Palliative medicine | Medical Care - Guidance for Desiging Services and Developing Physicians for Specialties

Designing services

Specialties

Palliative medicine

Description of specialty

Palliative medicine is concerned with the expert management of people with advanced, progressive or life-threatening disease, including co-existing chronic conditions, to live as well and as long as possible until the end of their natural lives. It focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness. Some palliative care services include supportive, rehabilitative, or end-of-life care in their service name. Palliative medicine is a core medical specialty; all patients in all settings should have access to timely specialist advice or assessment on a 7-day, 24-hour basis. Palliative care physicians may also be involved when life-prolonging treatment is being considered or offered.

Palliative care physicians provide clinical leadership and support to person-centred care based on the needs of the individual and not just their illness. Diagnostic and therapeutic priorities focus on meeting the patient’s goals through joint decision-making with the individual and those important to them. Palliative care physicians work within a multidisciplinary team (MDT) and in partnership with other relevant specialties. Specific medical expertise is demonstrated through:

the assessment and management of physical, psychological and spiritual symptoms and mitigating distress
clinical decision-making and supporting the analysis of complex scenarios when a patient’s clinical and personal interests are finely balanced, and where applying relevant ethical and legal reasoning alongside clinical assessments is paramount
skilled communication and coordination of care, especially at disease transitions and boundaries between care settings
care and support to those important to the patient, including facilitating bereavement care
some palliative care physicians may have a subspecialist disease-specific focus such as cancer/acute oncology, cardiac, renal or neurological disorders
some palliative care teams are offering symptom control and support earlier in the disease trajectory – most often in cancer patients – as ‘supportive care’ or ‘enhanced supportive care’.

The Association for Palliative Medicine provides an overview of the specialty as well as the vision and values for the Association.

A revised service specification for specialised level palliative care services (opens PDF, 515KB) for commissioners was published by NHS England in April 2016.

Last reviewed:31/12/2018

Roles of palliative physicians

Palliative care MDTs comprise:

consultants in palliative medicine
nurses specialising in palliative care
other professionals who have specialist experience in providing palliative care services:
- physiotherapy
- occupational therapy
- social care
- spiritual care specialists and psychological services.

In addition, services usually have access to, or shared services provided by, professional groups with specialist knowledge:

dieticians
speech and language therapists
pharmacists
specialists in interventional pain management.

Palliative medicine consultants attend site-specific cancer MDTs and those for long-term conditions, eg some cancer MDTs, chronic obstructive pulmonary disease (COPD), and renal MDTs. They may also join in primary care MDTs such as Gold Standards Framework meetings.

The overlap between ‘direct’ and ‘indirect’ clinical care (the latter through and alongside others) is significant and job specific. Sole consultant responsibility for inpatient care applies only when patients are admitted to specialist palliative care beds in hospital or a hospice. In community care, the responsibility is shared with the GP. Most other clinical care is a mixture of direct or joint assessment followed by advice on symptomatology, assistance with complex decision-making or availability for case conferences and multidisciplinary meetings. Outpatient work is frequently either joint or alongside other specialties.

Palliative care MDTs work across care settings and boundaries and many physicians hold joint NHS and voluntary sector employment contracts and cover patients in the community, residential facilities and acute hospitals simultaneously.

Palliative care physicians develop and deliver strategies for education and training, especially those for end-of-life care. Most are engaged with planning and development for service provision for the local population. Service configurations for palliative care delivery cross health and social care, the statutory, voluntary and commercial sector and may be very complex. Consultant physicians advise on strategic planning, development, evaluation and commissioning of such services. The place of palliative medicine in the wider community is set out clearly in Ambitions for Palliative and End of Life Care: A national framework for local action 2015–2020 published in September 2015 by the National Palliative and End of Life Care Partnership.

Last reviewed:31/12/2018