We present an interview with Tamar Bulia, a PhD student at the University of Georgia, who co-authored the paper “Benchmarking Georgia's palliative care system, using WHO's new actionable indicators: alignment with the European Association for Palliative Care (EAPC) 2025 atlas,” published in the international scientific journal Frontiers in Health Services.
The study assesses Georgia’s palliative care system in light of the World Health Organization’s new indicators and the European Association for Palliative Care’s 2025 Atlas. It aims to evaluate the current state of the system, identify systemic challenges, and determine priority areas for the development of palliative care.
In this interview, the author discusses the significance of the research, its potential practical impact on patients and their families, the challenges encountered during the research process, and the experience of international scientific collaboration. She also explores how the findings could contribute to the development of palliative care in Georgia and the improvement of the healthcare system.
What motivated you to research this topic?
My interest in researching this topic is directly related to my professional work in oncology and palliative care. In clinical practice, I see every day how important it is for patients to receive not only disease-focused treatment but also effective management of pain and other symptoms, psychosocial support, and timely access to quality palliative care services.
Despite the progress made in developing palliative care in Georgia, significant systemic challenges remain. These relate to service accessibility, geographical disparities, resource allocation, and the integration of palliative care into the healthcare system.
For me, it was particularly important to examine these issues not only on the basis of clinical experience but also through a systematic, evidence-based approach. This interest led to the idea for the study: to assess the extent to which the current state of palliative care in Georgia aligns with the indicators developed by the World Health Organization and with European standards.
The main motivation behind the research was to establish an objective picture of the current situation, identify systemic gaps, and present evidence that could support the development of palliative care and inform evidence-based healthcare policy decisions.
I believe that developing palliative care is about more than improving medical services. It is directly linked to human dignity, quality of life, and the principle of equitable access to healthcare.
How could the findings of this study affect people's lives?
One of the key contributions of our study is its scientific novelty. A comprehensive assessment of Georgia’s palliative care system using the World Health Organization’s new indicators had not previously been conducted. The study therefore created an opportunity to evaluate the country’s palliative care system within an international methodological framework, identify existing challenges, and determine priority areas for development.
The practical significance of the findings is directly linked to people's quality of life. Developing the palliative care system means not only increasing access to medical services but also ensuring effective management of pain and other distressing symptoms, strengthening psychosocial support, and creating services that are more responsive to the needs of patients and their families.
It is particularly important that the evidence generated by the study can be used to inform healthcare policy planning, targeted resource allocation, the reduction of regional disparities, and better integration of palliative care into the healthcare system.
Furthermore, the significance of this research extends beyond oncology, as palliative care is essential for people living with a range of serious, life-threatening illnesses.
Of course, scientific research does not automatically lead to systemic change. However, it provides the evidence base without which effective and sustainable decisions are difficult to make.
Ultimately, our goal is to ensure that the findings do not remain confined to academia but contribute to changes that result in better services for patients, reduced suffering, and an improved quality of life. This is the principal societal value of our research.
How can students become involved in research in this field, and why would you encourage them to do so?
Palliative care is inherently an interdisciplinary field that brings together clinical medicine, public health, psychology, social sciences, and healthcare policy. Consequently, research in this area offers valuable opportunities for students from a wide range of academic disciplines.
Students can begin by critically reviewing scientific literature, formulating research questions, and collaborating with experienced researchers. They can investigate the needs of patients and their families, quality of life, access to palliative care services, psychosocial support, and organizational challenges within the healthcare system. Research that combines clinical experience with public health approaches and seeks to scientifically assess real-world problems is particularly promising.
As a clinician and academic, I always encourage students to view research not only as an opportunity for professional development but also as a form of social responsibility. Research enables us to turn problems encountered in everyday practice into scientific questions, generate reliable evidence, and use that evidence to propose ways to improve the system.
Many aspects of palliative care in Georgia remain underexplored, allowing young researchers to contribute to the development of scientific knowledge that is important for the country.
In my view, the particular value of working in this field lies in the fact that the ultimate goal of research is not simply to acquire new knowledge. It is to apply that knowledge to alleviate human suffering, improve quality of life, and build a more person-centered healthcare system.
What were the main challenges involved in conducting this study, and what skills did it require?
One of the main challenges was identifying and systematizing the available data on Georgia’s palliative care system and aligning them with an international methodological framework. The use of the World Health Organization’s new indicators was particularly important, as assessing the system through these indicators requires more than analyzing individual statistical measures. It also involves examining healthcare policy, service organization, resource availability, and various components of systemic development as a whole.
Data availability and completeness also presented challenges. Information on palliative care is spread across different sources, and the data required to assess individual indicators are not always consistent or comprehensive. It was therefore essential to critically evaluate the information, verify the reliability of sources, and interpret the findings while taking existing limitations into account.
Conducting the study required a combination of epidemiological and analytical skills, knowledge of scientific methodology, critical thinking, and the ability to work with international standards. Interdisciplinary collaboration was also particularly important because assessing a palliative care system extends beyond clinical medicine and requires an in-depth understanding of public health and healthcare policy.
One of the most professionally significant aspects of this study for me was the integration of clinical experience with public health research approaches. Clinical practice allows us to recognize the needs of individual patients, while systemic research helps us understand the organizational and structural factors that determine how the healthcare system responds to those needs.
Ultimately, the main challenge was not simply collecting and analyzing data. It was transforming them into scientifically substantiated conclusions that accurately reflect the development needs of Georgia’s palliative care system and provide a valuable foundation for future decision-making.
What response has this particular paper received so far?
Significant scientific interest in the paper emerged even during its preparation. Of particular note was the involvement of Professor Koustuv Dalal, an internationally experienced researcher in public health, health economics, and healthcare systems assessment. His academic work includes numerous international scientific projects, including research published in prestigious journals such as The Lancet and Nature.
During the preparation of the study, Professor Dalal became interested in our work, positively assessed its scientific concept, methodological approach, and international significance, and expressed a desire to become involved in the research. As a result, he joined the author team. I particularly valued the interest and collaboration of a scientist with such extensive international experience in healthcare systems research.
We also received important positive feedback during the peer-review process. The journal’s reviewers particularly emphasized the paper’s potential contribution to the development of palliative care systems in low- and middle-income countries.
This assessment is especially significant given the study’s international comparative approach. Our paper does not focus exclusively on evaluating Georgia’s palliative care system. The research includes comparative analysis with both high-income countries and countries with socioeconomic characteristics similar to Georgia’s, as well as countries in geographically neighboring regions. This approach enabled us to assess Georgia’s palliative care system in an international context and identify priority areas for development.
The publication of the study in the international peer-reviewed journal Frontiers in Health Services represents another important step toward bringing Georgia’s experience to the international academic community.
I believe the paper’s particular value lies in its potential for international application. The methodological approach and findings may also be useful to other countries, particularly those developing their palliative care systems amid limited resources and significant structural challenges.
I believe this reflects one of the main purposes of scientific research: to generate knowledge that extends beyond the borders of a single country and contributes to the development of healthcare systems internationally.
What additional funding and support did the study receive?
The study was conducted without dedicated grant funding, based on the authors’ independent scientific initiative and international academic collaboration.
The combination of the author team’s professional experience, scientific expertise, and research resources played a decisive role in carrying out the study. International collaboration was particularly valuable, including the involvement of Professor Koustuv Dalal, whose scientific experience and professional support made a significant contribution to the development of the paper.
Despite the absence of dedicated financial funding, the team was able to conduct a methodologically complex study based on international comparative analysis and publish its findings in an international peer-reviewed scientific journal.
This experience further highlights that the success of scientific research depends not only on financial resources but also on the relevance of the research question, methodological rigor, professional responsibility, and effective academic collaboration.
