Analysis

Palliative care from diagnosis to death

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j878 (Published 27 February 2017) Cite this as: BMJ 2017;356:j878
  1. Scott A Murray, professor1,
  2. M Kendall, social scientist1,
  3. G Mitchell, professor of general practice and palliative care2,
  4. S Moine, general practitioner3,
  5. J Amblàs-Novellas, geriatrician4,
  6. K Boyd, honorary senior clinical lecturer1
  1. 1Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  2. 2Faculty of Medicine and Biomedical Science, University of Queensland, Brisbane, Australia
  3. 3Health Education and Practices Laboratory, Amiens University Hospital, Amiens, France
  4. 4Geriatric and Palliative Care Department, University of Vic, Barcelona, Spain
  1. Correspondence to: S A Murray Scott.Murray{at}ed.ac.uk

Evidence is growing that people can benefit from palliative care earlier in their illness, say Scott Murray and colleagues, but care must be tailored to different conditions

Many people still associate palliative care with care in the terminal stage of cancer, and patients with cancer remain more likely to receive it than those with other illnesses.1 It is often delayed until the last weeks or days of life once the illness is advanced and disease focused treatments are no longer effective. However, late palliative care is a missed opportunity to do better for patients, families, and health services. In high income countries, up to 80% of people who die could benefit from palliative care much earlier in their illness.2

The World Health Organization adopted a resolution on early palliative care in 2014. It states that palliative care should be considered from diagnosis onwards and integrated into care for people with any condition that means they may die in the foreseeable future.3 Palliative care can improve the quality of life of patients and their families through timely identification of deteriorating health, holistic assessment of needs, management of pain and other problems (physical, psychosocial, and spiritual), and person centred planning of care.

By embracing the principles of palliative care in their routine practice, clinicians can meet the multidimensional needs of people with deteriorating health more effectively. Palliative care specialists can provide support, training, additional advice, and direct involvement in more complicated or unstable situations.4

What is the evidence for early palliative care?

Randomised controlled trials and other studies show multiple benefits from early palliative care. A landmark randomised trial comparing standard care with outpatient specialist palliative care integrated with oncology for patients with advanced or metastatic disease improved quality of life and, for some people, longevity.5 Further recent trials and a systematic review report …

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