Palliative care and hospice

Domain IX · Biomedical, neuro & digital · Cicely Saunders · 1967 · London, UK (St Christopher's Hospice, Sydenham)

What it is

Palliative care is not a single therapy or a single registered profession. It is a model of care. WHO defines it as "an approach that improves the quality of life" of patients (adults and children) and their families facing life-threatening illness. It does this by preventing and relieving…

Format

• Stage C: Living with advanced illness (months, sometimes years). This is the main window for structured psychotherapy, because the person still has the energy and cognitive capacity for it. Typical formats: CALM, three to six individual sessions of 45–60 minutes over 3–6 months, at least monthly in…
• Stage D: Short prognosis (weeks). Typical format: dignity therapy, usually three or four contacts over about 7–10 days: an introductory meeting of about 30 minutes, a recorded session of about 60 minutes, then a final session of about 30 minutes to read back the edited document. The trial included…

Who practises it, and how they are trained or regulated

• Stage B: Holistic needs assessment and care planning. The practitioner carries out and documents an initial holistic needs assessment with the person. Staff need training to do this sensitively. Practitioners should know about the duty to offer carers' assessments (Care Act 2014) and young carers' assessments (Children and Families Act 2014) in England. Services find out what information people want, give it in…
• Throughout: staff support. Reflective practice, debriefing after difficult deaths, and attention to staff wellbeing. NG142 addresses staff training but not staff wellbeing.
• What it is. Palliative care is not a single therapy or a single registered profession. It is a model of care. WHO defines it as "an approach that improves the quality of life" of patients (adults and children) and their families facing life-threatening illness. It does this by preventing and relieving suffering through early identification, careful assessment and treatment of pain and other problems, "whether…

Evidence status, as the guide reports it

• Version followed: the WHO palliative care fact sheet (current online version) for the definition and model; NICE guideline NG142, End of life care for adults: service delivery, for UK service organisation; Cicely Saunders' concept of total pain as the Cicely Saunders Institute (King's College…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the therapist's own avoidance of endings. Working as intended: neither person is left with things unsaid.
• reluctance to "bother" staff (the person's and your own). Working as intended: problems are picked up early and crises are avoided.
• confusion about who coordinates care. Refer the person to the named coordinator, never fill gaps yourself. Watch also for psychological concerns that never reach the shared record.
• cynicism, avoiding certain patients, sleep problems, intrusive images, and increased sick leave. Working as intended: staff can name their reactions, ask for help, and stay engaged.
• psychological labels used to dismiss physical complaints. Watch for the team assuming distress is "for psychology" when it needs medical review. Working as intended: requests are acted on and…

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.