The need for palliative care in adults in Nepal: Projections based on modeling mortality data

Aims: With noncommunicable diseases rising in prevalence, Nepal has a significant need for palliative care, but little research has been conducted to evaluate this in depth. This study aimed to generate a quantified estimate of the projected need for palliative care in Nepal. Subjects and Methods: The World Health Organization mortality rates were multiplied by the percentage pain prevalence for each disease, to produce an estimate, by disease, of the number of adults requiring palliative care at the end of life. These projections were then broken down for the rural and urban populations. Experts were consulted on the findings to explore how their insight from experience compared to the figures generated. Results: Estimates found that there were a total of 58,000 adults needing palliative care in Nepal in 2012. Cardiovascular disease represented the greatest need (21,249) followed by cancer and chronic obstructive pulmonary disease. The majority of those requiring palliative care were found to be in rural areas. However, the majority of provision currently is for cancer in urban areas. Professionals consulted felt that the results were likely to be representative, although many responded that this was a minimum estimate and with more raw data and more diseases included, the figures could be far higher. Conclusions: The need for palliative care is great and is mostly represented by cardiovascular and respiratory disease in rural areas. Provision must be adapted and developed to meet this need, but more primary data is needed to inform such decisions.