INTRODUCTION TO
PALLIATIVE CARE
Alison Humphrey
Clinical Nurse Specialist in Palliative Care, STH
AIMS
 To explore development of Palliative Care
 Definitions
 Where are we now
 Service available and how to access them
HISTORY OF
HOSPICE/PALLIATIVE CARE
PALLIATIVE
CARE
SUPPORTIVE
CARE
END OF
LIFE CARE
MODERN HOSPICE CARE
Influenced by Ciceley Saunders
Separation 1945-1965
Transition 1965-1985
Incorporation 1985 - present
HISTORY OF HOSPICE
Existed in Roman Times – Charitable institutions for travellers
19th century religious influence and opened for care of the dying
PALLIATIVE CARE
PALLIATIVE CARE
SUPPORTIVE
CARE
END OF LIFE CARE
PALLIATIVE CARE
‘Palliative care is an approach that improves the quality of life
of patients and their families facing the problems associated
with life-threatening illness, through prevention and relief of
suffering by means of early identification and impeccable
assessment and treatment of pain and other problems
physical, psychosocial and spiritual’ (WHO, 2002)
Palliative Care should involve holistic care according to NICE
(2004) striving for ‘best quality of life’, ‘applicable earlier in
the course of the illness in conjunction with other treatments’
and ‘to help patients to live as actively as possible until death
and to help the family to cope during the patient’s illness and
in their own bereavement’ (p.20).
SUPPORTIVE CARE
 The emphasis of supportive care is to support patients
and families ‘during treatment and allowing them to live
as well as possible with the effects of the disease’ (NICE,
2004 p.18) and even mentions from diagnosis through
to cure as well as to death and bereavement.
 This would fit with the cancer survivorship, initiative
(DOH, 2007a, 2010); a cancer survivor being :
‘someone who has completed initial treatment and has
no apparent evidence of active disease, or is living with
progressive disease and may be receiving treatment but
is not in the terminal phase of illness, or someone who
has had cancer in the past’ (Corner, 2007).
 Long Term Conditions
END OF LIFE CARE
 End of Life Care Strategy (2008) has the aim of allowing
patients to ‘live as well until they die throughout the last
phase of life and into bereavement’.
 The last phase considered to be last 12 months of life.
 Advanced Care Planning
 Amber Bundles
EMPHASIS ON END OF LIFE
CARE
 One in 10 patients die during their hospital stay
Chris Smyth The Times Published: 19 March 2014
 Liverpool care pathway review shows challenges in
palliative care Melanie Henwood Guardian
Professional, Tuesday 23 July 2013
 Neuberger Report, 2013
 Francis Report, 2013
GENERAL PALLIATIVE CARE
 ‘General palliative care is the level of palliative care
which should be provided by all healthcare professionals,
in primary or secondary care, within their duties to
patients with life-limiting disease’
SPECIALIST PALLIATIVE
CARE
Holistic and multidisciplinary approach
MDT consist of Doctors, Nurses, Social Worker,
Therapists, Chaplain, Complementary Therapies
Provided at the expert level, by a trained, multiprofessional team in order to manage persisting,
sever or complex problems
REFERRAL CRITERIA
UUncontrolled
Complex
Symptoms
Complex
Social Issues
End of Life care
Psychological
Emotional
Issues
Related to
illness
Psychospiritual
Issues
REFERRALS NOT MEETING
CRITERIA
Condition
inactive
and stable
Respite
Chroni
c
Pain
Long term
care
Palliative
Package of
care
SERVICES AVAILABLE IN STH
Hospital Support Team consisting of Consultant, Registrar
and Clinical Nurse Specialists
Macmillan Palliative Care Unit – 18 bedded inpatient unit
Outpatient clinics run by Consultants and Registrars
Community Visits
Complex Case Management
COMMUNITY TEAM SERVICES IN
SHEFFIELD
 Community Specialist Palliative Care Team consisting
mainly of Clinical Nurse Specialists with access to
Consultant and Registrar Support
 St Luke’s Hospice Inpatient Centre – 20 bedded unit
 Therapies and Rehabilitation Centre – Day Care
OUT OF HOURS
 Community – Contact St Luke’s main switchboard.
 STH Palliative Care CNS Team providing seven day, 9-5
service
 STH after 5pm – Contact switchboard who will contact
Registrar on call for Palliative Care
HOW TO REFER
Complete referral form with as
much detail as possible and
urgency
Fax to appropriate number
Send additional information if
felt needed
REFERRAL FORM
REFERRAL FORM
HOW REFERRAL IS PROCESSED FOR
COMMUNITY SERVICES AND INPATIENT
UNIT
Discussion at Daily
Referral Meeting
If accepted,
allocated to
requested
service
Contact made
with patient
If not accepted,
reasons given
Referring Professional
contacted
REFERRAL TO HOSPITAL
SUPPORT TEAM
 Referrals reviewed by Palliative Care CNS
 Referrals prioritised
 Visit ward
REFERENCES
CORNER, Jessica (2007) Making the National Cancer Survivorship Initiative a Reality
powerpoint presentation at Britain against Cancer Conference London
http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/APPG/b
rita accessed
DEPARTMENT OF HEALTH, MACMILLAN CANCER SUPORT AND NHS IMPROVEMENT (2010)
National Cancer Survivorship Initiative (NCSI) Vision. London, Crown
DEPARTMENT OF HEALTH (2008) End of Life Care Strategy - Promoting high quality care for all
adults at the end of life. London, Crown
DEPARTMENT OF HEALTH (2013) MORE CARE,LESS PATHWAY A REVIEW OF THE LIVERPOOL
CARE PATHWAY
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (2004) Improving Supportive and Palliative
Care for Adults with Cancer London, National Institute for Clinical Excellence
Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry
www.midstaffspublicinquiry.com
The AMBER Care Bundle Design Team (2011) www.ambercarebundle.org
WORLD HEALTH ORGANISATION (2002) WHO Definition of Palliative Care
http://www.who.int/cancer/palliative/definition/en/