Role Delineation Framework for Adult Palliative Care Services

Palliative care is an approach that improves the quality of life of patients 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 (WHO, 2004). In the last twenty years, the scope of palliative care has broadened to providing palliative care at an earlier stage in the disease trajectory. In 1990 a World Health Organisation expert committee proposed that palliative care should be a gradually increasing component of care from diagnosis to death (WHO, 1990). It is important to recognise that the provision of palliative care is the responsibility of the whole healthcare system and not just specialist palliative care services. The term ‘generalist palliative care providers’ refers to all those services, health and social care providers who possess ‘palliative care approach’ or ‘general’ palliative skills. Their role is fundamental to the provision of high quality care for people with life limiting illnesses, and the needs of many patients with life-limiting conditions can be appropriately and effectively met with the support of generalist palliative care providers. However, should a patient experience unstable symptoms or problems of high intensity, complexity and/or frequency as a consequence of their illness, then input from specialist palliative care services should be provided.In order to ensure that patients can transfer seamlessly between care settings or service levels when their condition or circumstances change, the place and relationships of individual service providers within the broader mosaic of palliative care provision must be clearly described. This document builds on the work of the National Advisory Committee Report on Palliative Care (2001) to identify the scope of practice and services provided within three recognised levels of palliative care service provision in the context of current organisation of the healthcare system in Ireland. It provides important planning, resource allocation and accountability functions and describes the links that should exist between palliative care services at all levels in order to ensure that all elements of the healthcare service are working in partnership to meet the needs of the patient and their family.