Clear definition of palliative care patients lacking
By medwireNews Reporters
13 March 2013
BMJ Support Palliat Care 2013; 3: 46–52

medwireNews: Primary care physicians struggle to clearly define palliative care patients, research shows.

Without a concise definition of the palliative care patient, "there is a risk that some patients with palliative needs will not receive the necessary support, while others may access valuable resources before time," according to Simon Noble (Cardiff University, UK) and colleagues in the BMJ: Supportive and Palliative Care.

Given the integral role of palliative care in the management of patients with incurable disease, the UK requires that primary care physicians maintain a palliative care register. Palliative care traditionally dealt exclusively with cancer patients, but patients with advanced cardiac, respiratory, and neurologic diseases are now meeting the criteria for end-of-life care.

"The care needs of such patients are, therefore, harder to anticipate, with support potentially being required for many months, or even years," state the researchers. As a result, palliative care encompasses a widely heterogenous population and the definition of the palliative care patient varies among general practitioners (GPs).

In their study, Noble and colleagues interviewed eight GPs to investigate how they identified patients requiring inclusion on the palliative care register. The doctors treated a number of patients they considered palliative, with a range of one to 25 patients in their clinical practice.

On the basis of the interviews, the researchers report that most GPs found it difficult to define the palliative care patient and the decision to trigger inclusion on the palliative care register followed no fixed pattern. "Triggers appeared to be need based rather than associated with prognosis, resulting in patients with complex needs remaining on the list for some time," observe the researchers.

The decision to include a patient in the registry was often a multidisciplinary effort, with the decision taken after a discussion among individuals within the practice.

All the GPs agreed it was appropriate for noncancer patients to be included in the register. Patients with end-stage non-malignant disease were largely considered to have needs similar to those of cancer patients.

"While palliative care as a specialty is globally recognized, a specific definition of the palliative care patient remains one of conjecture," conclude Noble and colleagues. "Definitions based on estimated prognosis remain unreliable in the clinical setting and may thus limit the confidence with which clinicians identify palliative care patients."

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