Circles of care: should community development redefine the practice of palliative care?

Abstract

Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. This has mostly been done in the context of a service delivery approach to care whereby services have become increasingly expert in identifying health and social care need and meeting this need with professional services. This model of patient centred care, with the impeccable assessment and treatment of physical, social, psychological and spiritual need, predominantly worked very well for the latter part of the 20th century. Over the last 13 years, however, there have been several international examples of community development approaches to end of life care. The patient centred model of care has limitations when there is a fundamental lack of integrated community policy, development and resourcing. Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.

Bereavement and palliative care: A public health perspective

“…In general, bereaved people need to find support in their local communities, not be drawn back into professionally--organised contexts to receive support, while specialist bereavement services would best be accessed through general community programs. Palliative care services should thus resist 'keeping it in the family' thinking and make their contribution through a web of partnerships that extend into the community as well as encompass a range of other health services (31). While palliative care bereavement services are often intended as a strategy for maintaining contact with bereaved clients in order to identify complications if they arise, this is a less than effective screening method.…”

The Impact of Public Health Awareness Campaigns on the Awareness and Quality of Palliative Care

“…They refer to ''persons'' with an illness rather than ''palliative care patients'' and see the person at the center of concentric ''circles of care''. 55 This area of activity is often called health promoting palliative care, a concept that originated in Australia from the work of Kellehear. [56][57][58][59][60] It is in line with the framework presented by Ottawa Charter on Health Promotion.…”

Compassionate communities and end-of-life care

“…Typically, an inner network of support 5 contains two to five people. The person who is unwell may not want to interact with large numbers of people, whether they are family, friends, neighbours, community members or caring professionals.…”