Palliative Care Medicine

The traditional belief that “palliative care” implies only hospice and end-of-life care no longer holds true.

Increasingly, palliative care is recognised as being equally important as a service to support patients earlier in the course of a serious or life-limiting illness. This can sometimes be from the time of diagnosis, and patients can sometimes receive care and support from palliative care for many years.

In short, a referral to palliative care should not be feared. It does not always mean that a patient is imminently dying.

In fact, new research has shown that patients with incurable cancer, who are referred to palliative care at time of diagnosis, live longer than patients who just receive conventional oncology treatment from time of diagnosis.

As well as not just being appropriate for patients with cancer, palliative care also has much to offer patients with other illnesses, such as heart failure, chronic lung conditions, (such as COPD and pulmonary fibrosis), renal failure, MND and MS.

Though most people associate palliative care with care at home or in a hospice, in fact, most patients referred to palliative care avail of the service while they are in an acute hospital. Nationally in 2017, 11,500 new patients received palliative care input in the acute hospital setting, compared to 2,700 in hospice and 9,500 in Community Palliative Care.

It is often while in hospital that patients are sickest, and will have the greatest need for the input of the palliative care service to help with complex symptoms, such as pain, nausea, breathlessness, as well as the need for emotional and psychological support. Palliative care also helps to prepare patients for discharge home again from hospital. Research in Ireland has confirmed international research showing that the earlier a patient is referred to the palliative care service during a hospital admission, the better the outcomes, including clinical outcomes and quality of life – in particular, patients seen within a day or two of admission to the hospital had a much shorter length of stay than those patients seen later in their admission.

PAL.M.ED., an initiative developed by Assoc.  Prof. Eoin Tiernan, consultant in palliative medicine, is an early referral programme to palliative care in emergency departments. Results from PAL.M.ED. include a reduction in the average length of stay of over 10 days for patients referred early to palliative care in the ED compared with patients referred later during the course of their admission.

So, the key message is:

Palliative care is not all about dying – it’s about living, with a life-limiting illness, and putting quality at the centre of that time.