Palliative care is an approach to care focusing on promoting comfort through relieving pain and other symptoms. The aim of palliative care is to enhance the quality of life of those living with life limiting progressive conditions and their families.
Palliative care uses a team approach to address the needs of patients and their families. The team is comprised of doctors, nurses and other specialists who work with persons’ primary doctor(s) to provide an extra layer of support. The disciplines of medicine that may be involved include:
Palliative care is often described in terms of three ascending levels of specialisation.
LEVEL ONE – PALLIATIVE CARE APPROACH
Palliative care principles should be practiced by all
health care professionals. The palliative care approach should be a core skill of every clinician at hospital and community level. Many patients with progressive and advanced disease will have their care needs met comprehensively and satisfactorily without referral to SPC units or personnel. The palliative care approach aims to promote both physical and psychosocial well-being. It is a vital part of all clinical practice, whatever the illness or its stage and is informed by knowledge and practice of palliative care principles.
LEVEL TWO – GENERAL PALLIATIVE CARE
At this level, a proportion of patients and families will benefit from the expertise of health care professionals who, although not engaged full time in palliative care, have had some additional training and experience in palliative care, perhaps to diploma level. This intermediate level expertise may be available in hospital or community settings.
LEVEL THREE – SPECIALIST PALLIATIVE CARE
Specialist palliative care (SPC) services are those services whose core activity is limited to the provision of palliative care. These services are involved in the care of patients with more complex and demanding care needs, and consequently, require a greater degree of training, staff and other resources. SPC services are those services with palliative care as their core speciality and which are provided by an inter-disciplinary team, under the direction of a consultant physician in palliative medicine. SPC services are available in primary care settings, acute general hospital settings and specialist inpatient units (ie hospices).
Who Can Benefit From Palliative Care ?
Palliative care is appropriate at any stage for people with a life limiting illness including advancing neurological illnesses, heart, circulatory and respiratory disease. Palliative Care can be provided with curative treatment. It is not designed to replace treatment; rather it complements the treatment received.
The diagram below indicates some elements of the journey that people may encounter with advancing neurological illness. Depending on the complexity of symptoms Specialist Palliative Care (SPC) input may be required along the journey. However it is important to remember that everyone’s journey is individual and some of the steps on the journey may occur before others and may occur more than once.
When Is Palliative Care Appropriate?
Palliative care is appropriate at any stage from diagnosis of an illness through to the end of life. Using a palliative approach to care enables people to have the highest possible quality of life at whatever stage their illness is at. Palliative care can be provided by all healthcare professionals.
Specialist palliative care services can be accessed if there is uncertainty with regard to the care a person requires and should be provided in partnership with the primary healthcare team.
It is important to remember that specialist palliative care services can be accessed more than once throughout an illness and people may be discharged from specialist palliative care services this can vary on an individual basis.
Understanding of the term ‘end-of-life care’ is not universal. In the Irish Hospice Foundation we use this term to refer to all aspects of the care provided to a person with a life-limiting illness, from the time of diagnosis through the last months of life, up to and including the final hours. We consider 'end of life' to be a continuum rather than a point of time.