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Is a public health approach the answer to the challenge of providing palliative care for all?

Author: Caroline May
17 March 2016

Within the palliative and end of life care sector there has been a growing interest in adopting a public health approach – but what does this mean, and is it the answer to the challenges the sector faces?

Dr Julian Abel and Professor Allan Kellehear believe so. In the current issue of BMJ Supportive and Palliative Care they suggest that a public health approach could be the answer to the twin challenges the sector faces – the current inequity of access to palliative care and the need to increase the range and quality of care in the context of diminishing resources (1).

In the paper they set out their vision for a new model of care – a partnership between palliative care and community support – with communities and volunteers taking on much of the work currently undertaken by palliative care professionals.

"We envisage teams of carers, families, friends, neighbours and volunteers working directly in localities with palliative care nurses to provide support in multiple ways for the last phases of life," they explain.

They argue that not only does this model free up professionals to focus on the most vulnerable and those with the greatest need, but that the experience of end of life is more meaningful to patients and carers.

They also suggest that hospices are “ideally placed” to take the lead in changing how we support people at the end of life – although not exclusively so. And indeed, there are a number of hospices in the UK that are leading on these new approaches, such as Foyle Hospice, which is leading on Northern Ireland’s first compassionate communities project.

Abel and Kellehear's paper is a thought provoking read and, as ‘editor’s choice’, is currently free to access on the journal's website.

Building the evidence

This month has also seen publication, in the journal Palliative Medicine, of a systematic review of the evidence around a public health approach to end of life care (2).

The review, by Dr Libby Sallnow et al, describes and demonstrates the positive impacts that community engagement at the end of life can have on patients, carers and the wider community, as identified in a number of published studies.

The authors identify a number of immediate and practical benefits – such as the meeting of basic needs, tackling social isolation and carers feeling more confident and at ease in their role after receiving education and advice.

They also found that "changes can be detected beyond the immediate caring networks or individuals involved."

"Both the direct experiences of supporting those at the end of life and undergoing training around such issues ripple out into the wider community, producing structural and communal changes that embed the work in the fabric of the community," they explain.

There is not a lot of evidence, yet, in the published literature on public health approaches to palliative and end of life care, and the authors note that impact assessment should be an integral part of all future initiatives.


  1. Abel J, Kellehear A. Palliative care reimagined: a needed shift. BMJ Supportive & Palliative Care. 2016;6:21-26.
  2. Sallnow L, Richardson H, Murray SA, Kellehear A. The impact of a new public health approach to end-of-life care: a systematic review. Palliative Medicine. 2016;30(3):200-211.

You can read the original article on the UK edition of ehospice

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