Clinical Review

ABC of palliative care: Care in the community

BMJ 1998; 316 doi: (Published 31 January 1998) Cite this as: BMJ 1998;316:373
  1. Bill O'Neill,
  2. Ann Rodway

    The physical complexities of progressive and life threatening disease, coupled with attendant emotional and psychological consequences, demand careful coordination between primary, secondary, and tertiary care. Across the whole range of health services, an increasing amount of care is being provided on an outpatient basis or independently of hospitals altogether: most terminally ill patients spend most of their time at home.

    Issues of concern for terminally ill patients

    • Specific symptoms

    • Practical issues

    • Family concerns

    • Social factors

    • Psychological factors

    • Longevity v quality of life

    In the planning of care and agreeing a management plan, patients must be given an opportunity to express their wishes and these must be taken into account. Patients can make valid choices between treatment options only if they know what is happening, what help is available, what is likely to happen, and what help will be available in the future.

    Patients who make advance statements must be made aware that they cannot authorise or refuse in advance what they could not normally authorise or refuse— unlawful procedures such as euthanasia or futile or inappropriate treatment

    It is important to document accurately at each point what a patient's wishes are. Information must be tailored to patients to meet their need for knowledge and given at a pace with which they can cope. Rarely, patients may choose not to be informed. Some patients may wish to complete an advance statement, giving instructions about their wishes in the event of their losing the capacity to decide or to communicate.

    Demands of home care

    Equipment and modifications that may be needed for home care of patients

    Practical equipment

    • Commode

    • Wheelchair

    • Hoist

    • Incontinence supplies

    Medical equipment

    • Syringe driver

    Home modification

    • Hand rails

    • Widening doors

    • Raised toilet seat

    • Bath aids

    • Bed elevator

    • Pressure mattress

    • Nebuliser

    • Stair lift

    • Ramps

    It can be much easier to care for patients in a hospital, hospice, or nursing home because of the infrastructure and immediate support available. Caring for a patient at home presents a challenge, and sometimes …

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