Palliative Care – Introduction
What is Palliative Care?
- Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
- Click here for the WHO definition of palliative care
Why is a Basic Understanding of Palliative Care Essential?
- Palliative care is often associated with cancer and end of life care, however many chronic conditions can be life threatening and result in symptom burden e.g. end-stage heart failure, renal failure and neurological conditions such as motor neurone disease, multiple sclerosis and dementia. As a doctor you will be managing patients with many of these conditions and adopting a holistic approach will ensure that you provide good balanced medical care, whether this be in the patient’s last few years or days of life.
- During your time on both in hospital and in the community you are also likely to see large numbers of frail elderly patients with complex presentations and past medical histories. These patients are often likely to do badly and it is good practice to identify this early to allow patients and families time to plan for the future and communicate their wishes. The surprise question can be very useful to help with this:
- The surprise question: ‘Would you be surprised if this patient were to die in the next few months, weeks, days?’
What is End of Life?
- People are ‘approaching the end of life’ when they are likely to die within the next 12 months.
- This includes people whose death is imminent (expected within a few hours or days) and those with:
- Advanced, progressive, incurable conditions
- General frailty and co-existing conditions that mean they are expected to die within 12 months
- Existing conditions if they are at risk of dying from a sudden acute crisis in their condition
- Life-threatening acute conditions caused by sudden catastrophic events
- Click here for the Gold Standards Framework definition of end of life
What was the Liverpool Care Pathway (LCP)?
- The LCP was a standardised pathway that was formulated based on best practice and implemented to try and improve standards of care for dying patients in the acute setting.
- In 2013 an independent review into the LCP suggested that though based on gold standards, the pathway was a blunt tool and on occasion being misused and misunderstood by hospital staff (see The Neuberger Report).
- There is currently little national guidance or advice available to medical teams regarding the management of dying patients, however NICE released a draft publication ‘Care of Dying Adult’ in July2015.
- These pages aim to give some advice regarding this though most hospital Trusts will have their own local guidelines.
End of Life Care: a Political Priority
- Following the Mid Staffordshire inquiry multiple reports were published highlighting the importance of improving standards of care across the NHS such as the Francis and Berwick reports. End of life care has subsequently also been identified as a priority by the Care Quality Commission.
- Click here for details on the Mid Staffordshire inquiry
- Click here for UK government advice on patient safety
Perfect analgesia revision for doctors and medical students