Palliative care aims to improve patient and relative quality of life, and this can be supported by helping them to identify and draw on their internal, external, community and society-based resources. For today’s blog, Prof. Mathieu Bernard tells us about the ‘resource oriented’ approach which can complement palliative care practice.
The World Health Organization’s definition of palliative care focuses on the identification and treatment of health problems in the physical, psychosocial and spiritual domains – a deficit-oriented (what is missing and what is needed) approach, aimed at identifying and resolving physical symptoms, psychosocial and spiritual issues, and thus relieve suffering. However, recent research shows that patients’ and families’ quality of life improves more significantly and sustainably if the treatment also builds on enhancing the patients’ and relatives’ identified resources – a resource-oriented approach, which can be seen as a necessary complement to the deficit-oriented one. This approach is in line with the focus on patient autonomy and empowerment which characterises palliative care. A resource-based approach is not new in palliative care. It is consistent with the notion of resilience, which has been the subject of much work over the last 20 years in many scientific disciplines, including palliative care (1).
Resources for palliative care patients and families can be classified into four levels: internal (e.g., spirituality, gratitude), external (e.g., family, friends, home environment), community (e.g., caring communities, hospice volunteers), and societal (e.g., health care policies, palliative care availability). The first two levels concern the psychosocial and spiritual care of the individual patients and their significant others. Several studies have shown the importance and efficiency of strengthening patient and family resources such as gratitude or social relations in order to sustainably improve their quality of life. The last two resource levels concern palliative care as a public health issue, which involves creating the necessary political and society-based conditions for delivering palliative care (both through the deficit-oriented and the resource-oriented approach) to all members of the community in an equitable fashion.
To find and encourage these resources, it is necessary to look in depth at interactions between patients, their loved ones, and health care professionals, as well as support on offer from communities and society – a task that could be performed, for example, by a specifically trained social worker. Such support needs to be integrated and planned for within services to support people receiving palliative care, as it could take time to work with people to identify their resources. A resource-based approach also underlines the importance of inter-professionality in palliative care, as resources can be identified and fostered by all domains of care. One example of this interprofessional approach is a current multicentre research project led by the Lausanne Palliative Care Center which focuses on ‘Understanding patient altruism at the end of life’. Altruism is defined here as a personal and intentional interest in improving the wellbeing and welfare of others. The principal investigators of its five subprojects come from five different disciplines: medicine, ethics, nursing, psychology, and sociology, because the multi-faceted nature of resources such as altruism requires the intersection of different perspectives in order to understand the whole picture.
We believe that a resource-based approach to palliative care represents a complementary paradigm which may lead to significantly better quality of life, and clinical results, for patients and families, and should be valued more widely in health care.
1 Monroe, Barbara, and David Oliviere (eds), Resilience in Palliative Care: Achievement in adversity (Oxford, 2007; online edn, Oxford Academic, 17 Nov. 2011), https://doi.org/10.1093/acprof:oso/9780199206414.001.0001.
Links and resources
- An international scientific symposium at the Lausanne University Hospital on Tuesday, 13th June 2023, including esteemed international experts such as Prof. William Breitbart and Prof. Daniel Sulmasy, will highlight research on the diverse array of resources in palliative care. Thanks to the support of non-profit foundations, the symposium is free of charge and will be streamed online. Click here to register.
- Read EAPC public health and palliative care blog series here.
About the author
Prof. Mathieu Bernard is Chair in Palliative Psychology at the Palliative and Supportive Care Service of the Lausanne University Hospital (CHUV). In line with the general concept of ‘resource-oriented palliative care’, his main research interest concerns the application of positive psychology to palliative psychosocial care, and this has included research on the meaning in life, gratitude, post-traumatic growth, will to live, and altruism, and he has published extensively on these subjects. ORCID: 0000-0003-2823-8806.
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