Palliation in Chronic Illness

Palliation' is the term used for the care provided by health professional for patients with terminal conditions. Palliative care aims to alleviate symptoms of disease process that affect a patient's ability to live a satisfactory life, within the limitations of the condition. This places quality-of-life patient issues firmly at the centre of the decision-making processes regarding treatment. In recent times, this palliative care approach has significantly focused on patients with terminal cancer. However, it has now been recognised that this approach can be extended to the broader context of life-limiting chronic conditions. In fact, palliative care should not be associated exclusively with terminal care, since patients may require this care on diagnosis of the condition and well before the terminal phase (Costello, 2004). Johnston (2005, p. 3) informs that 'all life-threatening illnesses'be they cancer, neurological, cardiac or respiratory diseases'have implications for physical social, psychological and spiritual health, for both the individual and their family'. Broadening the scope of practice in palliative care is therefore necessary to enable care for all patients with life-limiting illnesses. Palliative care is a holistic patient-centred approach aimed at meeting the individual needs in the context of the setting. It is therefore important that nurses develop an understanding of their role within palliative care in the community, acute care, hospices and aged care areas. This chapter will provide the student with a brief overview of the historical development of palliative care. Discussion will then focus on contemporary issues and challenges to providing care for patients with cancer and other life limiting illnesses. The management of chronic illness is often complex and poly-symptomatic; individual planning is therefore a crucial component for successful nursing intervention. Two clinical case studies will be used to display examplehow philosophy and practice principles come together to guide care. These principles ensure that a holistic patient-centred palliative approach is underpinned by core skills throughout the chronic illness trajectory. To be successful, this approach requires a collaborative approach by a multi-professional team, which also includes doctors, allied healthcare disciplines, community support groups and, increasingly, complementary and alternative health practitioners. Each team member will be guided by the same underlying principles of care but will have a unique role to fulfil in order to meet the needs of the patient. The multi-professional team approach will be utilised in the case studies to show how key players can be incorporated into and effective plan of care.