The 2018 Taipei Declaration for Ultimate Integration of Palliative Care

Dear Editor:

Inadequate access to palliative care is an important problem globally, due to our aging population and exacerbated by cultural, social, and political barriers to palliative care delivery. Each year, an estimated 40 million patients with cancer, cardiovascular diseases, and other chronic conditions need palliative care, yet only 14% receive this care. ¹ Patients with palliative care needs are often complex with multiple symptoms and unmet needs, with dissonance between patients, family, and the health care system, and with prognostic uncertainty across different disease trajectories. ² There is an urgent need to identify patients who would benefit from palliative care across the health care system and to implement integrated comprehensive people-centered palliative care.^1,3 To address this challenge, the Taipei City Hospital initiated a community-based palliative care system in 2016. Across the city, 10 community-based comprehensive care centers composed of transdisciplinary health care teams engage actively in the care of patients in need of palliative care. The health care teams help patients voice their goals and preferences for future care by completing advance directives in accordance with the Taiwan “Patient Right to Autonomy Act.” The teams accompany patients across settings, from inpatient to home care, and also coordinate a supportive network in the community to integrate home-based palliative care, postacute care, long-term care, social support, and end-of-life care for each patient and family.

In an effort to expand this community-based comprehensive care system and create a model for others, the Taipei City Hospital hosts the annual Taipei International Symposium on Palliative Care and creates an annual declaration to guide and support this ongoing work. Building upon the World Health Organization framework on integrated people-centered health services, ⁴ the 2018 Taipei Declaration calls for integration of palliative care throughout the health care system, aiming to put patients with palliative care needs at the center of the health care system. This declaration is based on five principles: 1.

Equity in access: Develop adequate death literacy by raising public awareness of the importance of palliative care and providing universal access to resources and services related to palliative care.

It is our goal that, with the implementation of this declaration, we can improve quality of life for patients, families, and the community to the highest possible standards and achieve universal access to palliative care.