5 What is palliative care

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What is palliative care?

[Note: this is also the opening section of the IAHPC Manual of Palliative Care available in
https://hospicecare.com/what-we-do/publications/manuals-guidelines-books/manual-of-palliative-care/]

Palliative care is the care of patients with active, progressive, far-advanced disease, for whom the focus of care is the relief and prevention of suffering and the quality of life.

The following should be noted:

Palliative care should never be withheld until such time that all "active" treatment regimens for the underlying disease have been exhausted.

The message of palliative care is that whatever the disease, however advanced it is, whatever treatments have already been given, there is always something which can be done to improve the quality of the life remaining to the patient.

World Health Organization definition

"Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."

Palliative care

This definition is available in http://www.who.int/cancer/palliative/definition/en/

Types of Care: the meaning of "Palliative"

It is important to differentiate:

Frequently asked questions

Is Palliative Care the same as Hospice Care?

Is Palliative Care the same as Hospice Care?
Yes, the principles are the same.

Should a Palliative Care service provide care for patients with chronic diseases?
No, although their care is important.

Should a Palliative Care service provide care for patients with incurable diseases?
No, although their care is important.

Should a Palliative Care service provide care for patients incapacitated by their not-life-threatening disease (eg stroke, post trauma disability)?
No, although their care is important.

Should a Palliative Care service provide care for the elderly?
No, although their care is important.

Is Palliative Care just Terminal Care / Care of the Dying?
No.

Should Palliative Care stay separate from mainstream medicine?
No.

Is Palliative Care not just ‘old-fashioned’ care?
No.

Is Palliative Care what you do when "nothing more can be done"?
No.

Does Palliative Care include euthanasia and physician-assisted suicide?
No.

Is a palliative care service really a pain service and its doctors’ pain specialists?
No.

The need for Palliative Care:

The Goals of Palliative Care

For patients with active, progressive, far-advanced disease, the goals of palliative care are:

Palliative Care and Suffering: Inter professional Care

Suffering may be defined as the distress associated with events that threaten the intactness or wholeness of the person. In clinical practice, it is helpful to have a simpleclassification of the causes of suffering, so that the complex problems presented by patients can be disentangled, in order to provide comprehensive palliation and relief of suffering:

 The components of palliative care, or the aspects of care and treatment that need to be addressed, follow logically from the causes of suffering. Each has to be addressed in the provision of comprehensive palliative care, making a multidisciplinary team approach to care a necessity.
 Treatment of pain and physical symptoms are addressed first because it is not possible to deal with the psychosocial aspects of care if the patient has unrelieved pain or other distressing physical symptoms.
 The various causes of suffering are interdependent and unrecognised or unresolved problems relating to one cause may cause or exacerbate other aspects of suffering
 Pain and psychological suffering area inter-related

A multidisciplinary/team approach to assessment and treatment is mandatory

Multidisciplinary and Inter professional Teams

Successful palliative care requires attention to all aspects of a patient’s suffering. This requires input or assistance from a range of medical, nursing and allied health personnel—a multidisciplinary approach.

Established palliative care services work as a multidisciplinary or inter professional team

The patient may be considered a ‘member’ of the team (although they do not participate in team meetings), as all treatment must be with their consent, understanding and in accordance with their wishes.
 The members of the patient’s family can be considered ‘members’, as they have an important role in the patient’s overall care and their opinions should be included when formulating a plan of management, then fully explained to them.
 Volunteers play an important role in many palliative care services. They receive no pay but may be offered expenses. They work in reception, coffee rooms, library, appeals office, flower arranging, Day Unit, transport, charity shops but in most units do not perform ‘hand-on’ role with patients. They work under the direction of a Volunteer Service Manager, a salaried member of the staff.

The ideal core multidisciplinary clinical team consists of:

Very useful, but not essential, are:

More on staffing can be found in Getting Started (on this IAHPC website)

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