The biggest challenge facing 21st century health systems is demographic change and shifting patterns of disease: high-middle and low-income countries alike have growing numbers of older adults, and so increasing prevalence of multimorbidity, functional impairment, and dementia.
International evidence repeatedly demonstrates a ‘high cost, poor outcome’ paradigm for older people with serious and life-limiting illness: these populations account disproportionately for health and social care spending yet experience fragmented and uncoordinated treatment, and poor outcomes in health systems that were not designed to provide predominantly chronic care.
As more people live longer with multiple serious illnesses, including functional and cognitive disabilities, there is a growing need for systems change to ensure provision of skilled, co-ordinated care that appropriately addresses complex needs in a financially sustainable manner.
Palliative care is the multidisciplinary specialism that addresses the needs of people living and dying with serious illnesses through pain and symptom management, patient choice and autonomy, and communication.
It is a complex intervention that may be provided by different combinations of doctors, nurses and allied health professionals in the hospital, home and hospice settings. Access has expanded rapidly around the world over the last 25 years, although high levels of unmet need remain widespread.
The economics of palliative care is a recognised research and policy priority as health systems grapple with the high costs and poor outcomes associated with serious illness. Investigators aim to increase understanding on which interventions should be provided to people living and dying with serious illness in the context of varying clinical needs and resource scarcity. Conducting studies involves serious methodological, practical and ethical challenges that have kept the evidence base to date small.
The PaCE group is based at the Centre for Health Policy and Management in Trinity College Dublin. We work with clinicians, policymakers and other social scientists to generate high-quality evidence on what care and interventions should be provided to and prioritised for which groups of patients. Our current programme of work covers not only studies in Ireland but also collaborations with colleagues in England, the United States, Jordan, and elsewhere.