This research article, published in BMC Palliative Care in 2025, presents an exploratory study comparing the statutory coverage and access to palliative care for adult cancer patients across eight European countries. Palliative care is defined as treatment and person-centered care for individuals with serious end-stage illnesses, such as incurable cancers, aiming primarily to improve and maintain quality of life for both patients and their families towards the end of the patient’s life. Secondary aims can also include considering the well-being of health and social care professionals. It focuses on pain and symptom management, care coordination, and addresses physical, functional, psychological, social, and spiritual dimensions of problems, necessitating early identification and a coordinated treatment strategy. The need for palliative care is growing due to epidemiological developments and demographic changes, making understanding its provision crucial.
The study addresses a critical gap in understanding the practical application of palliative care across different European health systems. While palliative care is strongly associated with cancer patients—cancer being the second leading cause of death globally—the specific services can also apply to other conditions like cardiovascular, chronic respiratory, and neurological diseases. The research builds on previous work by the European Observatory on Health Systems and Policies, exploring the utility of a patient vignette approach to identify gaps and challenges in healthcare access.
To achieve its objectives, the study employed a patient vignette approach, a methodology involving a short description designed to simulate a real-world scenario. The palliative care vignette created for this study described a pathway based on best practice guidance for patients with incurable cancer, incorporating elements like chemotherapy, pain and symptom management (opioids, benzodiazepines, laxatives), psychological support, advance care planning, and services for carers. This vignette was developed using guidelines from Germany and the US, and was reviewed by clinical oncology and palliative care experts. Surveys accompanying the vignette were completed by health services researchers, practitioners, government officials, or teams with direct knowledge of palliative care in their respective countries. The eight participating countries were Bulgaria, Estonia, France, Lithuania, the Netherlands, Portugal, Sweden, and England, chosen to represent health systems with different operative features and geographical distributions. Experts were asked about population coverage, service coverage (what benefits are covered by the statutory health system), cost coverage (proportion covered and out-of-pocket costs), and factors influencing access gaps.
The results revealed that services envisioned in the vignette’s pathway are generally covered by statutory health systems. However, cost-sharing exists in some countries for hospital stays, certain medicines, and medical aids. Significant variations were observed in the coverage of social and financial assessments, home equipment, and financial advice, with coverage differing across nearly every country. For instance, in England, home equipment coverage involves means testing, while in the Netherlands, responsibilities shift between insurers and municipalities depending on the duration of need. Advance care planning conversations were fully covered in some countries (Bulgaria, England, Netherlands, Portugal) but non-existent or non-routine in others (Estonia, Sweden).
Key access barriers identified across nearly all countries included travel times to and availability of palliative care specialists, particularly impacting rural and suburban patients. Waiting times for care were also problematic in England and Estonia, with a lack of personnel being a specific concern in Estonia and Lithuania. Organizational barriers (e.g., limited pharmacy hours, lack of psychological professionals), societal stigmas (feelings of shame or guilt), and knowledge gaps (lack of experience or fear in prescribing certain medications, especially opioids) were also found to impede access to drugs and psychological therapies. The cross-sectoral nature of palliative care meant that issues like low densities of social workers or lack of systematic cooperation between health and social systems also created barriers. The study further highlighted that the actual care delivery in some countries, like Lithuania, is spearheaded by a general physician and nurses, differing from the vignette’s oncology and specialist palliative care team model.
In conclusion, while basic levels of coverage and access exist, substantial variations were observed in the scope of coverage and access to palliative care options across the surveyed European countries. The study offers crucial insights into how countries organize and offer palliative care services and the levels of access. As the future need for palliative care grows, the authors emphasize that health ministries and insurers must increasingly focus on guaranteeing coverage and access, and learn from best practices among countries. This research underscores the importance of addressing communication challenges, integrating palliative care across health and social services, supporting co-design of patient pathways, and ensuring workforce sustainability to avoid disruptions in care delivery.
Reference: Shuftan, N., Dayan, M., Scobie, S., Wee, B., Dimova, A., Atanasova, E., Murauskiene, L., Gandré, C., Or, Z., Augusto, G. F., Habicht, T., Köhler, K., Kahur, K., Axelsson, B., Kroneman, M., de Jong, J., de Veer, A., Bemelmans, W., Pereira, C., … Panteli, D. (2025). The variation of coverage and access to palliative care for cancer patients in eight European countries: an exploratory vignette approach. BMC Palliative Care, 24(188). https://doi.org/10.1186/s12904-025-01831-1
