The World Health Organization defines palliative care as:
An approach that improves the quality of life of individuals and their families facing the problems associated with life-limiting illnesses, through the prevention and relief of suffering by means of early identification and impeccable assessment and the treatment of pain and other problems, physical, psychosocial and spiritual.
World Health Organization
Palliative care in the Australian context
In alignment with the World Health Organization definition, palliative care in the contemporary Australian context is defined as:
Person and family-centred care provided for a person with an active, progressive, advanced disease, who has little or no prospect of cure and who is expected to die, and for whom the primary treatment goal is to optimise the quality of life.
Palliative Care Australia
Key points in the WHO approach
Underpinning these definitions are the following key points:
Palliative care is about living. It supports people to live their life as completely and as comfortably as possible in ways that are meaningful to them by focusing on:
The intention of palliative care is not to prolong or shorten life but to respect the natural moment of death. End-of-life care is a part of palliative care and refers to the last few days of life when a person is irreversibly dying.[4, 9]
|Quality of life|
Palliative care improves quality of life by focusing on living well with deteriorating health.[3, 5, 10] The following questions can assist to determine which area of their life the person with a life-limiting illness needs help and support with:
Palliative care treats the whole person, rather than just the symptoms of illness, in order to identify personal goals and preferences for care.[3, 5, 7, 8]
Palliative care can assist with a variety of needs:[4, 7, 8, 12, 13]
Psychological and Cognitive Needs
|Supporting families in palliative care|
Family members (or friends) who take on the role of principal carer are often stressed and can benefit from support. This support requires the consent of the person with the life-limiting illness, and can include:
|Prevention and relief of suffering|
Many palliative conditions have complex symptoms and unrelieved symptom issues can have a negative impact on a person’s quality of life. People affected by life-limiting illness frequently experience a myriad of symptoms due to a combination of:
|Early identification and assessment|
Early identification, impeccable assessment and comprehensive management of physical symptoms are central to the provision of high quality palliative care. Even small improvements in symptom management can significantly improve quality of life.[15, 16]
Early palliative care:
People affected by life-limiting illness often have complex and multifaceted needs. In order to be effective, palliative care should be provided by a range of health professionals, trained volunteers, family members and carers.[13, 21, 22] Not all people will need specialist palliative care.
Clinicians who have advanced training in palliative care deliver specialist palliative care services which includes providing direct care to people with complex palliative care needs, and providing consultation services to support, advise and educate non-specialist clinicians who are providing palliative care. [4, 9, 23]
This interdisciplinary approach enables collaborative and person-centred care. This can assist with care goals that are unlikely to be achieved by health professionals when working in isolation.[4, 7-9, 22, 24, 25]
- How do you define quality of life?
- How does your definition compare with those of other students – or your family and friends?
- How can the definition of “quality of life” change for a person as their illness progresses?
- Why is it important for healthcare professionals to understand a person’s own perception of quality of life and how it changes over time?
- The World Health Organization’s (WHO) definition of palliative care states that ‘palliative care’ is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications’.
- Describe what is meant by ‘early in the course of a life-limiting illness’.
- How does the WHO palliative care definition fit with your understanding of palliative care?
- How would you explain what palliative care is to a patient or their family member?
- World Health Organization. Definition of Palliative Care. 2017 [cited 2017 March 13]; Available from: http://www.who.int/cancer/palliative/definition/en/.
- Palliative Care Australia. Palliative Care Service Development Guidelines. 2018; Available from: http://palliativecare.org.au/quality.
- Murray, S.A., et al., Palliative care from diagnosis to death. BMJ, 2017. 356.
- Walbert, T., Maintaining quality of life near the end of life: hospice in neuro-oncology. Neuro-Oncology, 2018. 20(4): p. 439-440.
- Palliative Care Australia. What is Palliative Care A4 Brochure. 2015 [cited 2019 January 23]; Available from: https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2016/05/What-is-Palliative-Care-A4.pdf
- Palliative Care Australia. What is Palliative Care? 2015 [cited 2019 January 23]; Available from: https://palliativecare.org.au/what-is-palliative-care.
- Palliative Care Australia. National Palliative Care Standards. 2018; 5th Edition:[Available from: http://palliativecare.org.au/standards].
- CareSearch. Living with illness: Quality of Life. 2017 [cited 2018; Available from: https://www.caresearch.com.au/Caresearch/tabid/1077/Default.aspx.
- Waller, A., et al., Development of the Palliative Care Needs Assessment Tool (PC-NAT) for use by multi-disciplinary health professionals. Palliative Medicine, 2008. 22(8): p. 956-64.
- Therapeutic Guidelines Ltd, Overview of Palliative Care. 2018: Melbourne.
- CareSearch. Patients’ and Families’ Experience of End-of-Life Care. Clinical Evidence 2017 [cited 2017 August 30]; Available from: https://www.caresearch.com.au/caresearch/tabid/740/Default.aspx.
- Palliative Care Expert Group, Therapeutic Guidelines: palliative care. 4 ed. 2016, Melbourne: Therapeutic Guidelines Limited.
- Therapeutic Guidelines Ltd, eTG complete [Internet]. 2018: Melbourne.
- Higginson, I.J., et al., An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. Lancet Respir Med, 2014. 2(12): p. 979-87.
- Tassinari, D., et al., Early Palliative Care in Advanced Oncologic and Non-Oncologic Chronic Diseases: A Systematic Review of Literature. Rev Recent Clin Trials, 2016. 11(1): p. 63-71.
- Mitchell, G., et al., Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study. BMC Palliative Care, 2014. 13(1): p. 24.
- Sawatzky, R., et al., Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis. Ans. Advances in Nursing Science, 2017. 40(3): p. 263-279.
- Australian Government Department of Health. Understand your end of life care options. [Website] 2017 23 October 2017 [cited 2018 June 26]; Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/understand-your-end-of-life-care-options.
- Rome, R.B., et al., The Role of Palliative Care at the End of Life. The Ochsner Journal, 2011. 11(4): p. 348-352.
- Palliative Care Australia, Background Report to the Palliative Care Service Development Guidelines, prepared by Aspex consulting Melbourne, Editor. 2018.
- Klok, L., et al., Early Identification of Patients in Need of Palliative Care in Slovenian General Practice. Zdravstveno varstvo, 2018. 57(2): p. 55-64.
- Palliative Care Australia. Identifying Palliative Care Needs. 2017 [cited 2018 22/6/2018]; Available from: https://www.caresearch.com.au/caresearch/tabid/1507/Default.aspx.