6 Principles of palliative care

Table of contents

Principles of Palliative Care

Attitudes and principles required for successful palliative care

A caring attitude

Consideration of individuality

Cultural considerations

Consent

Choice of site of care

Communication

Clinical context: Appropriate treatment

Comprehensive inter-professional care

Care excellence

Consistent medical care

Coordinated care

Continuity of care

Crisis prevention (see Consistent Medical Care)

Caregiver support

Continued reassessment

Advance Care Planning

See Advance Care Planning

Communication with Patients

Important and potentially difficult discussions are frequently necessary with palliative care patients who have active, progressive, far-advanced disease, regarding

Decisions must be individualised for each patient and should be made in discussion with the patient and family. The following guide is to help you plan for and hold such discussions.

Before the Discussion

Ask yourself these questions:
Would you be surprised if this patient died of their disease within 6 months?
Bear in mind that even doctors with long experience tend to over-estimate prognosis.
This may provide a better guide for decision-making, as attempting to prognosticate may be difficult and inaccurate. Alternatively, assess how much the patient’s condition has deteriorated in the last month or six weeks, using observations by the team and objective measures such as x-rays and biochemistry. Observations by close relatives often help.
What specific therapies are available to treat the underlying disease?

About the Patient and Family

The Discussion

Appropriate setting

Introduce the discussion

Find out what they understand

Find out what they expect

Provide medical information, if necessary

Discuss realistic possibilities in the context of their view of the present and future

Discussing further active treatment for the underlying disease

Discussing prognoses

Discussing admission to palliative care units / services

Discussing appropriate medical care

Discussing ‘Do-not-resuscitate’ orders (DNR)

Respond sympathetically to emotional reactions
Agree on a plan, with provision that it can be modified if circumstances change

Remember, death is the natural end to life and is not a failure of medicine or any clinicians,

Advance Care Planning

Advance care planning is a means for patients to record their end-of-life values and preferences, including their wishes regarding future treatments (or avoidance of them).
Advance care planning involves a number of processes:

The principle of advance care planning is not new

The “Respecting Choices” program developed in Wisconsin is an example of advance care planning:

Models of Care

IAHPC believes that each developing country should be encouraged and enabled to develop its own model of palliative care, appropriate to the needs of the local patients and the available resources, taking advantage of the experience and expertise accumulated in developed countries, and not be expected to copy models more appropriate to affluent countries.

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