Which patients should receive palliative care?

Anyone with a life-limiting illness can benefit from a palliative approach to their care, regardless of their age, medical condition or place of care.

Patients with advanced cancer are still the most frequent recipients of specialist palliative care services. However, the burden of pain and other symptoms in patients with progressive nonmalignant conditions is often not fully appreciated, and these patients also benefit from palliative care. A palliative approach is increasingly used for patients with progressive organ failure (eg heart failure, chronic obstructive pulmonary disease, chronic kidney disease), progressive neurological conditions (including dementia), the end stages of genetic disorders (eg cystic fibrosis), and those awaiting organ transplants. Disease-orientated care can be continued while integrating a palliative approachLynn, 2003.

A palliative approach to care is also applicable for patients with acute severe illnesses or injuries who are not expected to recover. These patients are often treated with life-sustaining measures initially while their condition is assessed; however, once it is confirmed that life-prolonging treatment is not beneficial or desired, and after discussions with the patient and their family, the goals of care shift. Withdrawal of life-sustaining measures in these patients can result in rapid deterioration; adopting a palliative approach or referral to a specialist palliative care service can improve symptom management for the patient and provide support for the family.

For condition-specific advice on integrating palliative care for common life-limiting illnesses, see:

• cancer
• dementia
• heart failure
• chronic kidney disease
• chronic liver disease
• motor neurone disease
• Parkinson disease
• chronic respiratory disease.