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. Palliative care:
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope with the patients' illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
will enhance the quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO’s definition of palliative care appropriate for children and their families is as follows; the principles apply to other pediatric chronic disorders (WHO; 1998a):
Palliative care for children is the active total care of the child's body, mind, and spirit, and also involves giving support to the family.
It begins when the illness is diagnosed and continues regardless of whether or not a child receives treatment directed at the disease.
Health providers must evaluate and alleviate a child's physical, psychological, and social distress.
Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
It can be provided in tertiary care facilities, in community health centers and even in children's homes.
Hospice or palliative care services in the community are now a decade old. There has been progressing over the years. However, coverage of those who need such care is estimated to be only about 10%. We do have a long way to go to achieve what has been done in this part of the world – coverage of 66% in Singapore and 80% in New Zealand.
The need for palliative care is set to increase as the population ages and chronic disease become the norm. It is estimated that in relation to cancer currently there are about 25,000 patients who need such care and in terms of dedicated beds needed we have less than a hundred when we require 1000.
Palliative care should be available as a seamless care (home or in-patient) utilizing services run by the public hospitals and the NGO’s and expanded to cover the whole country. In addition, out of town areas can be brought into this network through the Rural Health Services which have a good infrastructure covering much of the country.
The scope of care Includes patients of all ages with the life-threatening illness, conditions or injury requiring symptom relief from physical, psychosocial and spiritual suffering.
The timing of palliative care Palliative care should ideally begin at the time of diagnosis of a life-threatening condition and should continue through treatment until death and into the family’s bereavement. Patients with distress should be managed in a timely manner so as to shorten the duration of suffering.
Patient and family centered care The patient and family constitute the unit of care which should be managed as a whole. Goals of care should be determined by the patient and family after the healthcare team has provided relevant information and guidance to enable decision-making.
Holistic care Palliative care must endeavor to alleviate suffering in the physical, psychological, social and spiritual domains of the patient in order to provide the best quality of life for the patient and family.
Multidisciplinary care Due to the holistic nature of palliative care, a multidisciplinary team approach is essential to address all relevant areas of patient care. Care may also cut across to mainstream disciplines such as surgical or oncology teams where active interventions may still remain relevant in order to alleviate symptoms in patients. Palliative Care Services Operational Policy 49.
Effective communication Good communication skills are essential tools in palliative care and healthcare providers must develop this in order to provide effective palliative care. This includes effective listening, providing information, facilitating decision making and coordinating care among the patient, family and other healthcare providers.
Knowledge and Skills Palliative care is active care and requires specific management for specific conditions. Healthcare providers have a responsibility to acquire proper knowledge and skills in order to deliver effective palliative care and maintain patient safety. Knowledge and skills in disease processes and prognostication are essential in order to determine management plans and set goals of care.
Seamless care Palliative care is integral to all healthcare settings (hospital, emergency department, health clinics and homecare). Successful palliative care is dependent on the existence of a system integrating care across all settings in order to provide continuity of care for the patient and an effective support system from hospital to home. Patients and families should be provided with a care plan on how to obtain help in a crisis at anytime in any place in a timely fashion.