Chapter 72 Palliative care
Development of palliative care
The main pioneer of the hospice (palliative care) movement in the UK was Dame Cicely Saunders, who worked as both a volunteer nurse and a social worker, and later as a doctor, at two of the first London hospices, St Joseph’s and St Luke’s. This experience made her aware of the need for a place of care that would specialize in pain and symptom control in the terminal stages of disease, but that would also provide an environment that would allow people to adjust emotionally and spiritually to their approaching death (Saunders & Sykes, 1993). Her subsequent foundation of St Christopher’s Hospice in London as a centre of excellence in palliative care provided the cornerstone of the modern hospice movement. Its rapid expansion over the past four decades has been accompanied by the recognition of palliative medicine as a medical specialty. It has also become a global movement, with palliative care services available in approximately 100 countries, including the USA, Asia and Africa (Stjernsward & Clark, 2004). These authors estimate that 33 million people currently dying in the world would benefit from a basic palliative-care approach, and this number triples when families and carers are included.
Defining palliative care
Although the advent of hospice care has dramatically improved the care of patients, particularly in the area of pain and symptom control, evidence suggests that these goals are still not being met in every setting in which palliative care is provided. There is, therefore, an increasing drive to make hospice standards of care available for all dying patients and not an exception for a small minority. New definitions now distinguish different levels of palliative care according to the setting in which it is provided and the expertise of staff delivering the care, although the number of levels is still being debated. At one level, the palliative-care approach aims to promote both physical and psychosocial well-being as an integral part of all clinical practice, whatever the illness or stage, through a knowledge and practice of palliative care principles (National Council for Hospice and Specialist Palliative Care Services, 1997). At the other end of the spectrum, ‘Specialist palliative care is the active total care of patients with progressive far-advanced disease and limited prognosis, and their families, by a multi-professional team who have undergone recognized specialist palliative care training’ (National Council for Hospice and Specialist Palliative Care Services, 2000). More recently the definition of palliative care has been expanded to include supportive and end-of-life care as the discipline attempts to encompass the whole disease trajectory (National Council for Hospice and Specialist Palliative Care Services, 2002; NICE, 2004; www.who.int/cancer/palliative/definition/en).
