1. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes. Palliative Care Services in Settings & demographic scenarios Xavier Gómez-Batiste MD, PhD Director, WHO Collaborating Center for Public Health Palliative Care Programs OSI/WHOCC Workshop 4

2. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Implementing Palliative Care Specialist Services

3. Institut Català d’Oncologia Specific Resources / settings Units Support teams Outp’s / Day care Acute Hospitals Nursing homes Mid term and long term, RHB, (Sociohealth Centers) Hospices Community / home

4. Institut Català d’Oncologia Types of services and Levels of complexity General measures in conventional Services (Hospitals, Primary care, Nursing homes, Emergencies, etc) Basic suport teams (home, hospitals, comprehensive) Reference: complexity+ training+ research Complete teams Units Transitional measures: individual Specialist nurses or consultants

5. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Standards of specific resources 1 support team at home / 100.000 h 80-100 beds / milion habitants (10-20% acute, 40-60% mid term, 20-30% nursing homes) 20-25 full time doctors / milion habitants 1 team available in every hospital (units in teaching) Models of organisation adapted to demographic scenarios: metropolitans, intermediate, or small sectors < 100.000 Models in specific resources (cancer institutes, nursing homes, etc) XGB 2005, WHOCC, 2008

6. Institut Català d’Oncologia Implementation strategies of services: initial phases To create a nucleus of solid experiences Combine different types: home, hospital, cancer, geriatric,…. Based in feasibility: active leaders, institutional comittment, …. Cathalitic measures: support teams, transitional, … Define services before starting implementation

7. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Models of organisation in demographic and geographic scenarios

8. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

9. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Demographic and setting scenarios Demographic Rural Urban Rural-urban Metropolitan Settings Primary/community care Nursing homes Longterm / intermediate Hospitals: district general, university Cancer Institutes Adapt the organisation to needs and contexts

10. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Exercise Select one setting in your country Discuss the models of organization of palliative care services in that setting

11. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes. The ‘Qualy’ End of Life Care Observatory WHO Collaborating Centre for Public Health Palliative Care Programmes whocc.info@iconcologia.net +34 93 260 77 36 ICO l’Hospitalet Hospital Duran i Reynals Gran Via de l’Hospitalet, 199-203 08908 l’Hospitalet de Llobregat Institut Català d’Oncologia