Book Details

Advances in Contemporary Palliative and Supportive Care

As we begin to near the end of this first decade of the new century, there is cause to reflect on the future of palliative and supportive care. The dramatic reforms in end-of-life care of the last half of the 20th century have been widely acclaimed and documented in a variety of publications, with the International Observatory on End-of-Life Care playing an important role in this process.

St Christopher’s Hospice, generally acknowledged as the first of the ‘modern’ hospices, was founded by Dame Cicely Saunders only 40 years ago. It is impressive that despite this relatively short time span, designated hospice and palliative care facilities are now found throughout the world. Australia was relatively early in acknowledging the importance of these new ideas in practice, with the first modern hospices established in the early 1970s, and community-based palliative care instituted in 1981.

Today’s hospice and palliative care services vary greatly by country, region and authority responsible, with different degrees of resemblance to Cicely Saunder’s original intentions of integrating high quality clinical care for the dying with education and research. But the widespread acceptance of the hospice and palliative care movement in only a few decades is indeed remarkable, although it remains clear that existing resources are far from adequate to meet present needs for palliative and supportive care. It should also be recognized that lack of knowledge and negative attitudes – especially with regard to opiate use – still inhibit use of those resources that are available.

As editors of this issue, we would like to critically reflect upon the future of hospice and palliative care movements from a stance of respect and admiration for all that has been accomplished to date. Through our long experiences in nursing, as clinicians, researchers and educators, we are well aware that the early stages of disciplinary development are often associated with defensiveness; this has perhaps also been the case with end-of-life scholarship. It is our belief that this field has now matured to the point of being able to foster a more critical dialogue.

We believe that one hinder for precise and critical communication is the lack of consistent terminology used to refer to supportive, palliative and end-of-life care. In many settings, these terms refer to different, although overlapping areas, with palliative care referring to a form of care provided towards the end-of-life, characterized by ‘active, total care’, as described in the original 1990 WHO definition. In contrast, supportive care often represents a more over-arching term, with broader implications from active treatment throughout the disease trajectory.

These already unclear distinctions have become perhaps even more confused in recent years. For example, the prominent US National Cancer Institute is notable in that they define the terms ‘palliative care’ and ‘supportive care’ identically, as aiming ‘to prevent or treat as early as possible the symptoms of the disease, side effects caused by treatment of the disease, and psychological, social, and spiritual problems related to the disease or its treatment’. These NCI definitions have much in common with WHO’s position statement from 2002, in which the WHO describes palliative care as ‘an approach’, rather than a form for organized care provision. While many may feel we focus unduly on semantics, we believe that the terminology used does have implications for how we conceptualize, organize and provide care.

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