Palliative care, often confused with end-of-life care, is aimed at improving the quality of life of patients with serious and progressive diseases.
1. Definition and scope of palliative care
According to the IGAS (French Inspectorate General for Social Affairs) the development of HAH (hospital at home services) for patients receiving palliative care has been growing steadily, with the number of stays and days doubling between 2005 and 2008, with a home hospitalization stay ranging from 1 to 146 days, with an average of 42 days.1
Palliative care concerns every field of medicine, without exception. Any doctor may find themselves caring for patients who require a palliative approach.2
Furthermore, patients with non-transmissible (chronic) diseases very often receive palliative treatment.3
The overall care given to the patient is personalized and involves various categories of healthcare professionals. Palliative care is aimed at improving the quality of life of patients with serious and progressive or fatal diseases.4
2. The palliative approach: the issues and challenges
An analysis of 38 studies concerning palliative care identifies numerous associated challenges and, in particular, limited education of general practitioners and increasing palliative care usage, despite limited reimbursement and limited access in certain areas.
Several palliative care models were observed in this same analysis, with variations depending on intervention types and providers, in particular. The publications included in the analysis were categorized by primary non-specialist interventions, specialist provider interventions, and hybrid non-specialist/specialist-provider interventions. The diagnoses included in the analysis were cancer, heart failure, Alzheimer’s disease (or related dementia) and multiple sclerosis.
This analysis demonstrates that there is a growing integration of palliative care services, with, nonetheless, very different care models depending on who provides the care, the diagnosis and the stage of the disease, in particular. In the different studies analyzed, it was also seen that there can be negative perceptions of palliative care, it being wrongly associated with death and hopelessness, resulting in decreased use of palliative care services in some cases. The analysis also mentions the importance of giving doctors and healthcare professionals the necessary training to improve the implementation of palliative care at home.
With life expectancies increasing and chronic diseases becoming more and more common, creative care management needs to be envisaged, hinged around palliative care. However, more studies are required to further improve palliative care models5
- Note méthodologique et de synthèse documentaire « Comment améliorer la sortie de l'hôpital et favoriser le maintien à domicile des patients adultes relevant de soins palliatifs ? [Methodological note and document synopsis “How to improve hospital discharge and help keep adult patients requiring palliative care at home?”], HAS, June 2016.
- Morel Vincent, « Les soins palliatifs : une spécialité ? » [“Palliative care: a specialisation?”], in: Dominique Jacquemin éd., Manuel de soins palliatifs. Paris, Dunod, « Guides Santé Social », 2014, p. 1139-1145. DOI: 10.3917/dunod.jacqu.2014.01.1139.
- Mechler K, Liantonio J. Palliative Care Approach to Chronic Diseases: End Stages of Heart Failure, Chronic Obstructive Pulmonary Disease, Liver Failure, and Renal Failure. Prim Care. 2019;46(3):415-432. doi:10.1016/j.pop.2019.05.008
- Daire R, Donabédian H, Tambouras V, Sagot C. Qualité de vie en soins palliatifs [Quality of life in palliative care]. Soins Gerontol. 2019;24(139):25-27. doi:10.1016/j.sger.2019.07.006
- Beasley A, Bakitas MA, Edwards R, Kavalieratos D. Models of non-hospice palliative care: a review. Ann Palliat Med. 2019; 8(Suppl 1): S15-S21. doi:10.21037/apm.2018.03.11