Primary Palliative Care Research Group

All times

Help people earlier rather than later, not just in the very terminal stage but from diagnosis of a life-threatening illness.

Integrating palliative and supportive with disease modifying care

With cancer, traditionally there was a period when a cure was attempted, then when cure was no longer possible, palliative care intervened. The new and better concept is that supportive and palliative care should start at diagnosis of a life-threatening illness and gradually increase while disease modifying care may decrease.

Integrate supportive care earlier, alongside disease modifying care rather than waiting to near the end of life

Research has shown that patients can manage both preparation for death and hope for the future, as they tend to have dual, competing narratives in their mind.(1)

The 'surprise' question

In the organ failure and frailty trajectories it has previously been more difficult to conceptualise and decide when a palliative care approach might be clinically appropriate. However, examining a typical organ failure trajectory, it is evident that events or triggers such as a hospital admission might be utilised to consider changing a chronic disease management approach, dealing largely with physical concerns, to a supportive and palliative care approach.

Alternatively, there might be clinical indicators such as breathlessness at rest, or even the "surprise question". This question is where a physician asks himself or herself the question "would I be surprised if this patient were to die in the next year"? If the answer is "no" consideration should be given to any additional supportive care needs of both the patient and carer(s) at this time.

Are there any tools to help identify individuals who may benefit?

A number of tools have been developed for use in primary care to help GPs and community nurses identify patients as they transition to a point when a supportive and palliative care approach is beneficial. The Supportive and Palliative Care Indicator Tool (SPICT) can be used opportunistically at patient consultations, or by scanning patient disease registers to identify such patients for a comprehensive assessment and a palliative care approach.(2) A copy of the SPICT tool can be found under 'resources'.

What about the last days of life?

In the last days of life, starting the patient on an end-of-life care pathway can ensure individualised care and that consideration is given to stopping unnecessary treatments and tests.

Anticipatory care planning

Anticipatory Care Planning in primary care: an after-death analysis of electronic Key Information Summaries.

Supportive & Palliative Care Indicators Tool (SPICT™)

The SPICT™ is used to identify people at risk of deteriorating and dying with one or more advanced conditions for palliative care needs assessment and care planning.

Computerised searching of GP records

Computerised searching of GP records to help identify patients who might benefit from palliative care, irrespective of diagnosis.
  1. Murray SA, Boyd K, Kendall M, Worth A, Benton TF, Clausen H. Dying of lung cancer or heart failure: prospective qualitative interview study of patients and their carers in the community. BMJ 2002;325:929-32
  2. Boyd K & Murray SA. Recognising and managing key transitions in end of life care. BMJ 2010;341:649-652