Global Consensus-Based Essential and Expanded Packages for Palliative Care and Pain Relief for Adults and Children: A Delphi Study.

Background: In 2018, the Lancet Commission on Global Access to Palliative Care and Pain Relief introduced the concept of serious health-related suffering (SHS) to quantify the need for palliative care and proposed an Essential Package of Palliative Care and Pain Relief (PCPR) to address it. However, this package did not account for complex and specialized needs, and its global implementation has been limited.

Objectives: We conducted a multi-stage, modified Delphi study to update and expand the initial Essential Package for children and adults METHODS: Two international panels -adult and pediatric- representing diverse geographical regions and income levels participated in two Delphi rounds. External validation was conducted by global experts in palliative care.

Results: Response rates for the Delphi rounds were 79.5% for adults and 64.0% for children. Consensus was achieved on the updated Essential Packages for both adults and children, with minor modifications. Expanded Packages were developed, including additional medications, equipment, and human resources to address broader needs. The study also revealed persistent inequities in medicine availability, particularly in low- and middle-income countries, and limited awareness of the Lancet Commission's Essential Package among health professionals.

Conclusion: These globally validated Essential and Expanded Packages for adults and children offer a practical adaptable framework to guide national health strategies, strengthen palliative care services, and reduce SHS. Their adoption can meaningfully contribute to achieving Universal Health Coverage.