Where did the concept of ‘Palliative Care’ come from? Dr Balfour Mount from Canada proposed the word palliate, which comes from latin word Pallium which means cloak, because symptoms are “cloaked” or “disguised” with treatments whose primary aim is to provide comfort even if cure is not possible.
Palliative Care Principles – WHO Definition:
Palliative Care is an approach that improves the quality of life of patients and their families facing the problem 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…. [click here for further part of WHO definition]
Dr Kraus unpacked the above definition for us into its components:
- What is QOL? Depends on individual values, presence and absence of certain symptoms. QOL is fundamentally unique to each individual! Don’t apply your version of what good quality of life is to your patients.
- What is a family? Legal family vs the people the patient perceives to be family.
- What is a life-threatening illness? Difficult to define and very important to base on your context. Interesting in the international oncology discussion on this topic they spoke about ‘progressive metastatic cancer’, an African oncologist asked that instead we change this to ‘metastatic cancer’ due to different management strategies/interventions available. The SPICT Tool is useful in this regards BUT remember doesn’t mention TB/HIV which is key in our setting.
- What is suffering? Suffering (patient, family & community) is multi-factorial. Important that suffering & discomfort are not the same thing. Discomfort may be normal or actually necessary.
- What is spirituality? We will discuss this at a later stage.. as we are doing an entire week theme on it.. Important to understand that Spirituality does not equal Religion.
Some thoughts/discussion points brought up regarding the definition: Important that not only TREAT suffering, but PREVENT suffering in the first place. Dr Kraus alluded to when her interest in PC began, which was working in rural SA in the height of the AIDS pandemic when ARVs were not yet available. At that stage there was no treatment option available. Something that is discussed a lot in EM circles.. regarding dying as a normal process. Using the “natural death” terminology. We discussed that dying and death is a process/journey not an event.
