Palliative Care traditionally have been taking care of patients with terminal diseases, whom a comprehensive care in the final phase of life is offered. Perhaps that is the reason why despite to be considered a valuable resource is difficult to release it from a negative connotation: offer something when medicine has already surrendered to death.
A recent publication in New England Journal of Medicine shows how the current conception of Palliative Care is much more extensive and positive covering the management of patients with serious illnesses not always terminals.
Palliative Care is an interdisciplinary specialty (physicians, nurses, social workers, attending religious and other specialists) focusing on improving the quality of life for anyone with a serious illness and their families. It includes different domains both structure and process, focusing on physical, psychological, social, spiritual and cultural aspects, care at the end of life, as well as ethical and legal aspects. This care allows setting specific goals that are individualized to the needs of patients, families and professionals who serve them and provide integrated care without having to give up curative treatments.
This new vision of Palliative Care should go positioning against classical view still deeply rooted in different health systems offer this resource exclusively to terminal patients in which is replaced the curative treatment for palliative one. This current design involves applying these care in the early stages of a serious disease and patients with diseases further than the classics such as cancer patients.
In this article, Kelley and Morrison make several considerations of this new model of palliative care:
– Beyond pain, there are other physical and psychological symptoms suffered by patients with serious diseases and require routine use of instruments validated to be able to diagnose and treat properly, such as anorexia, anxiety, constipation, depression, delirium, nausea, breathlessness and fatigue.
– Spiritual needs of the severely ill patients are common and usually are not covered properly. Although the scientific evidence is still inconsistent, some studies show the effectiveness of these needs, improving the quality of life and reducing unnecessary treatments in some patients.
– Effective communication is one of the key elements in the care of patients with serious diseases. The identification of competences and skills training related to reporting bad news have demonstrated their impact when planning in advance the care and decision making, improving the satisfaction of patients and their families through specific programmes.
– Although Palliative Care have expanded preferably at the level of acute hospitals, it´s required that this resource would be able to be offered through all the levels of care including primary care, home and the community health centers, developing different models of care that allow secure access to that resource.
– Every time there are more patients who can benefit from this multidisciplinary approach as well as to expand cancer patients to other pathologies such as neurological diseases, lung disease, patients with fragility and comorbidity, dementia and even those who independently of the vital prognosis need high loads of care for family members and caregivers.
There are still significant barriers that must be overcome if we want to extend this new discipline such as:
– The need to investigate and invest to demonstrate the potential impact of Palliative Care in adding value to the health care system, improving the knowledge, scientific evidence and cost effectiveness of some specific actions and define target populations for whom should be directed.
– To increase the number of Palliative Care specialists, enabling to meet the actual needs in the different levels of care.
– To include in the basic training of all health workers skills and abilities related to palliative care, especially communication skills.
– A cultural change that allows to adapt the conception of practitioners and the public in general about that specialty.
Expanding Palliative Care to the critically ill patients not always at the end of life may allow to improve the quality of health care for a significant benefit to many more patients, family members and healthcare professionals.
Should we open ICU to Palliative Care?
Dr. Marí Cruz Martín
Head of Intensive Care Unit.
Hospital Universitario de Torrejón