Outpatient clinics

The palliative care outpatient clinic provides an opportunity for other hospital clinicians and GPs and community teams to access advice, in relation to aspects of pain and symptom management or psychological, spiritual and family distress. Generally this is in the context of a progressive illness but sometimes may be in relation to adjustment and rehabilitation including support to those living alongside a chronic illness, particularly cancer. A specialist assessment and management plan is required.

The outpatient appointment offers both patient and carer a longer consultation in which they are enabled to make sense of what has been happening, to explore fears and anxieties for the future and to be supported in making decisions and plans to help them feel more in control. A key area is in relation to advance care planning for the end of life and the exploration of preferences and choices in relation to potential future crises. Palliative care physicians seek to facilitate patient/family engagement with the primary and community teams including local palliative care and hospice services.

Some clinics are run as parallel or joint clinic sessions alongside, for example, oncologists, neurologists, renal physicians or cardiologists. This promotes earlier contact with palliative care and breaks down boundaries for the patient who is struggling to come to terms with his or her prognosis. Palliative care outpatient appointments may also be held in a hospice or community setting; this can provide an initial and non-threatening first contact with the hospice for those who are fearful of the association with dying. An initial consultation, using a holistic needs assessment, can facilitate access to specific services such as managing breathlessness or lymphœdema, counselling, hospice day care and support for the children of those with a terminal illness.

The model for palliative care outpatient clinics is comparable to that for psychiatry in allowing time for skilled listening, reflection with the patient and supported decision-making. Typically a new consultation will take 45–60 minutes; a follow-up 30 minutes.

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