Clinical Practice Guidelines for the management of locally advanced ...

7 PALLIATIVE CARE
7.1 What is palliative care?
Palliative care has been defined in a number of ways. The World Health Organization (WHO) has
defined palliative care as
…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.
Palliative care:
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten nor postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and
in their own bereavement;
uses a team approach to address the needs of patients and their families,
including bereavement counselling, if indicated;
will enhance quality of life, and may also positively influence the course of
illness;
is applicable early in the course of illness, in conjunction with other therapies
that are intended to prolong life, such as chemotherapy or radiation therapy,
and includes those investigations needed to better understand and manage
distressing clinical complications. 1
This last point highlights that palliative care should be an active approach to patient management and,
when appropriate, integrated into continuing approaches to disease control.
The WHO has also advocated the integration of comprehensive palliative care and pain management
into cancer control programs. Palliative care programs are charged with providing pain relief, control
of other symptoms, and psychosocial and spiritual support. 2 This approach has been supported by the
Australian Government through its National Palliative Care Strategy 3 , and Palliative Care Australia,
the national peak body for palliative care, which sets a goal that ‘all people who have a life limiting
illness are able to access timely, high quality care appropriate to their needs’. 4
These plans highlight the importance of all health professionals, from primary care through all
specialties, recognising their role in the provision of palliative care, with specialist palliative care
services focussing on those patients with more complex needs. The need for access to palliative care
is also recognised in other prostate cancer guidelines, again emphasising that it should be available
when needed and not limited to the end of life. 5
Palliative care delivery has been characterised by a team working together to provide integrated care
in all domains—physical, emotional, psychological and spiritual. The team can involve a range of
medical, nursing and allied health personnel, including psychologists, social workers,
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