Region-specific macroindicators on palliative care development in the Eastern Mediterranean Region: a Delphi study

Sánchez-Cárdenas MA, Garralda E, Van Steijn D, et al. "Region-specific macroindicators on palliative care development in the Eastern Mediterranean Region: a Delphi study." East Mediterr Health J. 2022;28. copy at


Background: The World Health Organization Office for the Eastern Mediterranean Region (EMR), and a recently created palliative care experts’ network from the EMR, decided to develop region-specific indicators to monitor national palliative care development.

Aims: To identify relevant and feasible macroindicators of palliative care development for the EMR.

Methods: Palliative care experts from the EMR were nominated and invited to complete a 2-round Delphi study to rate macroindicators from previous studies and propose new ones based on regional characteristics. All indicators were assessed by regional relevance (R) and feasibility (F). A content validity index (CVI) was calculated. Indicators with CVI ≥ 0.7/1, and scoring ≥ 7/9 for the average of R and F were selected.

Results: Twelve of 22 countries were represented in the study. In the first round, 11 indicators were selected and 13 new ones proposed. In the second round, 15 indicators matched R, F and CVI criteria. Top-scored indicators were: existence of a current national palliative care strategy (R = 8, F = 8, CVI = 1); ratio of specialized services (for adults and children) in the country per population (R = 8, F = 7, CVI = 1); allocation of funds for palliative care in the national health budget by the Ministry of Health or equivalent government agency (R = 8, F = 6, CVI = 1); education for prequalification doctors/nurses (R = 8, F = 8, CVI = 0.9); and availability of morphine and other strong opioids (R =8, F = 8, CVI= 0.9).

Conclusion: A baseline set of 15 region-specific indicators for measuring development of palliative care were validated by regional experts.



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