Palliative care (from Latin root palliare "to cloak") is an interdisciplinary medical caregiving approach aimed at optimising quality of life and mitigating or reducing suffering among people with serious, complex, and often terminal illnesses.
The World Health Organization (WHO) describes palliative care as:"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".
[citation needed] Rather, a patient-centered model prioritises relief of suffering and tailors care to increase the quality of life for terminally ill patients.
It is ideally provided by interdisciplinary teams which can include physicians, nurses, occupational and physical therapists, psychologists, social workers, chaplains, and dietitians.
Palliative care can be provided in a variety of contexts, including hospitals, outpatient clinics, skilled nursing, and home settings.
[5][6] It is commonly the case that palliative care is provided at the end of life, but it can be helpful for a person of any stage of illness that is critical or at any age.
[4] The overall goal of palliative care is to improve quality of life of individuals with serious illness, any life-threatening condition which either reduces an individual's daily function or quality of life or increases caregiver burden, through pain and symptom management, identification and support of caregiver needs, and care coordination.
[11] Forty million people each year are expected to need palliative care, with approximately 78% of this population living in low and middle income countries.
However, only 14% of this population is able to receive this kind of care, with a majority in high-income countries, making this an important sector to pay attention to.
[13] For some severe disease processes, medical specialty professional organizations recommend initiating palliative care at the time of diagnosis or when disease-directed options would not improve a patient's prognosis.
In 2016 a movement began to extend the reach of concurrent care to adults who were eligible for hospice but not yet emotionally prepared to forego curative treatments.
[33][34] High-certainty evidence supports the finding that implementation of home-based end-of-life care programs may increase the number of adults who will die at home and slightly improve patient satisfaction at a one-month follow-up.
[36] An interdisciplinary palliative care team consisting of a mental health professional, social worker, counselor, as well as spiritual support such as a chaplain, can play important roles in helping people and their families cope using various methods such as counseling, visualization, cognitive methods, drug therapy and relaxation therapy to address their needs.
[38] This is the idea that a patient's experience of total pain has distinctive roots in the physical, psychological, social and spiritual realm but that they are all still closely linked to one another.
[39] Patients at the end of life can exhibit many physical symptoms that can cause extreme pain such as dyspnea[40] (or difficulty breathing), coughing, xerostomia (dry mouth), nausea and vomiting, constipation, fever, delirium, and excessive oral and pharyngeal secretions ("Death Rattle").
As an effect from radiation may take days to weeks to occur, patients dying a short time following their treatment are unlikely to receive benefit.
Pediatric palliative care practitioners receive specialized training in family-centered, developmental and age-appropriate skills in communication and facilitation of shared decision making; assessment and management of pain and distressing symptoms; advanced knowledge in care coordination of multidisciplinary pediatric caregiving medical teams; referral to hospital and ambulatory resources available to patients and families; and psychologically supporting children and families through illness and bereavement.
[18] The general approach to assessment and management of distressing symptoms in children by a palliative care team is as follows: The most common symptoms in children with severe chronic disease appropriate for palliative care consultation are weakness, fatigue, pain, poor appetite, weight loss, agitation, lack of mobility, shortness of breath, nausea and vomiting, constipation, sadness or depression, drowsiness, difficulty with speech, headache, excess secretions, anemia, pressure area problems, anxiety, fever, and mouth sores.
Finally, practitioners are supporting children and families in the queries, emotional distress, and decision making that ensues from the child's illness.
In some countries, this means a growing burden on national resources in the shape of social security and health care payments.
As aging populations put increasing pressure on existing resources, long-term palliative care for patients' non-communicable, chronic conditions has emerged as a necessary approach to increase these patient's quality of life, through prevention and relief by identifying, assessing, and treating the source of pain and other psychosocial and spiritual problems.
In some countries, additional members of the team may include certified nursing assistants and home healthcare aides, as well as volunteers from the community (largely untrained but some being skilled medical personnel), and housekeepers.
In the United Kingdom palliative care has been a full specialty of medicine since 1989 and training is governed by the same regulations through the Royal College of Physicians as with any other medical speciality.
These include fair access to end of life care for everyone regardless of who they are, where they live or their circumstances, and the need to maximise comfort and wellbeing.
Physicians practicing palliative care do not always receive support from the people they are treating, family members, healthcare professionals or their social peers.
They found that due to the lack of resources within both mental health and end of life services people with SMI's faced a number of barriers to accessing timely and appropriate palliative care.
[112][113] A review states that by restricting referrals to palliative care only when patients have a definitive time line for death, something that the study found to often be inaccurate, can have negative implications for the patient both when accessing end of life care, or being unable to access services due to not receiving a time line from medical professionals.
[127][128] Other research suggests that giving nurses and pharmacists easier access to electronic patient records about prescribing could help people manage their symptoms at home.
[129][130] A named professional to support and guide patients and carers through the healthcare system could also improve the experience of care at home at the end of life.
[131][132] A synthesised review looking at palliative care in the UK created a resource showing which services were available and grouped them according to their intended purpose and benefit to the patient.