CHALLENGES OF MODERN PALLIATIVE CARE. A NARRATIVE REVIEW
Abstract
Palliative Care (PC) is a person-centered, integrated health service designed to support patients with serious illnesses in living actively and with minimal pain until death. It addresses the diverse needs of patients with both cancer and non-cancer diagnoses, aiming to improve quality of life (QoL), relieve symptoms, and provide comprehensive support to patients and their families. Despite its well-documented benefits and recommendations for early improvement, contemporary palliative care faces numerous challenges that limit its effectiveness and accessibility. This article explores the multifaceted obstacles confronting modern palliative care, analyzing why current practices often fall short of meeting patient needs and proposing areas for improvement to ensure timely, equitable, and effective palliative care delivery worldwide.
Methods: The research methodology included an in-depth review if scientific articles available through databases such as Pubmed and Google Scholar. The team analyzed content from 2000 to 2025, placing special emphasis on the latest development. Through careful organization and validation, 83 of the most reliable publications were selected as the primary foundation for the study. The cited references of these publications were included in the analysis.
Results: The scientific studies in this work have demonstrated that palliative care faces major challenges including limited global availability, insufficient specialized workforce, restrictive and inconsistent eligibility criteria, and stigma associated with its terminology. The growing demand from aging populations and increasing cancer cases further strains resources, while financial burdens and a fragmented, under-regulated mobile app market limit effective symptom management and care delivery. Additionally, delayed access to palliative care, insufficient integration within health systems, ethical and legal complexities, and inadequate psychological support for patients and families contribute to these challenges. Emerging technologies like AI offer promise but require careful implementation to maintain person-centered care and address ethical concerns.
Conclusions: A well-functioning palliative care system is vital as it enables patients with serious illnesses to live actively and with improved quality of life, reduces symptom burden, and supports both patients and caregivers throughout the illness trajectory. Effective palliative care also has the potential to decrease healthcare costs by reducing unnecessary hospital admissions and facilitating care in preferred settings. Priorities for advancing palliative care include expanding service availability, revising eligibility criteria to focus on patient needs rather than prognosis, and improving education to reduce misconceptions and stigma. Sustainable funding, policy standardization, and multi-sector collaboration among healthcare providers, policymakers, patients, and communities are essential to building robust palliative care frameworks. Moreover, regulating and enhancing the accessibility of palliative care mobile applications can further support patients and caregivers by improving communication, symptom management, and advance care planning. Coordinated efforts across all stakeholders are crucial to overcoming existing challenges and ensuring equitable, high-quality palliative care that improves quality of life on a global scale.
References
World Health Organization. WHO definition of palliative care.
Higginson IJ, Evans CJ. What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer Princ Pract Oncol Annu Adv Oncol. 2012;2(5):423-435.
Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. The Lancet. 2014;383(9930):1721-1730. https://doi.org/10.1016/S0140-6736(13)62416-2
Hawley P. Barriers to Access to Palliative Care. Palliat Care. 2017;10. https://doi.org/10.1177/1178224216688887
Smith TJ, Temin S, Alesi ER, et al. American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. J Clin Oncol. 2012;30(8):880-887. https://doi.org/10.1200/JCO.2011.38.5161
Temel JS, Greer JA, Muzikansky A, et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. N Engl J Med. 2010;363(8). https://doi.org/10.1056/nejmoa1000678
Bakitas MA, Tosteson TD, Li Z, et al. Early versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol. 2015;33(13):1438-1445. https://doi.org/10.1200/JCO.2014.58.6362
May P, Garrido MM, Cassel JB, et al. Prospective cohort study of hospital palliative care teams for inpatients with advanced cancer: Earlier consultation is associated with larger cost-saving effect. J Clin Oncol. 2015;33(25):2745-2752. https://doi.org/10.1200/JCO.2014.60.2334
Kain DA, Eisenhauer EA. Early integration of palliative care into standard oncology care: Evidence and overcoming barriers to implementation. Curr Oncol. 2016;23(6):374-377. https://doi.org/10.3747/co.23.3404
Bakitas M, Lyons KD, Hegel MT, Bakitas M. Effects of a Palliative Care Intervention on Clinical Outcomes in Patients With Advanced Cancer The Project ENABLE II Randomized Controlled Trial. JAMA J Am Med Assoc. 2009;302(7):741-749.
Haun MW, Estel S, Rücker G, et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev. 2017;2017(6). https://doi.org/10.1002/14651858.CD011129.pub2
Howie L, Peppercorn J. Early palliative care in cancer treatment: Rationale, evidence and clinical implications. Ther Adv Med Oncol. 2013;5(6):318-323. https://doi.org/10.1177/1758834013500375
Akyar I, Dionne-Odom J, Yang G, Bakitas M. Translating a US early palliative care model for Turkey and Singapore. Asia-Pac J Oncol Nurs. 2018;5(1):33-39. https://doi.org/10.4103/apjon.apjon_73_17
Tedder T, Elliott L, Lewis K. Analysis of common barriers to rural patients utilizing hospice and palliative care services: An integrated literature review. J Am Assoc Nurse Pract. 2017;29(6):356-362. https://doi.org/10.1002/2327-6924.12475
Clark D, Baur N, Clelland D, et al. Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017. J Pain Symptom Manage. 2020;59(4):794-807.e4. https://doi.org/10.1016/j.jpainsymman.2019.11.009
Lynch T, Connor S, Clark D. Mapping levels of palliative care development: A global update. J Pain Symptom Manage. 2013;45(6):1094-1106. https://doi.org/10.1016/j.jpainsymman.2012.05.011
Strand JJ, Leblanc TW. Palliative care integration in haematological malignancies: Towards a needs-based approach. BMJ Support Palliat Care. 2018;8(3):289-291. https://doi.org/10.1136/bmjspcare-2018-001611
Tanzi S, Venturelli F, Luminari S, et al. Early palliative care in haematological patients: A systematic literature review. BMJ Support Palliat Care. 2020;10(4):395-403. https://doi.org/10.1136/bmjspcare-2020-002386
Dumanovsky T, Augustin R, Rogers M, Lettang K, Meier DE, Morrison RS. The growth of palliative care in U.S. Hospitals: A status report. J Palliat Med. 2016;19(1):8-15. https://doi.org/10.1089/jpm.2015.0351
Block SD, Billings JA. A need for scalable outpatient palliative care interventions. The Lancet. 2014;383(9930):1699-1700. https://doi.org/10.1016/S0140-6736(13)62676-8
Meier DE. Increased access to palliative care and hospice services: Opportunities to improve value in health care. Milbank Q. 2011;89(3):343-380. https://doi.org/10.1111/j.1468-0009.2011.00632.x
Lupu D. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manage. 2010;40(6):899-911. https://doi.org/10.1016/j.jpainsymman.2010.07.004
Albers G, Echteld MA, de Vet HCW, Onwuteaka-Philipsen BD, van der Linden MHM, Deliens L. Evaluation of quality-of-life measures for use in palliative care: a systematic review. Palliat Med. 2010;24(1):17-37. https://doi.org/10.1177/0269216309346593
Davis MP, Hui D. Quality of Life in Palliative Care. Expert Rev Qual Life Cancer Care. 2017;2(6):293-302. https://doi.org/10.1080/23809000.2017.1400911
Harding R, Simon ST, Benalia H, et al. The PRISMA Symposium 1: outcome tool use. Disharmony in European outcomes research for palliative and advanced disease care: too many tools in practice. J Pain Symptom Manage. 2011;42(4):493-500. https://doi.org/10.1016/j.jpainsymman.2011.06.008
Brasel KJ. Quality-of-life assessment in palliative care. Am J Hosp Palliat Care. 2007;24(3):231-235. https://doi.org/10.1177/1049909107301778
Morstad Boldt A, Yusuf F, Himelstein BP. Perceptions of the term palliative care. J Palliat Med. 2006;9(5):1128-1136. https://doi.org/10.1089/jpm.2006.9.1128
McInturff, B.; Harrington, E. 2011 Public Opinion Research on Palliative Care. A Report Based on Research by Public Opinion Strategies; 2011
Cacchione P. What’s another word for euphemism? Am J Hosp Palliat Care. 2000;17(1):6-7. https://doi.org/10.1177/104990910001700102
Chamberlain BH. What’s in a name? Am J Hosp Palliat Care. 2001;18(6):367-369. https://doi.org/10.1177/104990910101800602
Sobocki BK, Guziak M. The terms supportive and palliative care — analysis of their prevalence and use: quasi-systematic review. Palliat Med Pract. 2021;15(3):248-253. https://doi.org/10.5603/PMPI.2021.0014
Hui D, De La Cruz M, Mori M, et al. Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2013;21(3):659-685. https://doi.org/10.1007/s00520-012-1564-y
Fadul N, Elsayem A, Palmer JL, et al. Supportive versus palliative care: what’s in a name?: a survey of medical oncologists and midlevel providers at a comprehensive cancer center. Cancer. 2009;115(9):2013-2021. https://doi.org/10.1002/cncr.24206
Pastrana T, Jünger S, Ostgathe C, Elsner F, Radbruch L. A matter of definition--key elements identified in a discourse analysis of definitions of palliative care. Palliat Med. 2008;22(3):222-232. https://doi.org/10.1177/0269216308089803
Hui D, Mori M, Parsons HA, et al. The lack of standard definitions in the supportive and palliative oncology literature. J Pain Symptom Manage. 2012;43(3):582-592. https://doi.org/10.1016/j.jpainsymman.2011.04.016
Grądalski T. Medical referral criteria for palliative care in adults: a scoping review. Pol Arch Intern Med. 2022;132(3):16223. https://doi.org/10.20452/pamw.16223
Cardenas V, Rahman A, Zhu Y, Enguidanos S. Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers. Am J Hosp Palliat Care. 2022;39(2):189-195. https://doi.org/10.1177/10499091211012605
Hui D, Bruera E. Models of Palliative Care Delivery for Patients With Cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2020;38(9):852-865. https://doi.org/10.1200/JCO.18.02123
Bradley N, McConnell T, Blair C, et al. Integrated palliative care and oncology: a realist synthesis. BMC Med. 2025;23(1):272. https://doi.org/10.1186/s12916-025-04083-1
Lau J, Flamer D, Murphy-Kane P. Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review. Can J Anaesth J Can Anesth. 2020;67(2):235-246. https://doi.org/10.1007/s12630-019-01482-w
Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. https://doi.org/10.1056/NEJMoa1000678
Integrating palliative care and symptom relief into primary health care. Accessed June 22, 2025. https://www.who.int/publications/i/item/integrating-palliative-care-and-symptom-relief-into-primary-health-care
Hui D, Bansal S, Strasser F, et al. Indicators of integration of oncology and palliative care programs: an international consensus. Ann Oncol Off J Eur Soc Med Oncol. 2015;26(9):1953-1959. https://doi.org/10.1093/annonc/mdv269
Callaway MV, Connor SR, Foley KM. World Health Organization Public Health Model: A Roadmap for Palliative Care Development. J Pain Symptom Manage. 2018;55(2S):S6-S13. https://doi.org/10.1016/j.jpainsymman.2017.03.030
Zhao P, Yoo I, Lancey R, Varghese E. Mobile applications for pain management: an app analysis for clinical usage. BMC Med Inform Decis Mak. 2019;19(1):106. https://doi.org/10.1186/s12911-019-0827-7
Jibb LA, Stevens BJ, Nathan PC, et al. Implementation and preliminary effectiveness of a real-time pain management smartphone app for adolescents with cancer: A multicenter pilot clinical study. Pediatr Blood Cancer. 2017;64(10). https://doi.org/10.1002/pbc.26554
Jibb LA, Stevens BJ, Nathan PC, Seto E, Cafazzo JA, Stinson JN. A smartphone-based pain management app for adolescents with cancer: establishing system requirements and a pain care algorithm based on literature review, interviews, and consensus. JMIR Res Protoc. 2014;3(1):e15. https://doi.org/10.2196/resprot.3041
MacPherson M, Bakker AM, Anderson K, Holtzman S. Do pain management apps use evidence-based psychological components? A systematic review of app content and quality. Can J Pain Rev Can Douleur. 2022;6(1):33-44. https://doi.org/10.1080/24740527.2022.2030212
Devan H, Farmery D, Peebles L, Grainger R. Evaluation of Self-Management Support Functions in Apps for People With Persistent Pain: Systematic Review. JMIR MHealth UHealth. 2019;7(2):e13080. https://doi.org/10.2196/13080
Reville B, Foxwell AM. The global state of palliative care-progress and challenges in cancer care. Ann Palliat Med. 2014;3(3):129-138. https://doi.org/10.3978/j.issn.2224-5820.2014.07.03
Whitelaw S, Bell A, Clark D. The expression of “policy” in palliative care: A critical review. Health Policy Amst Neth. 2022;126(9):889-898. https://doi.org/10.1016/j.healthpol.2022.06.010
Morrison RS, Meier DE. Clinical practice. Palliative care. N Engl J Med. 2004;350(25):2582-2590. https://doi.org/10.1056/NEJMcp035232
Crawford GB, Price SD. Team working: palliative care as a model of interdisciplinary practice. Med J Aust. 2003;179(S6):S32-34. https://doi.org/10.5694/j.1326-5377.2003.tb05575.x
Siouta N, Van Beek K, van der Eerden ME, et al. Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease. BMC Palliat Care. 2016;15:56. https://doi.org/10.1186/s12904-016-0130-7
L. Radbruch, Payne S, Bercovitch M. Standards and norms for hospice and palliative care in Europe: part 1. Zeitschrift fur Palliativmedizin. 2011;12(5):216-227. https://doi.org/10.1055/s-0031-1276909
Lynch T, Connor S, Clark D. Barriers to the dvelopment of palliative care in the countries of Central and Eastern Europe and the Commonwealth of Independent States. J Pain Symptom Manage. 2009;37(3):305-315. https://doi.org/10:1016/j.jpainsymman.2008.08.012
Arias-Casais N, López-Fidalgo J, Garralda E, et al. Trends analysis of specialized palliative care services in 51 countries of the WHO European region in the last 14 years. Palliat Med. 2020;34(8):1044-1056. https://doi.org10.1177/0269216320931341
Krakowiak P. Gaps in end-of-life care and lack of support for family carers in Poland and Central Eastern Europe. Palliat Care Soc Pract. 2020;14:2632352420958001. https://doi.org/10.1177/2632352420958001
Veloso VI, Tripodoro VA. Caregivers burden in palliative care patients: a problem to tackle. Curr Opin Support Palliat Care. 2016;10(4):330-335. https://doi.org/10.1097/SPC.0000000000000239
Alam S, Hannon B, Zimmermann C. Palliative Care for Family Caregivers. J Clin Oncol Off J Am Soc Clin Oncol. 2020;38(9):926-936. https://doi.org/10.1200/JCO.19.00018
Harnischfeger N, Rath HM, Oechsle K, Bergelt C. Addressing palliative care and end-of-life issues in patients with advanced cancer: a systematic review of communication interventions for physicians not specialised in palliative care. BMJ Open. 2022;12(6):e059652. https://doi.org/10.1136/bmjopen-2021-059652
Kamran R, Dal Cin A. Designing a Mission statement Mobile app for palliative care: an innovation project utilizing design-thinking methodology. BMC Palliat Care. 2020;19(1):151. https://doi.org/10.1186/s12904-020-00659-1
Zheng C, Chen X, Weng L, et al. Benefits of Mobile Apps for Cancer Pain Management: Systematic Review. JMIR MHealth UHealth. 2020;8(1):e17055. https://doi.org/10.2196/17055
Wong PTP, Yu TTF. Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective. Med Kaunas Lith. 2021;57(9):924. https://doi.org/10.3390/medicina57090924
Harnischfeger N, Rath HM, Oechsle K, Bergelt C. Addressing palliative care and end-of-life issues in patients with advanced cancer: a systematic review of communication interventions for physicians not specialised in palliative care. BMJ Open. 2022;12(6):e059652. https://doi.org/10.1136/bmjopen-2021-059652
Saad R, Abu-Saad Huijer H, Noureddine S, Sailian SD. Pediatric palliative care through the eyes of healthcare professionals, parents and communities: a narrative review. Ann Palliat Med. 2022;11(10):3292-3314. https://doi.org/10.21037/apm-22-525
Moresco B, Moore D. Pediatric Palliative Care. Hosp Pract 1995. 2021;49(sup1):422-430. https://doi.org/10.1080/21548331.2021.1964867
Wiener L, McConnell DG, Latella L, Ludi E. Cultural and religious considerations in pediatric palliative care. Palliat Support Care. 2013;11(1):47-67. https://doi.org/10.1017/S1478951511001027
Kass JS, Lewis A, Rubin MA. Ethical Considerations in End-of-life Care in the Face of Clinical Futility. Contin Minneap Minn. 2018;24(6):1789-1793. https://doi.org/10.1212/CON.0000000000000680
Agar M, Ko DN, Sheehan C, Chapman M, Currow DC. Informed consent in palliative care clinical trials: challenging but possible. J Palliat Med. 2013;16(5):485-491. https://doi.org/10.1089/jpm.2012.0422
Shreves A, Marcolini E. End of life/palliative care/ethics. Emerg Med Clin North Am. 2014;32(4):955-974. https://doi.org/10.1016/j.emc.2014.07.010
Faris H, Dewar B, Dyason C, et al. Goods, causes and intentions: problems with applying the doctrine of double effect to palliative sedation. BMC Med Ethics. 2021;22:141. https://doi.org/10.1186/s12910-021-00709-0
Nwosu AC, Mason S. Palliative medicine and smartphones: an opportunity for innovation? BMJ Support Palliat Care. 2012;2(1):75-77. https://doi.org/10.1136/bmjspcare-2011-000151
Alexander JC, Joshi GP. Smartphone applications for chronic pain management: a critical appraisal. J Pain Res. 2016;9:731-734. https://doi.org/10.2147/JPR.S119966
Meghani SH, MacKenzie MA, Morgan B, Kang Y, Wasim A, Sayani S. Clinician-Targeted Mobile Apps in Palliative Care: A Systematic Review. J Palliat Med. 2017;20(10):1139-1147. https://doi.org/10.1089/jpm.2017.0070
Rosser BA, Eccleston C. Smartphone applications for pain management. J Telemed Telecare. 2011;17(6):308-312. https://doi.org/10.1258/jtt.2011.101102
Salazar A, de Sola H, Failde I, Moral-Munoz JA. Measuring the Quality of Mobile Apps for the Management of Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale. JMIR MHealth UHealth. 2018;6(10):e10718. https://doi.org/10.2196/10718
Reynoldson C, Stones C, Allsop M, et al. Assessing the quality and usability of smartphone apps for pain self-management. Pain Med Malden Mass. 2014;15(6):898-909. https://doi.org/10.1111/pme.12327
MacKenzie Greenle M, Morgan B, Sayani S, Meghani SH. Identifying Mobile Apps Targeting Palliative Care Patients and Family Members. J Palliat Med. 2018;21(10):1380-1385. https://doi.org/10.1089/jpm.2018.0157
Portz JD, Elsbernd K, Plys E, et al. Elements of Social Convoy Theory in Mobile Health for Palliative Care: Scoping Review. JMIR MHealth UHealth. 2020;8(1):e16060. https://doi.org/10.2196/16060
Pinto A, Santos C, Aguiar R, Oliveira S, Cunha D. The Use of Artificial Intelligence in Palliative Care Communication: A Narrative Review. Cureus. 2025;17(3):e80524. https://doi.org/10.7759/cureus.80524
Oh O, Demiris G, Ulrich CM. The ethical dimensions of utilizing Artificial Intelligence in palliative care. Nurs Ethics. 2025;32(4):1285-1296. https://doi.org/10.1177/09697330241296874
Bressler T, Song J, Kamalumpundi V, Chae S, Song H, Tark A. Leveraging Artificial Intelligence/Machine Learning Models to Identify Potential Palliative Care Beneficiaries: A Systematic Review. J Gerontol Nurs. 2025;51(1):7-14. https://doi.org/10.3928/00989134-20241210-01
Views:
85
Downloads:
42
Copyright (c) 2025 Justyna Berent, Paulina Rzepa, Łukasz Brzost, Marta Danuta Cendrowska, Beata Choromańska, Julia Maszewska, Szymon Milnerowicz, Julia Procyk, Barbara Ponitka, Karolina Stępień, Aleksandra Klukowska, Wiktoria Szumlińska, Wiktoria Wasielewska

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

