Serious Health-Related Suffering 3.0 Background


The concept of Serious Health-related Suffering (SHS) was introduced in the report of the Lancet Commission on Pain Relief and Palliative Care (Knaul, et al., 2017). Suffering is health-related when it is associated with illness or injury of any kind.
Health related suffering is serious when it cannot be relieved without medical intervention and when it compromises physical, social, spiritual and/or emotional functioning.  ( SHS is most often used in the context of severe illness. Severe illness is a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments, or caregiver stress ( A new consensus-based definition of palliative care (PC) has been published by the International Association for Hospice and Palliative Care (IAHPC), based on the SHS concept (Radbruch, et al., 2020). Emphasizing suffering as a mainstay of the new definition allows a shift from a disease-centred conceptualization to a more person-centred approach to PC. The definition thus recognizes that PC should be delivered based on need rather than prognosis. The concept of SHS has been taken up by other research groups (Moine, et al., 2018; Nambiar, Rana, & Rajagopal, 2021; Sleeman, et al., 2019; Sleeman, et al., 2021). Currently, refined calculations are in progress to produce SHS 2.0, with more detailed consideration of children and young adults and non-decedents with non-communicable diseases. However, there are still methodological discussions on the identification and calculation of patients or days with SHS. A well-defined and consented methodology is needed, resulting in a robust process for calculating SHS, so that users can then calculate the SHS for specific groups, regions, and/or settings.


The objective of SHS 3.0 is to reconstruct a systemic process of building SHS, making sure we follow consistent criteria for each health condition when it comes to:
  • whether to include in the list
  • whether to include both decedents and non-decedents
  • what would be the multipliers to ascertain the proportion of deaths of prevalent cases that require palliative care
  • days in palliative care, and prevalence and duration of symptoms
  • days of encounter of palliative care at each level of health care facilities
  • the types and amount medicine, especially morphine - medical equipment, social support, and human resources required


Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, et al. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet 2018;391(10128):1391-1454.
Radbruch L, De Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, et al. Redefining Palliative Care - a New Consensus-based Definition. J Pain Symptom Manage 2020.
Moine S, Murray SA, Boyd K, Engels Y, Mitchell G, European Association for Palliative Care Primary Care Reference G. Palliative care and the endless cycle of serious health-related suffering. Lancet 2018;392(10146):471-472.
Nambiar AR, Rana S, Rajagopal MR. Serious health-related suffering and palliative care in South Asian countries. Curr Opin Support Palliat Care 2021;15(3):169-173.
Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health 2019.
Sleeman KE, Gomes B, de Brito M, Shamieh O, Harding R. The burden of serious health-related suffering among cancer decedents: Global projections study to 2060. Palliat Med 2021;35(1):231-235.