Palliative care pathway
‘An integrated clinical care pathway involving multi-disciplinary teams having the holistic approach to care the patient and to support his/her family or carer throughout the continuum of disease to achieve enhanced quality of life including a dignified death’
● Integrated –
Curative and palliative together
● Multi-disciplinary teams –
includes palliative care doctors, nurses, social workers,
spiritual advisors, dieticians, occupational therapists,
pharmacists, physiotherapists, respiratory therapists,
● Holistic approach –
patient is viewed as a whole person with physical,
psychological, social, spiritual and cultural gifts and
needs which are special to that person.
● Continuum of disease –
from pre-diagnosis/diagnosis till death and into
What matters most to the patient is the key concept in helping the patient to live well with the disease. Assessment
and communication should be a continuous process throughout the continuum of disease. Best suited palliative care pathway will be:
● Patient & family centred – Pt’s needs are the goals of
care. Respect pt.’s & family’s wishes, cultural beliefs
● Considering Ethics – Beneficence – Do good
Non- maleficence – Do no harm
Autonomy – Pt’s right to decide
Justice – Fairness
● Addressing – Symptom management; Emotional and
cognitive symptoms; Social challenges;
Understanding of diagnosis & disease progression;
Advance care planning and directives; Functional
status; Spirituality; Issues of grief and bereavement;
Satisfaction and quality of care; Caregiver wellbeing.
● Ensuring clinical interventions/assessments to
occur in time.
● Respecting Physician’s professional responsibility to
discontinue futile medical treatments.
● A team work ensuring continuity of care network
from hospital to home/community/hospice.
● Assuring Quality – by documentation, monitoring
progress using indicators and by high standard of
conduct & practice
● Enabling adherence to guidelines
● Evaluable – by regular audits/reviews
● Including End of life care
Liverpool care pathway (LCP)
– is the most widely used end of life care pathway internationally (version 12 – modified after regular & repeated
evaluations and reviews). It can be adapted to meet the needs of our country. But changes can be made in the best
interest of each patient to individualize the care to best suit that patient as the psych socioeconomic, spiritual & cultural needs are different to each patient.
Dr (Mrs) Nishanthini Ramesh
District General Hospital Vavuniya
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