- → there is no one right or wrong model for the provision of palliative care
- → the best model is determined by local needs and resources, in consultation with the local health care providers and authorities
- → IAHPC believes that each developing country should be encouraged and enabled to develop its own model of palliative care, appropriate to the needs of the local patients and the available resources, taking advantage of the experience and expertise accumulated in developed countries, and not be expected to copy models more appropriate to affluent countries
Types of Care: the meaning of "Palliative"
It is important to differentiate
- → palliative care principles which apply to all care, whatever the disease suffered by a patient
- → palliative techniques or therapies include medical and surgical therapies (e.g. stenting, paracentesis, internal fixation of fractures and radiotherapy) that are employed to palliate symptoms and ease suffering but are only a small part of the spectrum of care known as palliative care
- → specialist palliative care in some countries is practised in units operated exclusively for palliative care by doctors and nurses who are accredited specialists in palliative care. Whether such specialisation is important or essential is something that can only be debated in the context of national needs and resources.
Models of Care
Palliative Care Services operate in one or more of the following ways, reflecting local practice and needs, but there is no "right" or "wrong" type of service.
In-patient beds
- → an in-patient palliative care unit may be part of a hospital or an independent free-standing unit
- ☛ a hospital unit may be either a special ward within the hospital or a separate unit built in the hospital grounds
- ☛ a free-standing unit is physically separate from the hospital, but should still be able to access its staff and services
- → patients may be admitted for
- ☛ symptom management (physical or psychosocial)
- ☛ terminal care
- ☛ short duration rehabilitation/convalescence
- ☛ to provide a period of respite for family carers
- → in the UK, most units have few beds (6-30), an average length of stay of 2 weeks or less, and a discharge rate of 40-60%
- ☛ these figures vary greatly around the world and depend on local needs and resources, and the relationship to other services
Community services
- → there are various models for community based palliative care services
- ☛ services providing specialist advice and support for the family doctors and community nurses managing the patients
- ☛ services providing "hands-on" nursing and allied health services to patients at home, in co-operation with the patient’s own doctor
- ☛ comprehensive services providing medical, nursing and allied health care to patients and their families at home
Day Units
- → known as Day Care, Day Hospice, Day Palliative Care Unit
- → usually form part of a hospital or in-patient palliative care unit
- → provide care, rehabilitation, support and respite during the day for people under care at home, who are still well enough to be transported to and from the Day Care Unit, often by volunteer transport
Hospital Palliative Care Teams
- → operate in general and specialist hospitals
- → are staffed by doctors and palliative care nurses
- ☛ some also have a social worker or a pastoral care specialist
- → provide consultative advice on patients referred to them in any department of the hospital
- ☛ to advise on every aspect of palliation
- ☛ provide support for family member
- ☛ provide support and education for the staff
- → facilitates the provision of high quality palliative care in all wards
- ☛ where the patient is familiar with the staff and surroundings
- ☛ without the need to be transferred to another unit
- ☛ educates the ward staff about matters pertaining to palliative care
Source:
The IAHPC Manual of Palliative Care 3rd Edition
https://hospicecare.com/what-we-do/publications/manual-of-palliative-care/
