Palliative Care: Origins, Principles, and Delivery in Practice

This paper explores the origins and development of palliative care, examining its evolution from Dame Cicely Saunders' pioneering work to its current global recognition. It delves into the key principles of palliative care, emphasizing its focus on symptom management, emotional support, and enhancing quality of life for terminally ill patients. The paper further analyzes the practical delivery of palliative care, highlighting the importance of a multidisciplinary approach, the gold standard framework, and the seven Cs of effective care delivery. By understanding the origins, principles, and practical implementation of palliative care, healthcare professionals can better serve the needs of patients facing life-limiting illnesses.

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Table of Contents
INTRODUCTION...........................................................................................................................................1
1. Demonstrate a thorough understanding of origins and development of palliative care.....................2
2. Principles of palliative care..................................................................................................................3
3. Delivery of palliative care in practice...................................................................................................5
CONCLUSION...............................................................................................................................................6
REFERENCES................................................................................................................................................7
INTRODUCTION
The World Health Organization has defined Palliative Care in 2002 as, “an approach that improves the quality of life of
patients and their families facing the problems associated with life-threatening illness, through the prevention and relief
of suffering by means of early identification and impeccable assessment and treatment of pain and other problems,
physical, psychosocial and spiritual” (Gómez-Batiste, 2012). The origins and development of this modern concept of
palliative care and how it aids in providing a proper care to terminally ill patients will be discussed further through a
thorough understanding of the care principles and their application.

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1. Demonstrate a thorough understanding of origins and development of palliative care
The palliative care is the specialized care provided to people with fatal and terminal illness. Such a care is directed
towards the patients whose disease becomes so advanced that it becomes unresponsive to any curative measure.
In this phase of one’s life the main aim or the primary goal is achieving better quality of life and palliative care strives for
providing it to the patients. Since the curative measures towards the diseases of these people have failed to provide the
cure this palliative care does not aim to cure the illness but, aims to comfort by relieving the pain and distress, both
physical and psychological, of these terminal illnesses to provide a sound remaining period of life they have. It also
provides an emotional support to the patients, families and closed ones in approaching death and healing grief.
The palliative or the hospice care was introduced by Dame Cicely Saunders in 1948, who began her work with the
terminally ill and also worked towards the palliative care and founded the first modern hospice, the St. Christopher’s
Hospice in London in 1967 (Pratt and Wood, 2015).
From 1967 the palliative care has made developments and advances at a rapid pace and it has completely changed the
overall concept of treating the people with illnesses which are life-limiting. An inter-professional and multidisciplinary
approach works to offer a better quality of life to the people dying from a fatal illness by providing a holistic emotional,
physical and spiritual care along with control of pain and symptoms.

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After the establishment of St. Christopher’s Hospice the revolution in care for terminally ill people initiated. The dean of
Yale University, Florence Wald, got influenced with the work of Dame Cicely and after closely observing and learning
about the working of hospice, founded the Connecticut Hospice in Branford, Connecticut in the year 1974. With the
increase in awareness for the palliative care the government initiatives came forward in support of the hospice care
which in 1993 accepted and included it as a part of healthcare continuum (NHPCO, 2016).
The palliative or hospice care facility has expanded into a worldwide movement and has changed the perception of life
ending conditions changing the way healthcare approaches towards such people more towards providing with a
peaceful and calm terminal life. It has helped shifting the care from general towards the specialized end of life care and
provisions directed towards enhancing the life of patients, the cares and the families.
2. Principles of palliative care
The world health organization has also outlines few principles which determine the palliative care provided to the
people. These include:
 Providing relief from pain and distress due to multiple factors like the symptoms of illness or due to an
emotional breakdown from the debilitating disease.
 Regarding death and process of dying as a normal- it emphasizes on making the people and related closed ones
understand that death is a process that happens to every living being and living the rest of the period of life
qualitatively is of key importance. The strong emotional support palliative care provides help people tackle the
situation in a better and positive manner.

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 Providing the symptomatic care to comfort and doesn’t intend to hasten or postpone death process- the
palliative care is completely focused on providing care and not the cure. Comforting the patients to relieve the
symptoms they are experiencing is crucial for this care.
 Providing a complete care by integrating spiritual and psychological aspects
 Providing an active support system to the patients and family to cope up during the process
 Providing and using a multidisciplinary approach for addressing all the needs- a multidisciplinary team work can
only provide the best of the care as the palliative care is a multidimensional care which cannot be attained with
the help of a single functioning unit. Palliative care is a shift from general towards specified care ( Quill and
Abernethy, 2013).
 It aims towards enhancing the life quality of the patients.
 The applicability of this care is during the early course of illness along with the other therapeutic measures that
are intended to prolong life and investigating the illness for a better understanding to manage and deal with
symptoms and distressing complications.
The principles of palliative or hospice care helped in enhancing the life quality of the people with debilitating diseases. It
emphasized on the special needs and care required by these people and providing them with a total care which covers
all the care dimensions providing them with a satisfying way of living these crucial days of their lives. The advances and
research in management of pain and distress and control of the complications arising due to symptoms has facilitated in
providing a better care to the people through this palliative medicine approach.
The principles are devised such that they focus on overall development of establishing a healthy environment for the
patients and their closed ones to help them deal with the physical as well as the emotional and psychological impacts
such life limiting conditions have (Radbruch, and Downing, 2010).

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3. Delivery of palliative care in practice
The delivery of proper palliative care in practice is important once the principles are understood by the care providers
and hospice care authorities.
A death dominated by fear, poor emotional support and improper care and medicinal support is directly a failure of the
medical system and negligence on its part. Enabling a proper care delivery system is mandatory to provide the required
care services helping the patients in having a peaceful terminal period of their life and managing the emotional
disturbances the patients and their families go through.
To accomplish this sufficient and best possible delivery of care the healthcare systems providing care to terminally ill
patients have devised a standard approach towards care in order to maintain the consistency and best of the possible
care and support to these people. This is termed as the gold standard framework of care which includes all the criteria to
provide a better service and care to patients having a limited span of their lives.
The care is delivered equally following the gold standard to each and every patient nearing their end. The effective
delivery of care can only be accomplished when a proper assessment is done and the assessment part is composed of
three processes, the identification of eligible patients, assessing their needs and planning towards providing a more
proactive care to them.
The palliative care when follows the gold standards delivers the care by providing symptomatic relief to the patients,
their choices regarding the kind of living environment they chose to live in and place they want to spent their last

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moments of life are considered, a supported care with better facilities and lesser crises, and by making the care
providers and patients feel supported and satisfied.
The seven Cs or C7 that is: Communication, Coordination, Control of symptoms, Continuity and out of hours, Continued
learning Cover support and Care in the dying phase are considered as most important in accomplishing the better care
delivery (Shaw et al., 2013).
Following the protocols of the proposed gold standard framework with every patient in need aids in providing medical
and emotional support and care to the vulnerable patients and their families assuring a satisfied terminal period of their
lives with a better living and improved quality of life.
CONCLUSION
Understanding the importance and specific needs of people with terminal illnesses brought about a revolutionary
change in healthcare and medical system. A more specialized and focused care helped in providing a strong support and
satisfaction to the care seekers and people related to them. The concept of palliative care completely relies upon
providing a holistic care taking the emotional turmoil and physical challenges into consideration and providing the
specific care by establishing communication, psychological support and medicinal approach to diminish the distress.
REFERENCES
 Gómez-Batiste, X., Caja, C., Espinosa, J., Bullich, I., Martínez-Muñoz, M., Porta-Sales, J., Trelis, J., Esperalba, J. and
Stjernsward, J., 2012. The Catalonia World Health Organization demonstration project for palliative care
implementation: quantitative and qualitative results at 20 years. Journal of pain and symptom
management, 43(4), pp.783-794.

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 National hospice and palliative care organization (NHPCO), 2016 (online). Available at:
https://www.nhpco.org/history-hospice-care (last accessed on 10.06.18).
 Pratt, M. and Wood, M., 2015. Art therapy in palliative care: The creative response. Routledge.
 Quill, T.E. and Abernethy, A.P., 2013. Generalist plus specialist palliative care—creating a more sustainable
model. New England Journal of Medicine, 368(13), pp.1173-1175.
 Radbruch, L. and Downing, J., 2010. Principles of palliative care. Guide to pain management in low-resource
settings, p.47.
 Shaw, K.L., Clifford, C., Thomas, K. and Meehan, H., 2010. Improving end-of-life care: a critical review of the Gold
Standards Framework in primary care. Palliative Medicine, 24(3), pp.317-329.