Professor Scott A. Murray, a member of the International Association for Hospice and Palliative Care Board of Directors and St Columba's Hospice Chair of Primary Palliative Care, Edinburgh, Scotland, UK.
Palliative care was initially defined as an inclusive activity, as an approach that all health and social care professionals should have so that all people in need could benefit from a holistic and planned approach when faced with a life-threatening illness. However, in the past 20 years it has focused more on specialist inpatient care and is currently inaccessible to most people with palliative care needs, even in richer countries.
Nowadays, however, there is an increasing enthusiasm and upsurge through a number of charters, increasing research evidence, and policy directives to promote palliative care more in hospitals and the community. This public health approach is clearly voiced in the 2014 WHO resolution that palliative care should be integrated in all health settings. There is now a great opportunity to help national policymakers and developers meet their requirement to make palliative care accessible in all settings. We can direct policymakers and service providers to toolkits to help develop palliative care in the community, such as the one recently developed by the European Association for Palliative Care and the World Organization of Family Doctors (Wonca).
Authors such as Atul Gwande, an American surgeon, and Margaret McCartney, a Scottish general practitioner, have written easily read books calling for better end-of-life care in care homes, hospitals and especially for people at home. Hospices in the UK are starting to consider the needs of people dying in their geographic catchment areas, not just those accessing their services. Some hospices are sending specialist nurses to care homes and general practices to support and train generalists. There are now many national organizations set up to coordinate care and to help promote a public discourse about death and dying. Championed by Allan Kellehear, health promotion is starting to be applied to prevent much avoidable distress at the end of life, and to promote more community engagement in helping terminally ill people in the community.
The most difficult clinical challenge facing palliative care in all countries is how can primary health care and hospital workers identify patients who might benefit from this approach early in the course of their illness. The Supportive & Palliative Care Indicators Tool (SPICT) is a validated tool that our research team in Scotland has developed to help identify such patients and is now used in many countries.
Advance care planning is also being developed at great speed and the 5th International Conference on Advance Care Planning and End of Life Care conference in Munich in September is looking at how best to do this with various different conditions and also in different settings.
Also, in Africa, Asia, Eastern Europe and Latin America the work is going forward very strongly, facilitated by the regional Palliative Care Associations. So we really live in exciting times. Further advocacy work at this stage is likely to achieve a tipping point which will allow palliative care to be integrated into mainstream health service provision in most countries internationally. And, at the same time, by promoting more talk about the advantages of being open about death and dying, and encouraging communities to play their part, death can become less medicalized and less feared.
Let’s bring death back to life, and get viral with palliative care.
More links and resources
Professor Scott A. Murray, email: [email protected]
Read more about Prof. Scott Murray in his bio on the IAHPC website.
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