Dr Fliss Murtagh, Clinical Senior Lecturer and Consultant in Palliative Medicine, Cicely Saunders Institute, King’s College London, UK.
Just three days ago in Lleida at the 8th EAPC World Research Congress, we were challenged and inspired by Professor David Currow’s outstanding plenary presentation.
What challenges did he present? First, that we don’t systematically define and understand our patient population. And second, that we don’t routinely capture the difference we make for patients and families. And what were his recommended solutions? To make better use of routine administrative and clinical data to understand the whole population; and to measure patient-centred outcomes for all those we see.
To me, a specialist palliative care team has four defining characteristics: first, that palliative care is the core part of their daily work, second that it is skilled and expert, third that it is multi-disciplinary, and fourth that it provides both direct and indirect care; ‘direct’ care to patients and families, and ‘indirect’ care by supporting other professionals in their delivery of care. Professor Currow made the point that, around the different countries of the world, those who receive specialist palliative care vary considerably – from none in those countries with little or no provision, to larger proportions in those countries with established services. Not only does the population receiving specialist palliative care vary, but the population who receives ‘generalist’ palliative care (with or without ‘indirect’ input from specialists) varies even more widely! So, as Professor Currow proposes, we need to regain a ‘whole population’ perspective. We need to look at all those who die or all those living with advanced illness, and not just the ‘lucky few’ who get high-quality specialist palliative care.
We also need to ask what difference palliative care makes, if any, to the health of the whole population. In illustration, he quoted a study of bereaved spouses who themselves had improved survival following palliative care. This takes us beyond the ‘narrow’ impact on the patient and family in front of us, into the wider impact of palliative care on the health of society. So maybe as well as being a core part of daily work, expert in palliative care, multi-disciplinary, and providing direct/indirect care, a specialist palliative care team should also have a fifth characteristic – that of making a significant impact on the health of the community, an impact which is both measurable and, at the same time, actually measured.
Find out more…
- You can read two posts by Professor David Currow on the EAPC Blog: Developing research methodologies that can reliably examine the quality of end of life care and Uncovering an invisible network of direct caregivers at the end of life: a population study (selected as Palliative Medicine’s 2013 Paper of the Year award).
- Cicely Saunders Institute, King’s College London.