Palliative and End of Life Care
What is Palliative Care?
Palliative care is part of supportive care. It embraces many elements of supportive care. It has been defined by The National Institute for Clinical Excellence (NICE) as follows:
Palliative care is the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments.
Palliative care aims to:
- Affirm life and regard dying as a normal process
- Provide relief from pain and other distressing symptoms
- Integrate the psychological and spiritual aspects of patient care
- Offer a support system to help patients live as actively as possible until death
- Offer a support system to help the family cope during the patient’s illness and in their own bereavement.
Who Provides Palliative Care?
Palliative care is provided by two distinct categories of health and social care professionals:
- Those providing the day-to-day care to patients and carers: in their homes, in hospitals, in care homes.
- Those who specialise in palliative care (consultants in palliative medicine and clinical nurse specialists in palliative care)
Those providing day-to-day care should be able to:
- Assess the care needs of each patient and their families across the domains of physical, psychological, social, spiritual and information needs
- Meet those needs within the limits of their knowledge, skills, competence in palliative care
- Know when to seek advice from or refer to specialist palliative care services
Specialist Palliative Care Services
These services are provided by specialist multidisciplinary palliative care teams and include:
- Assessment, advice and care for patients and families in all care settings, including hospitals, at home and care homes.
- Specialist in-patient facilities (in hospices or hospitals) for patients who benefit from the continuous support and care of specialist palliative care teams
- Intensive co-ordinated home support for patients with complex needs who wish to stay at home.
This may involve the specialist palliative care service providing specialist advice alongside the patient’s own doctor and district nurse to enable someone to stay in their own home.
Many teams also now provide extended specialist palliative nursing, medical, social and emotional support and care in the patient’s home, often known as ‘hospice at home’
- Day care facilities that offer a range of opportunities for assessment and review of patients’ needs and enable the provision of physical, psychological and social interventions within a context of social interaction, support and friendship. Many also offer creative and complementary therapies.
- Advice and support to all the people involved in a patient’s care.
- Bereavement support services which provide support for the people involved in a patient’s care following the patient’s death.
- Education and training in palliative care.
The specialist teams should include palliative medicine consultants and palliative care nurse specialists together with a range of expertise provided by allied health professionals such as physiotherapists, occupational therapists, dieticians, pharmacists, social workers and those able to give spiritual and psychological support.
End of Life Care
What is End of Life Care?
The Department of Health (2008) Strategy for End of Life Care defines end of life care:
End of life care helps those with advanced, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patients and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support.
- End of life is described as the last 6 – 12 months of life
- The strategy aims to improve end of life care for all regardless of diagnosis and place of care