Palliative care - hospice and medicine palliative care, treatment, definition

Palliative care may be defined as the active, total care of patients whose disease is no longer responsive to curative treatment. The goal of this care is to achieve the best possible quality of life for patients and their families by controlling physical symptoms as well as recognizing psychological, social and spiritual problems. Death is accepted as a normal process, which should neither be hastened nor postponed and the need to provide a support system for the family in bereavement is also recognized.

Many symptoms suffered in incurable illness have a complex aetiology in which the physical component may be overlaid by psychosocial issues. For such patients considerable input from a multidisciplinary team of specialist palliative care professionals may be needed to resolve the symptoms. There is now good evidence that integration of palliative care and antitumour management early in the course of disease will reduce long-term distress and difficulty in symptom management. This view moves away from the traditional concentration on the provision of palliative care at the end of life.

The most appropriate first step in providing care in complex situations is often to deal with physical symptoms.

Approximately 60% of cancer patients will die in general hospital wards under the care of the physician or surgeon who first diagnosed their tumour, although many are being transferred to hospice care. It is therefore important that every clinician develops some basic skills in symptom control and the ability to recognize those patients who require more specialist intervention. Caring for this group of patients demands detailed attention to alleviating physical symptoms and the establishment of a secure environment for the patient and family to obtain information and support.

The practice of specialist palliative medicine has traditionally been confined to patients with cancer, although most services now cover HIV and AIDS and some of the rapidly fatal neurological diseases. These are all conditions in which the clinical situation is changing rapidly and where difficult symptoms exist. There are undoubtedly patients with non-malignant disease such as end-stage renal or cardiac failure who would benefit from a similar multidisciplinary approach to their care. Expansion of specialist palliative medicine into non-malignant situations is currently being actively considered. The patient-orientated principles of palliative medicine can, however, be usefully applied throughout all medical practice.

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