Definition and aims of palliative care

The end of a human life due to a life-limiting illness is generally characterised by progressive physical change and decline, and very commonly a period of disruption to the social, psychological, emotional and spiritual aspects of life for the patient and their family. Palliative care is the active, holistic care of a person during this phase of deteriorating health.

The World Health Organization defines palliative care as an approach that improves the quality of life for patients and their families facing problems associated with life-limiting illnessWorld Health Organization (WHO). It prevents and relieves suffering by early identification, correct assessment and treatment of pain and other problems—physical, psychosocial and spiritual.

Palliative care aims to:

  • provide relief from pain and other distressing symptoms
  • affirm life and regard dying as a normal process
  • neither hasten nor postpone death
  • integrate the psychological and spiritual aspects of patient care
  • offer a support system to help patients live as actively as possible until death
  • offer a support system to help the family cope during the patient’s illness and in their own bereavement
  • use a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
  • enhance quality of life, and if possible, positively influence the course of illness.

Good palliative care is not different from good clinical practice in any field—it includes:

  • holistic patient assessment (of both the physical and psychosocial dimensions of need)
  • drug therapy and other interventions tailored to the patient
  • regular review to ensure care is adapted to the changing needs of the patient and their family as death approaches.
The aspects of palliative care are summarised in Principles of palliative care.

Deciding to integrate a palliative approach reflects a recognition that the goals of care are shifting from managing disease and prolonging life towards optimising the quality of remaining life; it acknowledges that intensive efforts to prolong life are unlikely to be beneficial and may not be wanted by the patient.

Figure 1. Principles of palliative care.

[NB1] [NB2] [NB3]

Collaborate with, and define the roles and responsibilities of, clinicians, services, families and carers. Consider whether or when to refer to a specialist palliative care service—see Who provides palliative care?.

Educate the patient and their carer(s) about the prognosis, if appropriate—see Overview of communicating with and supporting patients with palliative care needs.

Discuss the patient’s preferences, values and goals of care initially and continue to review.

Support early and ongoing advance care planning including discussion of resuscitation and hospitalisation.

Identify and support emotional and psychosocial needs.

Anticipate and plan for transitions across various settings, and acknowledge patient and family preferences—see Where is palliative care provided?.

Create and maintain an individualised disease management plan to address current health problems and those expected to arise:

Support the family and principal carer.

Support patients and their families and carers experiencing loss, grief and bereavement.

Prepare for the last days of life

Support the family and carers after the patient’s death.

Note:

NB1: It is often appropriate to introduce palliative care from the time it is recognised that a patient has a progressive, life-limiting illness; palliative care can be continued alongside disease-orientated care.

NB2: Aspects of palliative care may need to be introduced or revisited depending on patient and carer needs and the clinical context. The approach and priorities of care often change with the phase of the illness.

NB3: Caring for patients with palliative care needs can be personally and professionally demanding—for further information and advice on building resilience and avoiding burnout, see Healthcare professional wellbeing in palliative care.