Palliative care reimagined: a needed shift

Abstract

Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers-an outgrowth of the recognition that routine work with the dying, their carers, and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach. However, the majority of people with terminal illnesses do not have access to palliative care teams, whose main focus of care remains patients with cancer. In the context outlined above this paper therefore poses two key questions: how can we provide an equitable level of care for all people irrespective of diagnosis and how can we increase the range and quality of non-medical/nursing supportive care in a context of diminishing resources? We argue that an important opportunity and solution can be found by adopting the principles of a public health approach to end-of-life care.Palliative care, since the formation of St Christopher's Hospice in 1967 has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers-an outgrowth of the recognition that routine work with the dying, their carers and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach.While most people will agree that these developments have been outstanding, yet some long-term problems remain while other recent national developments threaten early achievements. Among these current challenges are the following:1. The home death rate, over 30% in the 1980s in Britain, has remained low, with rates being near 20%. The National End-of-Life Care Strategy was published in the UK in 2008 with the specific purpose of resolving some of these problems. Despite the enormous effort that has taken place, the increase in home death rates is disappointingly modest, being 22.6% in 2014 1 2. Both primary and secondary care struggle to identify people who are at the last phase of their life and consequently there is limited uptake of advance care planning. Reporting da...

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

“…These communities can then develop their own solutions to palliative care issues, working in partnership with professional agencies. [51][52][53][54] They put forward a socially oriented alternative to medical models 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''.…”

End-of-life care in the Western world: where are we now and how did we get here?

“…While EOL care attempts to involve the family, the larger community is neglected and marginalised. Compassionate communities assume that ‘death and dying is everyone’s business’ and aims to facilitate a partnership between community support and palliative care (Abel and Kellehear, p. 24) 15. Proponents of this movement hold that ‘death, dying, caregiving and loss are social problems with medical aspects to them and not medical problems with social aspects’ (Abel and Kellehear, p. 25) 15.…”

“…Compassionate communities assume that ‘death and dying is everyone’s business’ and aims to facilitate a partnership between community support and palliative care (Abel and Kellehear, p. 24) 15. Proponents of this movement hold that ‘death, dying, caregiving and loss are social problems with medical aspects to them and not medical problems with social aspects’ (Abel and Kellehear, p. 25) 15. Ideally, this movement will provide practical relief, including financial demands, freeing up palliative care workforce, decreasing caregiver burnout and increasing home rather than hospital deaths.…”

Compassionate communities and end-of-life care

“…Care has been increasingly professionalised and attempts to address the inequity of endof-life care (EoLC) for those with a cancer diagnosis compared to those with non-cancer terminal illnesses, has been largely unsuccessful. 1 Addressing the needs of patients who have terminal illnesses is often complex and covers multiple domains of symptom control, social environment and care, psychological and emotional distress and spiritual care. A variety of ways exist to elicit which areas are important to patients, with multiple quality of life scores available.…”