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Palliative care from diagnosis to death

Author: Scott A Murray, Sébastien Moine, Jordi Amblàs-Novellas and Kirsty Boyd, members of the EAPC Primary Care Reference Group
07 April 2017

Celebrating World Health Day, 7 April 2017, Scott A Murray, Sébastien Moine, Jordi Amblàs-Novellas and Kirsty Boyd, members of the EAPC Primary Care Reference Group, mark World Health Day with an EAPC Blog post in English, German and French.

Recently, the newly formed European Association for Palliative Care (EAPC) Primary Care Reference Group published an analysis in the British Medical Journal that has proven very popular in social media internationally.

We wanted to present an evidence-based rationale for early palliative care based on the fact that the last stage of life can start much earlier for some people than others and that dying is a four-dimensional experience with dynamic changes in all dimensions of need.

To get this message across, we made a four-minute video, which is freely available from the abstract of this article even if you cannot access the full text. The video summarises the article.

It shows that in the rapid trajectory (typically cancer), a palliative care approach might be triggered at diagnosis as there may well be considerable psychological or existential distress then, and that waiting until the terminal stage misses the point.

In the intermittent trajectory of organ failure, similarly it shows that there can be social and psychological needs at the times of the acute episodes of decompensation; hence early holistic planning to both prevent and treat these emergencies is indicated.

In the gradually declining trajectory typically of frailty, the video graphically illustrates that social, psychological and even existential distress can occur months before the final physical decline and that preventing such issues and promoting resilience and carer support is indicated.

We then summarise that for good early palliative care we have to:

  • Identify an early trigger when this approach might be started.
  • Chat with the patient and carer to explain the likely course or trajectory of the illness and understand their goals in the light of this.
  • Make a plan together with the patient and carer, hoping for the best, but planning for the worse, accepting the inherent uncertainty.
  • Communicate the plan with everyone who might be involved.

Do have a look at the video and feel free to show it to educate students, professionals or at any conferences. The BMJ also posted the video on Twitter and Facebook where it is getting many thousands of views.

As the purpose of our Primary Care Reference Group is to advocate for early palliative care in all settings, especially the community, we would be delighted if anyone would like to translate the video or do a voice-over in your own language.

There are no copyright issues as we made the video – we especially thank Dr Jordi Amblas-Novellas, a geriatrician from Catalonia, for doing this in his spare time!

We are proceeding to make a similar video for people with various life-threatening conditions to help them understand how their illnesses might progress, and thus how they might master them by knowing about them and planning ahead.

Links and references

Scott A Murray, M Kendall, G Mitchell, S Moine, J Amblàs-Novellas, K Boyd. Palliative care from diagnosis to deathBMJ 2017; 356 doi: (Published 27 February 2017).

EAPC Primary Care Reference Group.

View the video here or here.

This article originally appeared in English, French and German on the EAPC blog.

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