|
|
Development Rationale Elements |
Lexicon Resources FAQ Miscellaneous |
|
| How to Establish a Palliative Care Program | ||||
 |
||||
Evolution in The United KingdomIn the United Kingdom and Ireland, free-standing inpatient units for the care of the dying developed first. These were developed for patients (predominately with cancer) with difficult symptom and psychosocial problems that could not be met elsewhere in the health care system. Further, these patients were at a stage where treatments directed at the cancer were no longer efficacious. Patients admitted usually had a prognosis of weeks to months. The National Health Service in the United Kingdom and in Ireland is a comprehensive system that provides hospital, nursing home, and home care services that includes home visits by doctors and nurses. Hospice developed to supplement this system. Two things became clear fairly quickly. First, many patients wanted to be able to be cared for at home, and to die at home. To augment the existing home care services, hospices developed home care support teams to consult and assist the general practitioner and district nurses. Second, consultation through office-based and hospital-based consultation teams was needed to bring the expertise developed in the inpatient hospices to patients and families in other settings. In response to the cost of the original inpatient hospices, and the demand for their use, average length-of-stay has declined. While they developed as a place where the dying could live for the rest of their lives, they have evolved into specialized inpatient facilities for the management of difficult problems. Once those problems have come under control, there is pressure to move the patient to places of lower acuity (e.g. home or nursing home) if death is not imminent. In the UK, the word hospice continues to mean an inpatient facility. It is usually free-standing and frequently located on hospital grounds. Although some are supported completely by the National Health Service (NHS), many are independent charities with contracts with the NHS to provide services. These independent hospice charities require up to 80% funding from philanthropy for their budgets. Today in the UK, palliative care has evolved to be a generic term that describes the care delivered in hospices, outpatient clinics, home care teams, and hospital-based consultation services. It implies care delivered to those with progressive far-advanced disease with poor prognosis. Palliative medicine means the physician specialty component of the interdisciplinary team delivering palliative care. In-hospital units and consultation teams were the last element to develop in the UK and Ireland. They are in close proximity to decision-making. They can take advantage of the resources of the hospital and can offer flexibility in treatments (e.g. chemotherapy, radiotherapy, surgery) when necessary. The unit at the Royal Marsden Cancer Hospital is an example. Consultation teams developed without inpatient beds of their own in some hospitals, e.g. St. Thomas' Hospital and St. Bartholomew's Hospital. While the consultation team is the most flexible of approaches, issues of continuity of care and authority problems have emerged. Evolution in:
|
|
Rationale |
|||||||||||||||||||||||
