The palliative approach aims to improve quality of life in all life-limiting illnesses. A palliative approach comes into play when there are transitions in the goals of care from cure to symptom control and supportive care to end of life care. Determining which patients require a palliative approach involves an understanding of the illness trajectory, and helping patients negotiate transitions in the goals of care.
Transitions may be less easy to identify in many chronic condition than in cancer, which has a more predictable trajectory. It has been suggested that advance care planning and a palliative approach are probably appropriate whenever the GP would not be surprised if the patient died within the next twelve months. However, a palliative approach is not limited by prognosis or diagnosis; it should be integrated into the care of all patients with life-limiting illnesses. See the End-of-Life / Palliative Education Resource Centre (EPERC) Fast Fact on advance care planning in chronic disease for guidance on approaching this.
There a several areas to consider when introducing a palliative approach:
- Palliative care is active care. Symptoms should be anticipated and managed pre-emptively whenever possible. The palliative approach is flexible and patient centered, and also attends to the patient’s family and other support networks.
- The focus is on choices; the big picture becomes the most important thing in palliative care - what is important to this person now? And with this prognosis? Prognostic information, given sensitively, allows patients to manage the last phase of their lives and deal with what is most important to them in that context.
- Conversations with patients about their hopes, fears, and wishes allow planning ahead, for both the patient and the care provider. Realistic plans for crises and being clear about the options if things are not going according to plan create a sense of safety and being cared for. Palliative care raises issues for both patients and doctors about what makes sense when confronted with the inevitability of death.
This page was created on 26 March 2007 and is due for review in March 2009