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Death should simply become a discreet but dignified exit of a peaceful person from a helpful society—without pain or suffering and ultimately without fear.
PHILIPPE ARIÈS 1977
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To enable a person to live in dignity, peace and comfort throughout their illnesses means responding to physical, psychological, emotional, social and spiritual needs.1
E FAIRBANK, T BANKS, PALLIATIVE CARE: THE NITTY GRITTY HANDBOOK, 1993
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Palliative care is comprehensive, continuing, multidisciplinary patient care that involves the patients and their carers, consultants, domiciliary nurses, social workers, clergy and other health professionals who are able to contribute to optimal team care.
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The fundamental principles of palliative care are:2
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good communication
management planning
symptom control
emotional, social and spiritual support
medical counselling and education
patient involvement in decision making
support for carers
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Palliative care applies not only to incurable malignant disease but also to several other diseases, such as end-stage organ failure (heart failure, kidney failure, respiratory failure and hepatic failure) and degenerative neuromuscular diseases. Thirty per cent of the population will die from cancer.
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THE SPECIAL ROLE OF THE FAMILY DOCTOR
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The GP is the ideal person to manage palliative care for a variety of reasons—availability, knowledge of the patient and family, and the relevant psychosocial influences. A key feature is the ability to provide the patient with independence and dignity by managing palliative care at home. Someone has to take the responsibility for leadership of the team and the most appropriate professional is a trusted family doctor.
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Most patients and their families require answers to the following six questions.3
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Caring honesty is the best policy when discussing the answers to these questions with the patient and family. Never lie to a patient and always avoid thoughtless candour.
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SUPPORT FOR PATIENTS AND CARERS
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Studies have indicated that the most common complaints of patients are boredom and fear of the unknown. This highlights the importance for the attending doctor of the following points.
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Give emotional support.
Listen and be receptive to unexpressed ‘messages’.
Treat the sufferer normally, openly, enthusiastically and confidently.
Show empathy and compassion.
Employ good communication skills.
Give honest answers without labouring the point or giving false hope.
Provide opportunities for questions and clarification.
Show an understanding of the patient's needs and culture.
Adopt a whole-person approach: attend to physical, psychosocial and spiritual needs.
Anticipate and be prepared for likely problems.
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These next special points are worth emphasising.
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