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25 - Palliative care

from Part III - Working with specific units

Published online by Cambridge University Press:  10 December 2009

By
Matthew Hotopf  and
Max Henderson
Edited by
Geoffrey Lloyd  and
Elspeth Guthrie
Geoffrey Lloyd
Affiliation:
Priory Hospital, London
Elspeth Guthrie
Affiliation:
University of Manchester
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Summary

Context

Palliative care arose as a discipline in the 1960s with the birth of the modern hospice movement. From its earliest origins palliative care championed what has come to be known as a ‘patient-centred’ approach to delivering care. In patients with advanced cancer (who remain the core patient group served by most palliative care services) the focus of care was to improve the quality, rather than the duration, of life. Symptom control – especially pain control – was key to this, but also a new approach to patient care in which the need for open and honest communication of diagnosis and prognosis was emphasized. The naïve view that by failing to inform the dying patient of his predicament, the doctor was somehow protecting him from unbearable distress was challenged. Palliative care also emphasizes the familial, social, cultural and spiritual context in which care is provided, and death and its aftermath are managed. Underpinning this is a multidisciplinary approach to the provision of care, with many hospices employing social workers, chaplains, other spiritual advisers, as well as bereavement counsellors, psychiatrists and psychologists.

Hospices are the most obvious means by which palliative care has been developed; however palliative care is not confined to them. The role of hospices is to provide more than terminal care; admissions may take place months or even years before death, in order to bring troublesome symptoms under control.

Keywords

advanced diseaseanxietydepressiondisturbed behaviourpalliative carepsychiatrists
Type
Chapter
Information
Handbook of Liaison Psychiatry , pp. 592 - 616
Publisher: Cambridge University Press
Print publication year: 2007

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