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Palliative Care in the Global Setting

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Table 1. ASCO Framework of Resource Stratification: Palliative Care Setting Definition Institutional Level in some LMICs for Palliative Care Basic Core resources or fundamental services that are absolutely necessary for any cancer health care system to function. Basic-level services typically are applied in a single clinical interaction. (However, palliative care is slightly different) Primary Health Care; Community Limited Second-tier resources or services that are intended to produce major improvements in outcome such as increased survival, and are attainable with limited financial means and modest infrastructure. Limited- level services may involve single or multiple clinical interactions. District Level facility Enhanced ird-tier resources or services that are optional but important. Enhanced-level resources should produce further improvements in outcome and increase the number and quality of therapeutic options and patient choice. Regional facility Maximal • May use high-resource settings' guidelines. • High-level/state-of-the art resources or services that may be used/available in some high-resource countries and/or may be recommended by high- resource setting guidelines that do not adapt to resource constraints but that nonetheless should be considered a lower priority than those resources or services listed in the other categories on the basis of extreme cost and/or impracticality for broad use in a resource-limited environment; to be useful, maximal-level resources typically depend on the existence and functionality of all lower level resources. Health budgets still require hard choices, and private insurers or public systems may carefully ration access to the most costly therapies. National Level facility NOTE: Data adapted. To be useful, maximal-level resources typically depend on the existence and functionality of all lower-level resources.

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