Kantonsspital St.Gallen

Swiss-Romanian Cooperation Programme: Overcoming disparities on access to quality basic palliative care in the community: Partnerships to identify and improve clinical, educational, legal and economical barriers

Florian Strasser


The project is based on a Swiss-Romanian partnership to develop palliative care in Romania, based on a systematic analysis of the needs, with Swiss experts input in drafting and answering major challenges in offering care to cancer patients. The burden of cancer continues to increase at global level. Cancer is the second leading cause of death in Romania. Over 70% of the new cancer cases are diagnosed in late stages (III and IV) of the disease thus representing advanced and terminal patients. As result, Romanian health care system is witnessing an increasing number of cancer patients in need of palliative care (i.e. multidisciplinary, specialized care involving physical aspects such as pain and symptom control, as well as psycho-emotional, social and spiritual support). After the ’90s the development of palliative care in Romania was done inconsistently, based on isolated individual initiatives, limited financial resources and specialized human resources available. Thus, according to the data collected in 2010, there was 5.9% coverage, with highly uneven spread over the country (26 counties out of 41 had no palliative care at all).
The disparities are identified on four dimensions: clinical care of patients, education of general practitioners (GPs), legal and policies aspects in providing palliative care and financial barriers. These are the key levels for activities within the project. The target groups consist of different socio-economical groups, such as: cancer patients and their families, general practitioners, health authorities involved in decision making, in legal and economic aspects of health care, patients’ associations and other stakeholders.

The general objective of the project is to design a new model of care for reducing gaps in access to palliative community care for cancer patients, based on Swiss-Romanian cooperation and expertise exchange. This will be reached through the following specific objectives:

1. Design a disparity and needs reality frame in providing care for patients diagnosed with cancer in 4 pilot counties (Brasov, Bucharest, Cluj and Iasi).
2. Develop and pilot interventions (education, key elements of care and pilot interventions) to overlap disparities based on the research findings and partners’ expertise in delivering health services.
3. Empower stakeholders to enact policy changes in palliative care for reducing disparities in health in Romania.

A systematic collection of data from the stakeholders will offer a reality map of the general perception on the patients’ needs, educational needs of the GPs, legal and funding aspects in providing palliative care for cancer patients. This process will be a cooperation between Romanian and Swiss research experts. After consultation with representatives of the Swiss organisations for the four dimensions of interest, a meeting will be organised in Romania for analysing
the findings of the study. The data will be presented in a Consensus document on the situation of community palliative care in Romania, agreed by the main stakeholders involved. This reality consensus paper will be used in the second phase of the project for the design of education programs and key palliative care clinical interventions in the community. This will be tested in 4 pilot counties for 100 patients and evaluated. The results will be disseminated and will empower authorities to produce policy and financial adjustments.
project partner Hospice Casa Sperantei (HCS) - Romania, Saint Gallen Cantonal Hospital (SG) (including 6 subpartners) - Switzerland and Median Research Centre Foundation (MRC)- Romania
type of project clinical studies
status automatically closed
start of project 2013
end of project 2016
responsible person Florian Strasser