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 SUPPORTIVE END OF
CARE CARE 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 END OF LIFE CARE

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, multi-professional

team in order to manage persisting, sever or complex
problems
REFERRAL CRITERIA

UUncontrolled
Complex
Symptoms Complex Social Issues

End of Life care

Psychological Psychospiritual
Emotional Issues
Issues
Related to illness
 REFERRALS NOT MEETING
CRITERIA
Condition
inactive
Respite
and stable

Chroni
c
Pain
Palliative
Long term Package of
care 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
REFERRAL FORM
REFERRAL FORM
HOW REFERRAL IS PROCESSED FOR
COMMUNITY SERVICES AND INPATIENT
UNIT
 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/brita
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/