assess all categories of suffering: physical; psychological; social; and 
spiritual. The target population may be small or large. It may be just one community, clinic population or 
hospital 
(25,107,108) or it may be an entire region or country (109,110). The situation analysis may use 
multiple detailed surveys 
(110), or it may use only one short survey. Ideally, data on types of suffering 
should be collected directly from patients rather than from family members or clinicians. However, many 
patients who are having discomfort or are near the end of life are unable to participate in long surveys. 
Thus, there is a benefit to using very concise surveys that nevertheless address all types of suffering. One 
example is the Palliative Outcomes Scale that exists in several forms for various populations and has been 
validated in several languages 
(111,112). This instrument can yield useful information both for researchers 
and for clinicians. It is brief enough to be incorporated into routine hospital or clinic forms for recording 
patient history and physical examination, and these forms, whether electronic or hardcopy, can be used 
both for palliative care situation analysis and quality assurance, assuming appropriate research ethics 
regulations are followed 
(25).
Attitudes towards disability, suffering, dying, death and palliative care can also be studied with standardized 
surveys. While no assumptions should be made about any individual patient based on ethnicity, religion, 
perceived culture, sex, education or any other demographic parameter, and each patient’s views and values 
should be explored, understanding of attitudes and values common in a target population is important for 
developing optimum palliative care training and services 
(113). Guidance is available on how to design 
such research that is based on issues relevant to potential users, for example, patients and carers, and 
thereby to avoid waste 
(114). Involving the community in setting research agendas is recommended (115). 

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Integrating palliative care and symptom relief into primary health care