World Health Organization 20, Avenue Appia

5
A WHO guide for planners, implementers and managers
What is palliative care?
WHO defines palliative care as the prevention and relief of suffering of adult and paediatric patients 
and their families facing the problems associated with life-threatening illness 
(4). These problems include 
physical, psychological, social and spiritual suffering of patients and psychological, social and spiritual 
suffering of family members. Palliative care 
(5):
n
entails early identification and impeccable assessment and treatment of these problems; 
n
enhances quality of life, promotes dignity and comfort, and may also positively influence the course 
of illness;
n
provides accompaniment for the patient and family throughout the course of illness;
n
should be integrated with and complement prevention, early diagnosis and treatment of serious or 
life-limiting health problems;
n
is applicable early in the course of illness in conjunction with other therapies that are intended to 
prolong life;
n
provides an alternative to disease-modifying and life-sustaining treatment of questionable value 
near the end of life and assists with decision-making about optimum use of life-sustaining 
treatment;
n
is applicable to those living with long-term physical, psychological, social or spiritual sequelae of 
serious or life-threatening illnesses or of their treatment; 
n
accompanies and supports bereaved family members after the patient’s death, if needed;
n
seeks to mitigate the pathogenic effects of poverty on patients and families and to protect them 
from suffering financial hardship due to illness or disability;
n
does not intentionally hasten death, but provides whatever treatment is necessary to achieve an 
adequate level of comfort for the patient in the context of the patient’s values;
n
should be applied by health care workers at all levels of health care systems, including primary care 
providers, generalists and specialists in many disciplines and with various levels of palliative care 
training and skill, from basic to intermediate to specialist;
n
encourages active involvement by communities and community members; 
n
should be accessible at all levels of health care systems and in patients’ homes; and
n
improves continuity of care and thus strengthens health systems.
The specific types and severity of suffering vary by geopolitical situation, socioeconomic conditions and 
culture. People in LMICs often endure less healthy social conditions. They also typically have less access 
to disease prevention, diagnosis and treatment, to social support, and to specialists and specialized 
services of many kinds than people in high-income countries (HICs). For example, many people around 
the world have limited or no access to cancer chemotherapy, radiation therapy or surgery, to effective 
chemotherapy for multidrug resistant tuberculosis, or to neonatal intensive care. Palliative care should 
never be considered a substitute for disease prevention and treatment or critical care, and palliative care 
workers have a responsibility to advocate for these interventions wherever they are not yet accessible (
5). 
But palliative care should also be universally accessible
(2).

---

Integrating palliative care and symptom relief into primary health care
6
Many countries also lack rehabilitation medicine specialists and services and long-term care facilities to 
care for people with non-life-threatening but serious disabilities such as paraplegia or quadriplegia or 
those due to brain injuries or congenital anomalies. In addition, mental health services and social welfare 
programmes may be of limited capacity, difficult to access or unavailable. Palliative care can help to fill 
these needs (Table 1). Further, the types of suffering typically associated with life-threatening illness – pain, 
other physical symptoms, psychological symptoms – also occur acutely or in association with non-life-
threatening conditions. But in low-resource settings, prevention and relief of acute or non-life-threatening 
suffering typically are inadequate or unavailable. In countries where pain medicine does not yet exist as a 
specialty and where prevention and relief of pain from trauma or burns or surgery are inadequate, clinicians 
trained in palliative care can fill this therapeutic void. In these settings, clinicians trained in palliative care 
can intervene either by training colleagues in symptom control, by providing direct symptom relief, or both. 
Planning and implementing palliative care services should be based on assessment of the types and extent 
of inadequately prevented or relieved physical, psychological, social or spiritual suffering. This attention to 
local needs is necessary for palliative care services to be people-centred: tailored to local need and to the 
needs of individual patients and families (Annex 3) 
(1,6). 

---

7
A WHO guide for planners, implementers and managers

---

---