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.
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.

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 recognized by Saudi Commission for Health Specialists (SCFHS). Training has taken part in the palliative center of excellence in KFMC. In March 2021 the last batch of students completed their training in the Kingdom. The existence of official Specialization in Palliative Medicine since 2001 for physicians (now a 2-year Palliative Medicine Fellowship), has been officially recognized by the SCFHS. The existence of a current national palliative care plan named is included in the MOC Vision 2030, including national strategy, national palliative guideline (2018) and national palliative care standard (2021). There are now 50 specialized palliative care consultants in the country. There are 2.6 Physicians per 1 000 inhabitants 2014-2018 [4].
The Kingdoms’ 1st 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.

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].

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.

1. Alshammary SA, Abdullah A, Duraisamy BP, Anbar M (2014) Palliative care in Saudi Arabia: Two decades of progress and going strong. J Health Spec 2(2): 59-60.
2. Nixon A (2003) Palliative care in Saudi Arabia: A brief history. J Pain Palliat Care Pharmacother 17(3-4): 45-49.
3. Alshammaray S, Duraisamy B, Albalawi Y, Savithri R (2019) Development of palliative and end of life care: The current situation in Saudi Arabia. Cureus 11(3): e4319.
4. (2021) Atlas of palliative care in the Eastern Mediterranean Region 2021.