Palliative care is a relatively new medical speciality pioneered by Dame Cicely Saunders. It is an approach aimed at improving the quality of life of patients with terminal illness. Palliative care also advocates the importance of supporting the families of these patients before they pass away and during the grieving period thereafter.
It is obvious that to be able to carry out this daunting task, palliative care needs to be delivered by a team of professionals who work in a coordinated manner, addressing the different issues which may arise during the disease process.
The ethos of palliative care is "total care", a term coined by Dame Cicely. Total care implies an approach that looks at different dimensions which may affect the patient and family. As such, there are three dimensions.
The physical dimension is the one that immediately comes to mind. Indeed, the control of symptoms through various medical and non-medical therapies is a cornerstone of palliative care.
However, there are two other dimensions to total care. The psycho-social dimension refers to how the patient deals with the acceptance of the disease process, the impact the disease has on the patient and family, the changing family dynamics and roles due to the disease process, finally ending with the provision of bereavement support.
The third dimension is the spiritual one, namely the meaning patients give to their disease in relation to their life. Many times, but not necessarily, this is dictated by religion. However, there is a distinction between religion and spirituality in that even people who have no denomination can have spiritual issues that may need addressing.
The multi-disciplinary team involved in palliative care includes doctors, nurses, social workers, physiotherapists, complementary therapists, a chaplain and also occupational therapists. Their aim is that, thanks to their various fields of expertise, they will work together they address the three dimensions mentioned above.
The Malta Hospice Movement has been providing free palliative care services to the Maltese population for the last 20 years. Guided by the palliative care philosophy, Hospice has now started to extend its services to better address the needs of patients. Hence, besides taking on patients with advanced cancer and motor neurone disease, the movement has started to take on patients with terminal respiratory disease of non-cancer origin.
This extension of services is informed by research showing that the needs of these patients are as great, if not greater than, those of patients with advanced cancer.
In addition, Hospice has set up a Hospital Palliative Care Team based at Mater Dei Hospital whose role is to support staff in the control of symptoms of patients, facilitate discharge planning and help out in the many needs that these people may have.
This is just a brief introduction to the significant and expanding contribution which the Malta Hospice Movement makes to our country in the provision of holistic support services to terminally ill patients and their families.
Dr Abela is a medical officer with the Malta Hospice Movement.