**3. Implications and ideas for better global palliative care going forward**

How to respond meaningfully to the data from reports like those of the Economist and to general calls for addressing palliative care globally is challenging [1, 19]. In this chapter, we argue that there can be a constructive way forward with immediate impact by taking a patient-centric, bottom-up approach to clinical practice systems, their barriers to palliative care, and the potential of IT tools and software. The system we present can in part and wholly be adapted to other country's circumstances, through a relatively minor investment of resources. High-income countries are beginning to develop and use such tools and systems in palliative care, and integration of such systems into established electronic medical record systems is achievable when the control issues can be worked out [2]. Until then, this system can economically function as a program auxiliary to facilities with medical records and those without. The system we present is particularly important in being directed at engaging clinicians/physicians who might otherwise avoid, refer, or somehow abandon their patients who now need palliative care. It can also be employed in noncancer specialties other than oncology that deal with chronic pain, and even be a resource for clinicians with less frequent need for palliation, or those in rural areas with fewer resources. Because our system is patient-centric and relies on and facilitates greater patient and family engagement and control, it also encourages stronger family support.

The entire system focus on palliative care might be expected to generally lower the total care costs, with minimal patient family expenses for submission of symptom reports and clinical office visits. In general, while limited, the available data suggest that facilitating home palliative care is effective for symptomatic relief of patients and is grief-limiting for families, while the overall cost efficacy remains to be well-understood [20]. We believe that after being extensively piloted, our system in Nepal and Bangladesh should be rigorously evaluated in a randomized clinical trial to document the impact on symptoms over time and overall patient survival.

The increasing use of IT technologies in patient care, including the use of video images and consultations, offer many ways of adding to the capacities of the system we describe. It would very much seem that affordable, efficient, and effective home care/palliative care should be within the reach of many more countries and global citizens.

## **Acknowledgements**

The authors wish to acknowledge very helpful discussions about the development of the system discussed in this chapter with Reza Salim, Tahmina Ferdousy, Arunangshu Das, Bishnu Paudel, Deepak Shrestha, and Roshni Gautam.

*Palliative Care*
