Background to Palliative Care
Palliative Care is an area of healthcare provision which is gathering increasing prominence in recent years. The World Health Organisation (WHO) defines Palliative Care as an approach that improves the quality of life of patients and their families facing the problems 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.
Since 1990, with the WHO publication of “Cancer Pain Relief and Palliative Care”, the WHO has advocated 4 pillars of cancer control, which are Cancer Prevention, Early Detection, Cancer Therapy and Palliative Care. Particularly in developing countries where 80% of cancers are diagnosed late in the course of the disease when cure is unlikely, the WHO advocated that countries allocate resources for the provision of palliative care. Even in developed countries such as the USA, the American Society Clinical of Oncology (ASCO) in 2012 recommended that all patients with metastatic cancers be referred for palliative care at diagnosis, concomitant with standard oncologic therapy.
More recently in May 2014, the annual meeting of WHO health ministers in Geneva at the World Health Assembly passed a resolution* calling on WHO member states to work to integrate palliative care into national healthcare systems. All the health ministers from the WHO member states are expected to report on the progress in this area at the 2016 World Health Assembly.
With its emphasis on pain relief and symptom control, as well as psychosocial support for the patient and family, palliative care plays a vital role in the relief of suffering in patients with advanced diseases, such as end-stage heart, lung, kidney and liver failure, as well as advanced cancer. Palliative Medicine is a recognised specialty or sub-specialty in most developed countries, such as the UK, Australia, Canada, the USA, Hong Kong and Singapore. A public health approach to the provision of palliative care is advocated, so that such care may reach patients at home in rural as well as urban communities. Yet centres of excellence in teaching hospitals are also needed to provide training and tertiary referral support.