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Patients Needing Palliative Care

Many patients have problems that can be helped greatly with a palliative care approach. Important factors to consider when a patient with palliative care needs is identified are:

Who are your palliative care patients?

GPs care for many patients with life-limiting illnesses such as advanced heart or respiratory disease, end-stage renal failure or liver disease, progressive dementia, cancer, or degenerative neurological conditions. Palliative care focuses on quality of life in all life-limiting illnesses where cure is no longer possible. 

Palliative care is not limited to any particular diagnosis or expected prognosis. It is as important for patients who have end-stage organ failure, or frailty and dementia, as it is for those with cancer.

When should palliative care begin?

Think about palliative care any time that the goals of care change. Points of transition include:

  • When cure is not possible - trying to prolong life and maintain quality of life becomes the goal
  • In the later stages, identifying the focus of end-of-life care, where minimising suffering is paramount.

These transitions can be hard to identify in non-malignant diseases. For patients with end-stage organ failure and increasing frailty and dependence, the need for acute hospital admissions may be a signal to reassess the goals of treatment and tailor the treatment approach accordingly.

  GP Tip   TIP - As a rule of thumb, a palliative care approach can be considered if you would not be surprised if this patient died within the next twelve months.

 

Benefits of palliative care

  • Palliative care is active care
    Palliative care is about shifting the goals and focus. Symptoms are anticipated and managed pre-emptively whenever possible, considering potentially reversible conditions and the treatment options. Palliative care also supports the patient’s family and other social networks.
  • Consider the balance between benefits and burdens of treatment 
    In a palliative approach all of a patient’s treatments and investigations should be regularly reviewed from this perspective.
  • Emphasise choices
    The big picture is the most important thing in a palliative approach - what is important to this person now? And with this prognosis? Prognostic information, given sensitively, lets patients manage the last phase of their lives and deal with what is most important to them in that context.
  • Planning ahead 
    Palliative care emphasises the individual’s concerns and the wishes of patients and their family carers when making plans for future care.

 

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This page was created on 26 May 2009.*