Development of Palliative Care: The Current Situation in Saudi Arabia

Palliative care is a specialty of its own consisting of comprehensive multidisciplinary healthcare delivery to patients with a wide range of life-threatening and life-shortening diseases, including cancer. Its primary goal is to relieve symptoms of suffering such as physical pain, psychosocial and spiritual problems that affect the quality-of-life for patients as well as their families. Palliative care has a vital role in providing comfort to patient and family during active interventions like chemotherapy and radiation therapies [1]. The palliative care service in Saudi Arabia started over three decades ago at the King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh by Dr. Isbister [2]. Since then, the specialty has slowly expanded. Real changes came about in 2016 when the Ministry of Health (MOH) launched the Palliative Care/Last Phase Initiative as part of the Transformation of Healthcare Vision 2030 [3]. By 2030, the Cancer care in Saudi Arabia is expected to grow by five to 10-fold. This prediction is defined by the changing demographics, with the age group most affected by cancer being the middle-aged and elderly [1]. The palliative care community in Saudi Arabia saw this as a great opportunity to develop the specialty on a national scale. The process of the development of Palliative Care/ last phase interventions was a long and meticulous one and has been very successful.


Introduction
Palliative care is a specialty of its own consisting of comprehensive multidisciplinary healthcare delivery to patients with a wide range of life-threatening and life-shortening diseases, including cancer. Its primary goal is to relieve symptoms of suffering such as physical pain, psychosocial and spiritual problems that affect the quality-of-life for patients as well as their families. Palliative care has a vital role in providing comfort to patient and family during active interventions like chemotherapy and radiation therapies [1]. The palliative care service in Saudi Arabia started over three decades ago at the King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh by Dr. Isbister [2]. Since then, the specialty has slowly expanded. Real changes came about in 2016 when the Ministry of Health (MOH) launched the Palliative Care/Last Phase Initiative as part of the Transformation of Healthcare -Vision 2030 [3]. By 2030, the Cancer care in Saudi Arabia is expected to grow by five to 10-fold. This prediction is defined by the changing demographics, with the age group most affected by cancer being the middle-aged and elderly [1]. The palliative care community in Saudi Arabia saw this as a great opportunity to develop the specialty on a national scale. The process of the development of Palliative Care/ last phase interventions was a long and meticulous one and has been very successful. Now there are several primary health care facilities scattered throughout the whole nation with secondary facilities, tertiary care hospitals and even virtual health care providing palliative care services through inpatient units and consultation services, as well as outpatient clinics and community palliative care teams. The first hospice care service was Launched in March 2018 in Riyadh health cluster 2 and since then it has expanded rapidly.

Education
It is important to invest in the education of physicians, nurses, and other healthcare professionals, particularly regarding opioid use and basic palliative care, emphasizing the safe use of such medication. In 2018, large scale education for 21 palliative MDTs, each one including physician, nurses, social worker, PT, OT, spiritual advisor, clinical pharmacist, and others. MDT education including theory and clinical disciplines and ending with certificate

NACS.000640. 6(3).2021
The Kingdoms' 1 st pediatric palliative care hospice in MOH was launched in May 2019 Alyamamh. New MOC allocation of funds for Palliative Care (2016) in the national health budget by the Ministry of Health. Availability of morphine and other strong opioids in all MOH facilities throughout the kingdom. 7.2 the latest Reported annual opioid consumption -excluding methadone -in Morphine Equivalence (ME) per capita [4].
2021 -Palliative care included in national health insurance plans. Availability of centers of excellence for palliative clinical care, education, and research example KFMC. Existence of grants to finance palliative care research through Saudi Society of Palliative Care (SSPC) and other palliative care centers.

Public Awareness
Most Saudis, though being concerned about cancer, have very limited knowledge about cancer related pain, palliative care services and also have numerous misconceptions regarding the use of opioids for pain relief [3]. Concerns include risk of addiction, risk of side-effects and the social stigma. There are already over fifteen cancer centers in the country, each with its own palliative care department and 21 palliative units already exist in each MoH health clusters. The increasing demand and need for palliative care are closely related to a better understanding of patients' pain and symptomatic management, and hence, the need to provide a better quality-of-life. The development of palliative care in the country has shown society that pain, and suffering caused by the disease and its treatment can be significantly reduced with proper management [1].

Conclusion
Palliative care in Saudi Arabia is expanding rapidly and covers all levels of healthcare from primary and secondary to tertiary care. We are moving to celebrate 'Palliative Care International Day' this year supported by the Minister of Health and SSPC. We believe that WHO will improve the ranking of Saudi palliative healthcare services due to the significant improvements and investments in palliative care that have been applied across the Kingdom.