What is palliative care? The principles that you need to know

Palliative care

When a person is told they need palliative care, it can be an emotional and confronting thing for them and their loved ones. It is quite natural to feel afraid when hearing the words ‘palliative care’ for the first time, but with the right information and support the process can be made easier.

Palliative care essentially means that a person is at the end of their life, and a big focus is on keeping them comfortable so that they are able to live out their final time on this earth – with a focus on quality of life rather than counting the days.

The World Health Organisation defines palliative care as “the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families.”

Palliative care can seem like a scary process, but essentially it’s a support system to help a patient and their loved ones cope.

The principles of palliative care

Palliative care is not simply a process that a patient undergoes in hospital by themselves. It’s a philosophy that is integrated into their overall care and the care their family receives.

Palliative care:

  • Affirms life and regards dying as a normal process
  • Neither hastens nor postpones death
  • Provides relief from pain and other distressing symptoms
  • Integrates the psychological and spiritual aspects of care
  • Offers a support system to help patients live as actively as possible until death
  • Offers a support system to help patients’ families cope during the patient’s illness and in their own bereavement

Pain management

Physical pain is an unfortunate part of many health conditions at the end of life stage. Although it is a common symptom, not everyone receiving palliative care support will experience pain.

Pain relief should therefore be something that includes the physical, psychological, social, and spiritual aspects of suffering.

As pain is layered and multidimensional, there is no one way of treating it. Physical pain cannot be treated separately from the psychology and anxieties of pain. And vice versa, the mental suffering cannot be addressed independently from the physical experience.

The first principle of managing pain is an adequate and full assessment of where the underlying pain is coming from. Keep in mind that patients may have more than one area of pain and different pains have different causes.

The World Health Organisation has developed the three-step “ladder” for pain relief in adults, which can essentially be used in palliative care.

They recommend that pain medication should be given “by the clock” – which is approximately every 3-6 hours, rather than “on demand”.

If pain occurs, there should be prompt oral administration of drugs in the following order:

  1. Non-opioids (aspirin and paracetamol);
  2. Then, as necessary, mild opioids (codeine);
  3. Then strong opioids such as morphine, until the patient is free of pain.

To calm fears and anxiety, additional drugs – “adjuvants” – should be used.

A comprehensive knowledge of the underlying pathophysiology of pain is essential for effective management.  The three-step approach of administering the right drug in the right dose at the right time is supposed to be inexpensive and 80-90% effective.

There must always be considerations given to treating the underlying cause of the pain – this could be by surgery, radiotherapy, chemotherapy, or other appropriate measures.

Where can people access palliative care?

Palliative care is provided where the person and their family wants, where possible. It is not exclusively locked into a clinical or hospital setting.

This may include:

  • At home
  • In hospital
  • In a hospice
  • In a residential aged care facility

Many people indicate a preference to die at home and making this possible often depends on several factors, such as the nature of the illness, the amount of care the person needs, how much support is available from the person’s family, and whether the person has someone at home who can provide physical care and support for them.

For more information or resources visit Palliative Care Australia.

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  1. I came to understand the principles of Palliative Care when my Mum was diagnosed with terminal pancreatic cancer and we made an informed decision to have mum stay at home. The team from Banksia PC were amazing and helped me as primary carer to understand where Mum was up to as the disease progressed.Mum and I were also able to spend a lot of quality time together during the short 4 months we had left because her pain was managed,she was not restricted to a hospital environment and was able to get around,enjoy our garden and pets and so many other things.We could talk long into the night sharing mother/daughter things – precious moments ddn’t have to wait and didn’t pass us by as they might have in a hospital environment. I now work as a volunteer at a cancer centre – often in the Palliative care ward – I beieve that we have to reclaim what has shifted from the natural process of dying at home to the clinical surroundings of hospital whenever possible.

  2. Palliative is everyone’s business i pray and work to see to it that by year 2030 atleast all medics will have the palliative care knowlrdge and st least 80% of non medics will have the knowledge of palliative care.
    Again i pray and trust that government will ensure those with palliative care needs will access frer treatment ie as many as possible comprehensive cancer care centers.Also cancer patients to be treated with dignity,there should be special inpatient facility to cater for patients with palliative care needs.

  3. Thanks so much for the most useful up-to-date information on Palliative care.

    Best Regards



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