Indirect estimation of the need for palliative care during the COVID-19 pandemic: A descriptive cross-sectional study using mortality data in the Biobío Region, Chile

BACKGROUND: People with chronic diseases in their advanced phase require palliative care. This is essential to ensure their quality of life as it ends. However, a very low percentage of patients receive the necessary palliative care. The COVID-19 pandemic has adversely affected the planning and provision of palliative care. Despite this, in Chile, palliative care coverage was extended by law to cover nononcological chronic diseases. Implementation of this law is expected to be a significant challenge in terms of material resources, as well as the need for the formation of specialized palliative care teams. Therefore, it is essential to estimate the need for palliative care for all chronic diseases to generate useful input for planning and decision-making in public health. OBJECTIVES: To indirectly estimate the need for palliative care among people with Chronic Oncological Diseases (COD) and Chronic Non-Oncological Diseases (CNOD) during the prepandemic and pandemic context due to COVID-19 in the Biobío Region in Chile. METHODS: Cross-sectional study based on mortality data from chronic oncological and nononcological diseases during the prepandemic (2010-2018) and pandemic (2020-2021) contexts due to COVID-19 in a Region of Chile through indirect estimation using minimal estimate, standardized mortality rates and geographically weighted regression. RESULTS: It was estimated that 76.25% of deaths from chronic diseases in the Biobío Region would have required palliative care, which represents 77,618 people who should have been included in these health benefits. The pandemic had a significant effect on the average number of deaths from CNOD. People belonging to this group were more likely to die from COVID-19 than from their baseline disease, unlike the deaths of people from COD, where no significant changes were observed. CONCLUSION: These estimates highlight the potential size of the population requiring palliative care and emphasize the importance of recognizing the rights of individuals with COD and CNOD conditions. It is evident that there is a significant demand for palliative care services, as well as a pressing need for adequate resources, effective management, and strategic planning to cater to the needs of this population. This is particularly crucial in the heavily impacted areas and communes of the Biobío Region, Chile.