From the Guidelines
Palliative care in primary care settings should prioritize comprehensive symptom management, advance care planning, and coordination of multidisciplinary services to improve the quality of life for patients with life-limiting illnesses. The most recent and highest quality study, 1, emphasizes the importance of recognizing and addressing physical, emotional, social, and spiritual needs of patients with incurable diseases, such as heart failure. This can be achieved by using validated assessment tools to identify these needs and providing palliative care interventions alongside cardiologic management.
Key aspects of palliative care in primary care include:
- Comprehensive symptom management, such as treating breathlessness, pain, and depression
- Advance Care Planning to ensure that the patient's future treatment and care align with their personal values and goals
- Coordination of multidisciplinary services, including cardiologic management, palliative care specialists, and bereavement services
- Addressing psychological and spiritual needs, in addition to medical treatment, to maintain personal integrity and promote emotional healing
According to 1, most palliative care concerns can be addressed by the usual care team, supported by a palliative care specialist if needed. The study also highlights the importance of dynamic assessment of the patient's needs during the dying process and the provision of intensive palliative care when required. Furthermore, 1 defines palliative care as an approach that focuses on comfort and quality of life for those affected by life-limiting illness, and emphasizes the importance of a palliative approach to care, which can be provided by non-palliative care specialists.
In terms of specific interventions, primary care physicians can follow the WHO analgesic ladder for pain management, starting with acetaminophen or NSAIDs for mild pain, adding weak opioids like codeine for moderate pain, and strong opioids like morphine for severe pain. Common symptoms such as dyspnea can be addressed with opioids, anxiety with benzodiazepines, and nausea with antiemetics. Regular assessment of caregiver burden using tools like the Zarit Burden Interview can help identify families needing additional support. By integrating these palliative care approaches into primary care, patients with life-limiting illnesses can receive comprehensive symptom management and support, improving their quality of life and dignity whilst dying.
From the Research
Palliative Care Needs in Primary Care
- The comprehensive assessment of needs in palliative care is crucial to identify areas where patients require attention, guiding clinical decisions and tailoring care provision 2.
- Primary-care clinicians play a vital role in providing primary palliative care and referring patients to palliative-care specialists when necessary 3, 4.
- Palliative care needs in primary care include assessing beyond core domains such as physical, psychological, social, and spiritual needs, with a focus on information and practical needs 2.
- Patients with serious illnesses require dignified and person-centered care, which can be achieved through adequate training of healthcare staff and the implementation of specific care models 5.
- Patient-centered dissemination and implementation frameworks and strategies are essential in palliative care settings to improve quality of life and health outcomes 6.
Key Components of Palliative Care in Primary Care
- Symptom control and management
- Existential distress and psychological support
- Social and spiritual support
- Information and practical needs
- Referral to specialist palliative care services when necessary
- Ongoing training and education for primary-care clinicians to improve palliative care skills 3, 4