Palliative Care in Chronic Illness and Multimorbidity

Extended chronic phases of life-limiting illness and increasing multimorbidity present growing challenges that require a new approach to healthcare. A population-based approach is needed to harmonize policies, systems and services relating to chronic and palliative care. Partnerships are needed between different healthcare disciplines and specialties, and between health services and communities. Technology is likely to play an increasingly important role in transfer of information (including advance care plans) and enabling coordination of care. During periods of stability, patients and families should be actively involved in keeping well and helped to “hope for the best while preparing for the worst” to support sustained coping. A rapid response is needed to clinical events that helps people return to stability and takes preventive action against future events wherever possible. Transitions between chronic and terminal phases of illness and different settings (community, residential and hospital) need focal support to prevent people “falling through the gaps.” The optimal timing of referral to specialist palliative care services is the subject of ongoing debate and research. Consumer advocacy may play an important role in raising awareness and advocating for appropriate resourcing and changes to policy and legislation

Palliative Care in Pediatric Oncology

Pediatric palliative care (PPC) in oncology is the active total care of the child’s body, mind, and spirit and involves giving support to the family. Pediatric palliative oncology includes patients across the age spectrum from infancy through young adulthood, and can be embodied as a philosophy of care or applied by an interdisciplinary team of experts. PPC should be initiated at the time of a child’s cancer diagnosis and continued regardless of whether or not the child receives treatment directed at the cancer. PPC aims to prevent and relieve suffering across multiple realms (physical, psychological, social, and existential or spiritual) and enhance quality of life. PPC can be either primary (administered by the primary oncology team) or specialty-focused (administered by an expert or team of experts in PPC), depending on the unique needs of the patient, family, and health care team. Despite evidence demonstrating the benefits of PPC, numerous barriers to its implementation remain. Ongoing education and research are necessary to support consistent access for patients, families, and health care clinicians