{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T02:02:51Z","timestamp":1789351371449,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003125","name":"Finnish Cultural Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Access to palliative care (PC) is a fundamental right. While an increasing number of European countries have adopted national PC laws, it remains unclear how effective these laws are in advancing access and enabling development within health systems. This was a comparative multimethod study combining systematic analysis of national PC legislation with semi-structured interviews with national experts. Legal texts were analysed using a standardized extraction framework aligned with the WHO PC development model. Interview data provided interpretive context, contextualized legislative intent, and perceived system-level reach of laws. Fourteen countries had a national legal mandate explicitly addressing PC, either through standalone laws or binding frameworks within the health system. Laws varied widely in their aspiration and operational strength. Although almost half (6\/14, 43%) explicitly recognized PC as a right, only France and Italy combined rights-based recognition with explicit mechanisms for implementation, governance, and financial sustainability. National experts linked stronger operational design with greater service development and integration, whereas predominantly declarative laws had limited practical relevance. Across countries, gaps were greatest in provisions related to research, access to essential medicines, and workforce development. National laws can function as important public health instruments to support access to PC and foster system-level development; enforceable implementation mechanisms and integration within health systems are crucial. Legislation should be understood as an enabling instrument whose impact depends on governance, financing, political commitment and health-system implementation.<\/jats:p>","DOI":"10.1093\/eurpub\/ckag147","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:17:13Z","timestamp":1785323833000},"source":"Crossref","is-referenced-by-count":0,"title":["National palliative care laws in Europe: do they enable access and effectively promote the development of palliative care within health systems? A comparative multimethod analysis"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0117-8559","authenticated-orcid":false,"given":"Timo P","family":"Carp\u00e9n","sequence":"first","affiliation":[{"name":"Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital and Faculty of Medicine, University of Helsinki , Helsinki,","place":["Finland"]},{"name":"Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network , Toronto, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Monz\u00f3n-Llamas","sequence":"additional","affiliation":[{"name":"ATLANTES Global Observatory of Palliative Care, University of Navarra, Institute for Culture and Society (ICS) , Pamplona (Navarra),","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0881-555X","authenticated-orcid":false,"given":"Breffni L","family":"Hannon","sequence":"additional","affiliation":[{"name":"Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network , Toronto, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0425-4502","authenticated-orcid":false,"given":"Leszek","family":"Paw\u0142owski","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Medical University of Gda\u0144sk , Gda\u0144sk,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiina H","family":"Saarto","sequence":"additional","affiliation":[{"name":"Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital and Faculty of Medicine, University of Helsinki , Helsinki,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reino T","family":"P\u00f6yhi\u00e4","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Centeno","sequence":"additional","affiliation":[{"name":"ATLANTES Global Observatory of Palliative Care, University of Navarra, Institute for Culture and Society (ICS) , Pamplona (Navarra),","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"2026091321114409600_ckag147-B1","author":"Garralda","year":"2025"},{"key":"2026091321114409600_ckag147-B2","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.jpainsymman.2025.07.026","article-title":"First-ever global ranking of palliative care: 2025 world map under the new WHO framework","volume":"70","author":"Tripodoro","year":"2025","journal-title":"J Pain Symptom Manage"},{"key":"2026091321114409600_ckag147-B3","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1093\/eurpub\/ckv201","article-title":"Policy on palliative care in the WHO European region: an overview of progress since the council of Europe\u2019s (2003) recommendation 24","volume":"26","author":"Woitha","year":"2016","journal-title":"Eur J Public Health"},{"key":"2026091321114409600_ckag147-B4","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1186\/1472-6963-13-275","article-title":"Comparison of legislation, regulations and national health strategies for palliative care in seven European countries (results from the Europall Research Group): a descriptive study","volume":"13","author":"Van Beek","year":"2013","journal-title":"BMC Health Serv Res"},{"key":"2026091321114409600_ckag147-B5","year":"2021"},{"key":"2026091321114409600_ckag147-B6","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.jpainsymman.2007.02.022","article-title":"Palliative care as an international human right","volume":"33","author":"Brennan","year":"2007","journal-title":"J Pain Symptom Manage"},{"key":"2026091321114409600_ckag147-B7","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1016\/S0140-6736(13)62416-2","article-title":"Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial","volume":"383","author":"Zimmermann","year":"2014","journal-title":"Lancet"},{"key":"2026091321114409600_ckag147-B8","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1200\/JCO.2016.70.5046","article-title":"Effects of early integrated palliative care in patients with lung and GI cancer: a randomized clinical trial","volume":"35","author":"Temel","year":"2017","journal-title":"J Clin Oncol"},{"key":"2026091321114409600_ckag147-B9","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1056\/NEJMoa1000678","article-title":"Early palliative care for patients with metastatic non-small-cell lung cancer","volume":"363","author":"Temel","year":"2010","journal-title":"N Engl J Med"},{"key":"2026091321114409600_ckag147-B10","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1093\/eurpub\/ckaf044","article-title":"Impact of specialist palliative care on utilization of healthcare and social services at the end-of-life: a nationwide register-based cohort study","volume":"35","author":"Ahtiluoto","year":"2025","journal-title":"Eur J Public Health"},{"key":"2026091321114409600_ckag147-B11","doi-asserted-by":"crossref","first-page":"e137","DOI":"10.1136\/bmjspcare-2020-002302","article-title":"Inappropriate end-of-life cancer care in a generalist and specialist palliative care model: a nationwide retrospective population-based observational study","volume":"12","author":"Boddaert","year":"2022","journal-title":"BMJ Support Palliat Care"},{"key":"2026091321114409600_ckag147-B12","doi-asserted-by":"crossref","first-page":"e2440977","DOI":"10.1001\/jamanetworkopen.2024.40977","article-title":"Timing of palliative care, end-of-life quality indicators, and health resource utilization","volume":"7","author":"Mah","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026091321114409600_ckag147-B13","doi-asserted-by":"crossref","first-page":"e883","DOI":"10.1016\/S2214-109X(19)30172-X","article-title":"The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions","volume":"7","author":"Sleeman","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2026091321114409600_ckag147-B14","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.jpainsymman.2009.03.003","article-title":"Advancing palliative care as a human right","volume":"38","author":"Gwyther","year":"2009","journal-title":"J Pain Symptom Manage"},{"key":"2026091321114409600_ckag147-B15","author":"Brennan","year":"2008"},{"key":"2026091321114409600_ckag147-B16","doi-asserted-by":"crossref","DOI":"10.4135\/9781529716641","volume-title":"Managing Quality in Qualitative Research","author":"Flick","year":"2018"},{"key":"2026091321114409600_ckag147-B17","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1093\/heapol\/czaa064","article-title":"Document analysis in health policy research: the READ approach","volume":"35","author":"Dalglish","year":"2021","journal-title":"Health Policy Plan"},{"key":"2026091321114409600_ckag147-B18","volume-title":"Analyzing Qualitative Data","author":"Ritchie","year":"1994"},{"key":"2026091321114409600_ckag147-B19","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"2026091321114409600_ckag147-B20","doi-asserted-by":"publisher","year":"2025","DOI":"10.2471\/B09419"},{"key":"2026091321114409600_ckag147-B21","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1741-7015-8-8","article-title":"Access to pain treatment as a human right","volume":"8","author":"Lohman","year":"2010","journal-title":"BMC Med"},{"key":"2026091321114409600_ckag147-B22","doi-asserted-by":"crossref","first-page":"e13\u201322","DOI":"10.1016\/S1470-2045(15)00365-4","article-title":"Barriers to access to opioid medicines: a review of national legislation and regulations of 11 Central and Eastern European countries","volume":"17","author":"Vranken","year":"2016","journal-title":"Lancet Oncol"},{"key":"2026091321114409600_ckag147-B23","doi-asserted-by":"crossref","first-page":"e221253","DOI":"10.1001\/jamanetworkopen.2022.1253","article-title":"Achieving global pediatric palliative care equity-what we have yet to learn","volume":"5","author":"Umaretiya","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026091321114409600_ckag147-B24","author":"Arias-Casais","year":"2019"},{"key":"2026091321114409600_ckag147-B25","doi-asserted-by":"crossref","first-page":"e529","DOI":"10.1016\/j.jpainsymman.2021.12.031","article-title":"International standards for pediatric palliative care: from IMPaCCT to GO-PPaCS","volume":"63","author":"Benini","year":"2022","journal-title":"J Pain Symptom Manage"},{"key":"2026091321114409600_ckag147-B26","doi-asserted-by":"crossref","first-page":"e422","DOI":"10.1016\/S2214-109X(24)00476-5","article-title":"The evolution of serious health-related suffering from 1990 to 2021: an update to the lancet commission on global access to palliative care and pain relief","volume":"13","author":"Knaul","year":"2025","journal-title":"Lancet Glob Health"}],"container-title":["European Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag147\/70823323\/ckag147.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag147\/70823323\/ckag147.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T01:11:49Z","timestamp":1789348309000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurpub\/article\/doi\/10.1093\/eurpub\/ckag147\/8772167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":26,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/eurpub\/ckag147","relation":{},"ISSN":["1101-1262","1464-360X"],"issn-type":[{"value":"1101-1262","type":"print"},{"value":"1464-360X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,4]]},"article-number":"ckag147"}}