Location of care
Care for patients with advanced disease will take place in a range of community-based settings outside of the hospital. These may include the patient’s home, palliative care units, and/or residential care facilities. The MDC team should create links with specialist services and health professionals, especially those based in the community; these include community health nurses and community palliative care specialists.
Ideally, community-based services should be locally available and locally coordinated. Patients from regional and rural locations should benefit from their professional carers’ networks to facilitate their MDC.
Supportive care addresses a range of issues and needs for patients with cancer, including informational, emotional, spiritual, psychological, physical, practical, and financial needs. The role of supportive care is crucial in the management of patients with advanced disease. The supportive care needs of patients with advanced disease and their caregivers will be specific to the patient and their caregivers and will change over time.
Palliative care is care provided for people of all ages who have a life-limiting illness, with little or no prospect of cure, and for whom the primary treatment goal is quality of life.
The aim of palliative care is to optimise the patient’s comfort and levels of function. Palliative care stresses the importance of advanced planning with a focus on the whole person within their social and emotional context, rather than just the disease. Patients may experience a range of physical symptoms that will need to be managed, as well as the related psychosocial distress associated with having advanced disease. It is important for teams to assess the quality of life of their patients and take this into consideration when planning their treatment and care. MDC teams should aim to maintain function and quality of life for the patient throughout the course of their disease.
The term ‘palliative care’ is confronting for many patients, their caregivers and health professionals. Misconceptions about what palliative care involves, and its role in a patient’s care, can influence a patient’s decision as to whether they accept palliative care services as part of the MDC approach.
Palliative care is often seen as a service that is provided only at the end of life, but early referral can allow patients and their caregivers to benefit from a range of services and support.
For patients with complex needs the involvement of an interdisciplinary specialised palliative care service, working alongside primary clinical carers, is likely to be of benefit. A referral to palliative care services may be made by the lead clinician, although some services will accept a referral from the patient, a family member or friend, a local community health centre or local hospital. The manner in which the referral is discussed with the patient and caregivers can help to avoid undue stress.