According to the World Health Organisation, palliative care is an approach that improves the quality of life of individuals and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. A General Practitioner (GP) providing comprehensive first contact care in a continuing basis for individuals and families and is resident in the community, is the best person to provide this type of care. With the knowledge he has about the patient’s family and psychosocial background and the established doctor patient relationships, he is in the best position to provide palliative care. He also plays a pivotal role in coordinating care when necessary. Thus with the knowledge he has about the families, he can arrange care for the patient as well as the family carers in the most practical way during their terminal stage in life.
Main aim of providing good palliative care is to improve the quality of life of patients and families. In order to do that many aspects have to be looked in to. Some of these are pain and other symptom management, preparing the patient to face the death and preparing families for the bereavement. GPs who are willing to provide palliative services need to be trained in symptom management, advance communication skills to discuss sensitive issues like death and bereavement and in identifying points of referral. However, providing palliative services need time and commitment. It is very difficult to provide all these services effectively by the GP alone, especially on a long-term basis. Therefore it is timely to work towards developing “multidisciplinary teams” with the participation of all stakeholders. Until such time GPs have to lead the way.
Earlier, palliative care services concentrated mainly about the patients with cancer. However, now palliative care services have extended to include many other diseases that afflict the people like heart failure, COPD, CKD. Changes in the population structure with more elderly people and the increasing non-communicable diseases, have increased the need for more comprehensive palliative care services. Despite the increase in the demand for palliative services, Sri Lanka is yet to develop a national palliative care programme. Being in the community and with the strong relationship with the patients and families, GPs are in a position to initiate palliative care services at this hour of need. This will be helpful in reducing the burden to families as well as to the healthcare system of the country.
Dr. Shyamale Samaranayaka
Head of the Department / Senior Lecturer
Department of Family Medicine
Faculty of Medical Sciences
University of Sri Jayewardenepura
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