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Murray et al (2002) have produced a timely article highlighting the
plight of a large group of patients treated through the paradigm of
contemporary hospital medicine, and suffering through their ending days as
a result of inadequately prepared Primary Care.
Such patients need skilled practitioners able to apply medical
therapies as well as provide palliative care should the need arise.
However, this leap in care requires several important features:
1.The development of a research base to generate a body of knowledge
with effective strategies for provision of holistic care for such
2.The generation of a research agenda that considers the needs of all
patients with terminal illness (irrespective of diagnosis) and develops
solutions to meet this suffering.
3.The development of an agenda of research and education that
clarifies the attitudes of practitioners towards those dying from non-
malignant causes and generates changes towards the acceptance of
palliative care values for such patients.
4.There is an urgent need to determine how PCTs can channel funds and
resources effectively to maximise benefit to such patients so that the
merry-go-round of home-GP-hospital-home finally becomes one of home-
6.There is an urgent need to determine what is the best way to
provide palliative services for such patients- is it an expansion of
palliative care? does primary care need to expand to take on such work?
are there more effective collaborative approaches appropriately assessed
for quality and cost-effectiveness?
Clearly the agenda for change is immense, and this article forms a
huge step forward in allowing us to understand the perspective of the
patient and their relatives in living and dying with such an awful