ABC of palliative care: Principles of palliative care and pain control

doi:10.1136/bmj.315.7111.801

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Bill O'Neill,
Marie Fallon

Introduction

The World Health Organisation defines palliative care as “the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families.”

Palliative care is necessarily multidisciplinary. It is unrealistic to expect one profession or individual to have the skills to make the necessary assessment, institute the necessary interventions, and provide ongoing monitoring.

Principles of palliative care

Palliative care

Affirms life and regards dying as a normal process
Neither hastens nor postpones death
Provides relief from pain and other distressing symptoms
Integrates the psychological and spiritual aspects of care
Offers a support system to help patients live as actively as possible until death
Offers a support system to help patients' families cope during the patient's illness and in their own bereavement

Development of palliative care

Modern palliative care originated in the development of St Christopher's Hospice in London in 1967. Recognising the unmet needs of dying patients in hospital, Dame Cecily Saunders established the hospice and, with others, conceived of a comprehensive approach to dealing with the variety of symptoms and suffering often experienced by patients with progressive debilitating disease. Careful observation of the use and effects of morphine and similar drugs also originated at the hospice.

Dame Cecily Saunders, founder of St Christopher's Hospice. (Reproduced with permission)

Traditionally, hospice care was reserved for those with incurable cancer. Increasingly, care is provided for other patients such as those with AIDS and neurological disorders, including motor neurone disease and multiple sclerosis. When palliative medicine was accorded specialist standing in the United Kingdom, in 1987, the agreed definition was “the study and management of patients with active, progressive, far-advanced disease, for whom the prognosis is limited and the focus …