Strategy
4. Action Plan
Mission Unit for Integrated Continuous Care. Lisbon, December of 2010
LONG TERM CARE Health and Social Support
Fall
2010
Strategy for the Development of the National Palliative Care
Programme
2 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
4.1 Action Lines
The Action Plan for the next triennium, here presented, takes into
account the goals defined in NPCP, the diagnosis of the current
situation for the PC and also the priorities presented in the previous
chapter. In this sense the action lines are:
1. Consolidate NPCP: NPCP incorporates the NHS as a public health
policy, developed using an integrated form, sustainable and
adequately resourced to meet existing needs;
2. Improving the quality of care: ensuring quality in the organization
and delivery of care throughout the continuum of care according to
the best practices and organizational assistance;
3. Promote the expertise of teams and scientific research: to ensure
that all staff who coordinates the NPCP and those who provide direct
care to patients with advanced and progressive disease have the
necessary skills according to the type of service where they are and
their professional profile. Distinguish clinical from organizational skills.
Integrate scientific knowledge production as a measure for the model
adequacy and qualifications of the teams;
4. Developing critical mass and to disseminate the results: promoting
the creation of a pool of actors (politicians, providers, professionals,
civil society) committed to the development of NPCP.
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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4.1.1 Consolidate NPCP
DESCRIPTION: NPCP incorporates the NHS in an integrated, sustainable
way and adequately resourced to meet existing needs.
4.1.1.1 Ensuring Leadership
Actions:
1. Formally appoint the referring technicians in each region to
coordinate the implementation of NPCP;
2. Develop mechanisms for coordination and communication between
the national and regional coordination;
3. Set a training plan aimed at national and regional leaders;
4. Create strategic partnerships at national and regional levels that
may add value to NPCP;
5. Develop an annual action plan for each region;
6. Develop a National Action Plan for the triennium 2013-2016 and
ensure its implementation.
4 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
4.1.1.2 Assess needs and plan care provision in a phased manner
Actions:
1. Develop Palliative Care Programs integrated into regional plans in
late 2013;
2. Set the answers based on the needs of population coverage
encompassing various organizational models for demographic area
(urban, semi-urban, rural) and including all types of service (specific
and conventional);
3. Adjust annually the planning to the needs of population coverage
and implementation capacity;
4. Prepare regional annual implementation plans identifying:
• The possibilities of optimization / exploitation of existing resources;
• New resources;
• The existence of teams with the necessary technical skills to ensure
the provision of care;
• Areas of reference that meet specifications in order to be constituted
as example areas / excellence of care ;
• Award of merit to the units considered as "Excellence of Care".
4.1.1.3 Implementation
Actions:
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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1. Implement annual regional and national action plans in line with the
NPCP;
4.1.1.4 Set the necessary resources and ensure their availability and
sustainability
Actions:
1. Define and allocate annual budgets for implementation of NPCP;
2. Assess the total cost (direct and indirect) for each type of team;
3. Define minimum human , physical and material resources required
for each specific type of Palliative Care;
4. Include in procurement all the requirements for human, material and
physical resources, for each specific type of Palliative Care;
5. Ensure the availability of opioid medications listed in vademecum;
6. Ensure the availability of assisted devices and social support services;
4.1.1.5 Promoting the integration of care and coordination of resources
Actions:
1. Create awareness and information actions about the value of the
provision of early palliative care and integrated with the provision of
other health care;
6 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
2. Define and develop joint NPCP with other health related areas,
notably the National Programme for Disease Control and Prevention
and the National Oncological Control of Pain;
3. Define and develop mechanisms for coordination and linkage with
social support services, ensuring their availability especially for patients
receiving palliative home care.
4.1.1.6 Develop and manage all necessary procedures for the proper
services functioning
Actions:
1. Include the admission criteria defined in the system of registration
and referral of the Integrated Continuous Care National Network;
2. Define the minimum set of information to appear on referral;
3. Define the minimum set of information for the registration system and
monitoring and frequency of registration by the providing teams;
4. Provide access to aggregated information at a regional level by
regional team coordination;
5. Define management information available to the national / regional
Coordination and its periodicity;
6. Elaborate a Plan and develop training actions within the functional
organization and utilization of instruments of NPCP.
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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4.1.1.7 Design and implement tools for outcomes monitoring and
control
Actions:
1. Define and include indicators in the contracts of Palliative Care
team providers;
2. Periodically disclose the results.
4.1.1.8 Ensure continuous assessment
Actions:
1. Monitor and evaluate the development of National Action Plan;
2. Monitor and evaluate the development of regional action plans;
3. Using the results of evaluations propose measures for improvement
and continuous development in order to establish it as the WHO
Demonstration Project, according to NPCP;
4. Periodically and systematically evaluate the outcomes of providers’
contracts;
5. Periodically analyze the indicators - key specific results for Palliative
Care, contained in a futurely elaborated document;
6. Comparative studies of national and international levels;
8 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
7. Monitor the financial execution of plans;
8. Verify compliance with the requirements of human, material and
physical resources set for delivering teams .
4.1.2 Improving the quality of care
DESCRIPTION: Ensuring quality in the organization and delivery of care
throughout the continuum of care according to organizational and
care best practices.
4.1.2.1 Ensure care in the adequate service and time
Actions:
1. Train professionals in signaling and referral of patients in need of
palliative care;
2. Develop a communication plan that will:
• Inform professionals of the positive value of palliative care;
• Extend the knowledge that they are not opposed to curative (can
coexist) and that the earlier the need of Palliative Care is detected the
more effective it is, which is not exclusive to patients with cancer;
• Raise awareness of the importance of providing local care and, if
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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possible, at home where conditions are met to ensure the quality of
care and patient safety;
4.1.2.2 Ensure the provision of holistic care
Actions:
1. Evaluate patients and their family background in a multi and
interdisciplinary way, ensuring that the physical, social, emotional and
spiritual needs are properly assessed and answered;
2. Develop an Individual Intervention Plan (IIP) in an interdisciplinary
context, for each patient;
3. Implement and periodically evaluate the individual intervention plan
for each patient;
4. Define for each case the frequency of communication with the
patient and family and identify a contact point for the team;
5. Include the degree of knowledge of the patient and family /
informal caregivers of their health status and prognosis in the medical
history chart ;
6. Integrate the user's preferences regarding the process of care and
expectations of the place of death in the medical history, information,
dischargement and referral charts;
7. Identify and provide specific support in the process of Grief;
10 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
8. Develop guidelines for action on the patient’s privacy and comfort;
9. Establish committees of ethics and bioethics.
4.1.2.3 Ensure continuity in care providance
Actions:
1. Identify and prepare the expected date of dischargement from the
time of admission of the patient, if applicable;
2. Include in the referral record/ dischargement the identification of
the preceding service, doctor / nurse in charge, direct contacts and
availability;
3. Promote the development and preparation of protocols and clinical
cross guidelines involving professionals of different levels of care and
types of services in each area;
4. Facilitate communication and coordination through the
implementation of information technology and communication.
4.1.2.4 Fostering health literacy for patients and support for informal
caregivers
Actions:
1. Inform the patient of every therapeutic goal defined by the team
and review them together;
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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2. Maintain appropriate and personalized communication with intensity
and resources in line with the needs of each case;
3. Educating the caregiver / family and the patient in care / self-care;
4. Support decision-making from the patient and family / informal
caregiver, through clarification of the care process;
5. Develop guides for information on palliative care for patients and
carers / family members.
4.1.2.5 Develop mechanisms to support the caregiver
Actions:
1. Define methodologies for identifying early symptoms of burnout in
team professionals;
2. Provide support to practitioners suffering from exhaustion.
4.1.2.6 Promote good practice in care providance
Actions:
1. Develop guidelines for good care practice in accordance with the
principles and recommendations elaborated by organizations of
recognized scientific value ;
12 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
2. Disclose forms containing the most widely used drugs in palliative
care, according to international principles and recommendations.
4.1.2.7 Promote and evaluate the quality of care
Actions:
1. Define the core of core indicators and quality targets;
2. Include the core indicators and targets in contracts with the teams
providing palliative care;
3. Perform annual satisfaction survey for professionals, patients and
carers in all types of care;
4. Encourage / support the creation of "forums" of participatory
discussion with national and international providers of palliative care,
as well as the involvement of patients, relatives and representatives of
civil society;
5. Conduct external audits on all types of services (inpatient,
outpatient, home) with more than one year of operation;
6. Include conducting internal audits as a mandatory requirement in
the contracts and determine their frequency.
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4.1.3 Promote the expertise of teams and scientific research
DESCRIPTION: Ensure that all professionals who take care of patients
with advanced and progressive disease have the skills identified as
necessary in accordance with the type of service they are in and their
professional profile.
Support the qualification of services in the organization and delivery of
palliative care through the generation of scientific knowledge.
4.1.3.1 Training
Actions:
1. Undertake a survey of all theoretical and practical skills of each
professional, by type and professional profile;
2. Prepare and develop annual training plans based on identified
training needs. The plans should include:
• Lectures;
• Practical component: training;
3. Prepare and develop a training plan specific to conventional
services professionals (general practitioners and nursing) which
includes:
• Identification of patients in need of palliative care;
• Management of the main symptoms;
14 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
4. Elaborate and develop a joint Workshop in PC, for the national
coordination team and regional teams;
5. Prepare and develop a training plan aimed at patients, family /
primary caregiver and volunteers;
6. Prepare and develop a training plan for the integration of new
professionals in specific palliative care teams;
7. Prepare and develop a training plan to support the delivery of
palliative care to specific groups of diseases (eg, rapidly progressive
neurological diseases, AIDS);
8. Defining the training plan and developing specific training in the use
of opioids;
9. Conduct and disseminate program / training evaluations;
10. Create reference centers to provide theoretical training of
undergraduate, postgraduate and practical training at regional and
national level.
11. Sensitize the authorities to the importance of integration of palliative
care in medical and nursing curricula, both in undergraduate courses
and in graduate ones;
12. Sensitize the authorities to the importance of including the Palliative
Care program in practical classes / internship courses;
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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13. Sensitize related fields such as psychology, social welfare officers,
physiotherapy and others to formulate a plan of specific training in
palliative care.
4.1.3.2 Research
Actions:
1. Start / strengthen lines of research for all palliative care services.
(Hospitals, RNCCI, Primary Care), scientific societies, professional
associations, universities and others.
4.1.4 Develop critical mass
DESCRIPTION: Fostering the creation of a pool of actors (politicians,
providers, professionals, civil society) committed to the development of
NPCP.
4.1.4.1 Encourage wide participation and commitment in implementing
the action plan by regional coordination teams, RNCCI providers,
professionals and civil society
Actions:
1. Prepare and develop a communication plan to disseminate the
NPCP and the Action Plan and its progress;
16 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
2. Schedule and conduct workshops for critical thinking with several
agents (eg, providers, professionals, associations, ....)
3. Develop volunteer incorporating programs for the teams: develop
selection criteria , training program, conditions of participation;
4. Conduct a population survey to ascertain what each individual
thinks about dignified death and what their expectations are regarding
their own death;
5. Inform the authorities of the need to support informal caregivers in
order to facilitate the effective availability of care provision.
4.1.4.2 Ensure the social and scientific visibility
Actions:
1. Prepare and develop a communication plan to inform the civil
society, technicians and politicians about:
• What is Palliative Care;
• Its Goals;
• Who should be referenced and how it should be referenced;
• What are the services provided;
• Number of existing providers.
2. Plan and implement actions to sensitize the media to create valid
information and not sensationalist, preserving the rights of families and
patients;
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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3. Planning and carrying out internal and external benchmarking;
4. Conduct studies of results and publish them in recognized scientific
journals;
5. Define and develop actions to implement the NPCP in order to
achieve recognition as a WHO Demonstration Project.
18 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
4.2 Schedule of implementation
Goal 1: Consolidating the NPCP
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013) 1st
YEAR 2nd YEAR
3rd YEAR
1. Formally appoint the referring technicians in each region to coordinate the implementation of NPCP
2. Define and develop mechanisms for coordination and communication between the national and regional coordination.
3. Develop a plan for continuing education aimed at national and regional leaders.
4. Create strategic partnerships at national and regional levels that add value to NPCP.
5. Prepare the Annual Action Plan by region.
1.1. Providing leadership
6. Review and validate Regional Annual Action Plans by the national coordination.
1.2. Study the needs and plan care provision in a phased manner
1. Set answers based on the needs of population coverage, encompassing various organizational models for each demographic area (urban, semi-urban, rural) and all types of service (specific and conventional).
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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SCHEDULE OF IMPLEMENTATION
STRATEGIES 3 YEAR ACTIONS (2011-2013) RESPONSIBLE
1st YEAR
2nd YEAR
3rd YEAR
2. Annually adjust the planning to the needs of population and implementation capacity.
RNCCI/ECR
1.2. Study the needs and plan care provision in a phased manner (cont.)
3. Prepare annual plans / regional and national implementation plan, identifying opportunities of: optimization / utilization of existing resources, new resources, teams with the necessary technical skills; reference areas (gather characteristics of example areas).
RNCCI/ECR
1.3. Implement
1. Implement annual, regional and national plans of action
RNCCI/ECR
1. Annually define and allocate the funds for implementation of PNCP.
Funds transferred to each ARS/ predicted funds
1.4. Define the necessary resources and ensure their availability 2. 2. Assess the total cost (direct
and indirect) for each typology of team;
RNCCI
20 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
3. Define minimum human, physical and material resources required for specific typology of Palliative Care.
4. Include in the program-contracts the requirements for human, physical and material resources for each specific type of Palliative Care.
5. Ensure the availability of opioid medications listed in vademecum.
1.4. Define the necessary resources and ensure their availability (cont.)
6. Ensure the availability of assisted devices and social support services
1. Create awareness raising and information about the value of early palliative care and integrated with other services.
2. Define and implement activities to coordinate the plan with other activities related to health plans.
1.5. Integrate and coordinate care resources
Social Support
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
1. Include the admission criteria defined in the system for recording and monitoring.
2. Define the minimum set of information to appear on referral
3. Define the minimum set of information for the registration system and monitoring and frequency of registration by the providing teams.
4. Provide access to aggregated information at the regional level by regional team coordination.
5. Define management information to provide the coordination national / regional level and their frequency.
1.6. Develop and manage the necessary means for developing the National Palliative Care Programme
6. Develop a training plan and develop training within the organization and functional use of the instruments of the Programme.
1. Define and include indicators and targets of CP on the program-contracts from providing teams.
1.7. Define indicators and outcome targets
Outcomes
22 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
1. Monitor and evaluate the development of National Action Plan.
2. Monitor and evaluate the development of Regional Action Plans.
3. Using the results of evaluations to propose measures for improvement and continuous development, aiming to establish itself as a demonstration project of WHO.
4. Periodically and systematically evaluate the outcomes of providers’ contracts.
5. Comparative studies of national and international levels.
6. Monitor the financial execution of the plans.
1.8. Ensure continuous assessment: decisions should be based on evidence in order to improve outcomes
7. Verify compliance with the requirements of human, material and physical resources set for providers teams.
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Goal 2: Improving quality of assistance
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
1. Training professionals in signaling and referral of patients in need of PC.
2.1. Ensure care in the adequate service and time
2. Develop a comunication plan.
1. Evaluate in an interdisciplinary context and ensure that the needs are answered. 2. Develop an interdisciplinary IIP for each user. 3. Implement the IIP 4. Define for each patient the frequency of communication with the patient / family and identify a caller.
2.2. Ensure the provision of holistic care 5. Include medical history, the
degree of knowledge of the patient and family / caregiver of their health status and prognosis.
ONGOING ACTIVITIES AND ATTACHED TO CARE
24 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
6. Include medical history, and note the referral of patient dischargement preferences and family / caregiver and expectations of the care process. 7. Identify and provide specific support in the process of pathological mourning.
ONGOING ACTIVITIES AND INHERENT TO CARE
8. Develop guidelines for action concerning privacy and comfort of the patient.
2.2. Ensure the provision of holistic care (cont.)
9. Establish committees of ethics and bioethics.
1. Identify and prepare the dischargement from the time of admission of the patient, if applicable.
ONGOING ACTIVITIES AND INHERENT TO CARE
2. Include in the referral record / dischargement the identification of the preceding service, doctor / nurse in charge, direct contacts and availability.
3. Promote the development and preparation of protocols and crossed clinical guidelines involving staff at different levels of care and types of services in each area.
2.3. Ensuring continuity of care
4. Facilitate communication and coordination through the implementation momentum of ITC.
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
1. Inform the patient of every therapeutic goal defined by the team and review them together 2. Maintain appropriate and personalized communication with intensity and resources in line with the needs of each case.
ONGOING ACTIVITIES AND INHERENT TO CARE
3. Educating the caregiver / family in care / self-care.
4. Support decision-making from the patient and family / informal caregiver through clarification on the process of care.
2.4. Promote the empowerment of patients and informal caregiver support
5. Develop guides for information on palliative care aimed at patients and caregivers / family members.
1. Define methodologies for early symptoms of burnout in professionals.
2.5. Develop mechanisms to support the caregiver formal
2. Provide support to professional exhaustion.
ONGOING ACTIVITIES AND INHERENT TO CARE
2.6. Develop good practice guides
1. Develop guidelines for good practice in providing care in accordance with the principles and recommendations from organizations of recognized scientific value.
26 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
Internationals.
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
1. Set a core of core indicators and quality targets.
2. Include the core indicators and targets in contracts with the teams providing palliative care.
3. Perform annual satisfaction survey for professionals, patients and carers in all types of care.
4. Conduct external audits on all typologies over 1 year of operation.
2.7. Develop and monitor indicators and quality standards of care
Periodicity.
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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Goal 3: Promote skills and techniques of research teams
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
1. Make a diagnosis on the theoretical and practical skills of professionals by type and profile.
2. Prepare and develop annual training plans, based on the diagnosis made, including: theoretical and internships.
3. Prepare and develop a training plan specific to conventional services professionals (general practitioners and nursing) which includes: the identification of patients in need of PC and management of the main symptoms.
4. Prepare and develop a continuous plan for the national coordination team and regional teams.
5. Develop a training plan aimed at patients, families / primary caregivers and volunteers.
3.1. Training
6. Prepare and develop a training plan for the integration of new professionals in specific Palliative Care teams.
28 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
7. Prepare and develop a training program to support the care of specific collective (eg, neurological diseases, AIDS and children).
8. Prepare and develop specific training in the use of opioid medications.
9. Define criteria for selection of faculty.
10. Conduct and disseminate program / training evaluations.
11. Create a referral center with theoretical training (under and post-graduate) and corporate practice as an activity center.
12. Sensitize the authorities to the importance of integrating palliative care into the curricula of medicine and nursing, both in undergraduate courses and in postgraduate courses.
3.1. Training (cont.)
13. Sensitize the authorities to the importance of including the PC in trainning / practical classes / internship.
3.2. Research
1. Start / strengthen lines of research especially in the specialized services of PC level 3 (high complexity).
Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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Goal 4: Develop critical mass and disseminate results
SCHEDULE OF IMPLEMENTATION
STRATEGIES
3 YEAR ACTIONS (2011-2013)
1st YEAR
2nd YEAR
3rd YEAR
1. Prepare and develop a communication plan to disseminate the NPCP and Action Plan and its progress.
2. Schedule and conduct seminars for critical reflection with the participation of several agents.
3. Develop and incorporate volunteer programs for the teams: developing criteria for selection, training program type and conditions of participation.
4. Conduct a population survey to ascertain what each individual thinks about dignified death and what their expectations are regarding their own death.
4.1. Encourage wide participation and commitment in implementing the action plan by regional coordination teams, RNCCI providers, professionals and civil society
5. Inform the authorities of the need to support informal caregivers in order to facilitate the effective availability of care provision.
Outcomes
4.2. Ensure social and scientific visibility
30 Mission Unit for Integrated Continuous Care Strategy for the Development of the National Palliative Care Programme
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