Department of Palliative and Supportive Care, Burjeel Medical City, Abu Dhabi, UAE; Khalifa University, College of Medicine and Health Sciences, Abu Dhabi, UAEUnited Arab Emirates
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The United Arab Emirates (UAE) has recently celebrated its 50th birthday since its inception as an independent sovereign federal state in 1971. Over the past 5 decades, the UAE’s health-care sector has grown exponentially to include over 140 hospitals in both the public and private sectors.
OpenJournal PUBLISHERS Commentary An Update on the State of Palliative Care Development in the United Arab Emirates 1,2* Neil A. Nijhawan, BSc(Hons), PhD, MBBS(UK), MRCP(UK), CCT UK (Palliative Medicine)1,2* 1Department of Palliative and Supportive Care, Burjeel Medical City, Abu Dhabi, UAE 2Khalifa University, College of Medicine and Health Sciences, Abu Dhabi, UAE * *Corresponding author Neil A. Nijhawan, BSc(Hons), PhD, MBBS(UK), MRCP(UK), CCT UK (Palliative Medicine) Consultant in Palliative Medicine, Department of Palliative and Supportive Care, Burjeel Medical City, Abu Dhabi, UAE; Adjunct Clinical Senior Lecturer, Khalifa University, College of Medicine and Health Sciences, Abu Dhabi, UAE; E-mail: drneilnijhawan@gmail.com Article information th th th th Received: July 25 , 2022; Revised: August 10 , 2022; Accepted: August 10 , 2022; Published: August 10 , 2022 Cite this article Nijhawan NA. An update on the state of palliative care development in the United Arab Emirates. Palliat Med Hosp Care Open J. 2022; 8(2): 27-29. doi: 10.17140/PMHCOJ-8-149 he United Arab Emirates (UAE) has recently celebrated its private healthcare sector. The American Hospital in Dubai pro- th 50th birthday since its inception as an independent sovereign vides in-patient and out-patient consults and in-patient palliative T federal state in 1971. Over the past 5 decades, the UAE’s health- care beds and, like Tawam Hospital, their referrals are exclusively care sector has grown exponentially to include over 140 hospitals for patients with a diagnosis of cancer. in both the public and private sectors.1 Hospitals within the UAE provide a wide variety of services and maintain high quality stan- In September 2019, Mediclinic City Hospital in Dubai dards, with over 206 national institutions and speciality programs launched its palliative care service and currently provides in-pa- boasting the Joint Commission International (JCI) gold seal of tient and out-patient consults and in-patient palliative care beds. approval–exceeding all other countries in the Middle East.2 The An additional consultation service was initiated at a sister hospital, majority of medical specialties are represented, particularly in the Parkview Hospital, in 2020. The most recent addition to the pal- major conurbations of Dubai and Abu Dhabi. liative care service landscape was in March 2020 with the launch of the Palliative and Supportive Care service at Burjeel Medical Palliative Care is among the more recent additions to the City (BMC) in Abu Dhabi. Like Tawam Hospital, BMC also pro- medical specialty landscape in the UAE (Figure 1). The first pal- vides a comprehensive palliative care service, with in-patient and liative care service within the public health service was established out-patient consults integrated with pain medicine and physical in 2007 at Tawam Hospital in Al Ain, Abu Dhabi, as a consult medicine and rehabilitation clinics, an in-patient consultation ser- service alongside their oncology service. This matured into a sep- vice, dedicated palliative care in-patient beds and a palliative care arate division within the oncology department and now provides nurse outreach service. The Burjeel healthcare ecosystem also in- in-patient and out-patient consults for both adults and children, cludes a homecare service, and the palliative care team is able to dedicated in-patient beds, a palliative care nurse outreach service provide some support for patients requiring palliative care input and close collaboration with anesthesia for interventional pain and end-of-life (EoL) care at home.
management. To date, the Tawam palliative care team remains the sole palliative care service within the public health sector. Since Most patients receiving palliative care input are either 2015, the number of palliative care services has grown within the
PUBLISHERS hospital in-patients or patients who are well-enough to attend the services will also grow. The alignment and earlier integration of out-patient clinic in person or have symptoms that are well-con- palliative care alongside oncology services is a natural progression trolled on oral/trans-dermal medications and their relatives can and the benefits for patients are well-established in the literature.5 attend the clinic to discuss and have their prescriptions refilled.
These benefits are not limited only to patients with a diagnosis However, for patients who wish to have EoL care at home, the of cancer, but applicable to patients with end stage organ failure, situation is more complicated. Not all insurance providers offer progressive neuromuscular disease, advanced dementia, essentially, home care as a standard option and the current prescribing regu- wherever there is healthcare related suffering, the case can be made lations pertaining to controlled medicines (including opioids and for the benefits of access to palliative care services.6 other centrally acting medicines) do not permit the prescription of the injectable forms of these medicines for patients outside of the The only way to improve palliative care service provision hospital.3 The net effect of these limitations is that for the pallia- at the national level is by advocating for palliative care at the level tive care team at BMC, in the past 28-months, only three (3) of our of policy makers. A number of initiatives in this direction are un- patients have received EoL care at home.
derway: Access to essential palliative care medications goes hand- • The department of health in Abu Dhabi has formed a Pallia- in-hand with the development of palliative care services. Having tive Care Taskforce to provide technical advice and contribute to worked in other parts of the world, I can say that we are fortunate the development and implementation of palliative care pathways in Abu Dhabi that we do have access to all of the essential pal- within Abu Dhabi. This task force is comprised of the above-men- liative care medicines listed by the International Association of tioned physicians with specialist training in palliative care.
Hospice and Palliative Care (IAHPC). While not all formulations • This group is currently organizing and running a series of we- of every medication may be available, what we do have access to, binars, endorsed by the department of health, focusing on several allows significant flexibility in our prescribing. However, there is key issues that affect the day-to-day provision of palliative care substantial variability with regards to accessing these medicines within the UAE. At the end of the webinar series, our aim is to from one hospital to another and from emirate to emirate.
generate a consensus document that identifies the areas for devel- opment and provides practical recommendations to achieve this.
The financial justifications for palliative care services are • To give this group credibility and a platform for advocacy, we well established in the literature, with patients who receive pallia- have recently been granted permission to for a UAE palliative care tive care input (compared with those receiving usual care) typically Special Interest Group; the aim of which is to raise the profile of having a reduced number of hospitalisations, a shorter duration palliative care within the UAE to help in improving the quality of hospital stay, reduced intensive care unit admissions and fewer of life for patients with serious health related suffering, by bring- visits to the emergency department. Whether health care is deliv- ing together all the members of the palliative care interdisciplinary ered within the government health system or the private sector, team.
payment for services will either be as part of a health insurance • Dr Neil Nijhawan, Palliative Care Consultant at Burjeel Medical ecosystem or self-paid by the patient. Within the UAE, each emir- City in Abu Dhabi was appointed to the World Health Organiza- ate has different laws for medical insurance with Abu Dhabi and tion (WHO) Eastern Mediterranean Region Expert Network on Dubai mandating that employers are legally obligated to provide Palliative Care in May 2022.
medical cover for employees and their dependents. The current reimbursement system has added complexity to being able to offer Yes, there is much work to be done in improving access palliative care input to patients. Like many other non-procedure- to palliative care across the UAE, but it is starting to feel as if we based health care interventions, palliative care consultations includ- are taking steps in the right direction.
ing advance care planning are generally undervalued; there is a lack of value assigned to this cognitive, empathic and communication-