Palliative care services may contain one or more of the following elements:
- inpatient specialist palliative care units (hospital and hospice)
- community palliative care teams
- hospital palliative care support teams
- day therapy services
- outpatient clinics.
Referrals to palliative care services are made from multiple sources:
- GPs or district nurses
- hospital doctors
- other specialist palliative care teams
- patients themselves or their carers.
Due to the wide spectrum of progressive, life-threatening and incurable diseases, such as cancer, end stage organ failure (cardiac, renal, respiratory, liver disease) or a degenerative neurological disorder, palliative medicine may be part of the overall approach to care, working alongside other specialist services, or it may be the primary approach to care in the later stages of the disease.
Patients should give their informed consent to the referral to specialist palliative care services or if unable to do so, the referral should follow a ‘best interests’ decision (according to the Mental Capacity Act 2005). A referral may be made at any point in the patient pathway if the patient has needs requiring the input of a palliative care physician or specialised level palliative care services.
Key triggers for referral include:
- at diagnosis
- alongside disease modifying treatment, for symptom control or support
- through physical symptoms, psychological adjustment or carers’ needs
- disease progression and discontinuation of disease-modifying treatments
- disease recurrence or relapse where the outlook for the patient has significantly changed
- recognition of the last 12 months of life
- recognition of the last days or weeks of life.
Access to individual NHS and voluntary sector palliative care services inpatient and medical outpatient services are received from:
- primary care and community nursing services
- secondary care – hospital doctors and nurses
- tertiary care such as cancer centres, regional neurological, renal or cardiac services.
Access to individual services:
1 Inpatient care (hospice and hospital specialist palliative care beds)
2 Medical outpatient clinics are provided in hospices, community and hospitals