Professional perspectives of rehabilitative palliative care

Individuals from a range of disciplines share their perspectives of rehabilitative palliative care.

Palliative medicine consultant

Palliative care often seems to be viewed from the outside as an approach to care that is primarily focused on symptom management at the end of life. While this aspect of care is indeed frequently critical in a population with life-limiting disease the goals of symptom control are not only to make a person comfortable; importantly they should enable a person to function to their fullest potential and achieve optimal quality of life. The primary aim of palliative care is therefore better summarised as the amelioration (or healing) of the suffering of the person,(1) who is often facing an uncertain future. How does a rehabilitative approach sit within this aim?

In the past the idea of rehabilitation in the context of palliative care was counter-intuitive to many, but now it is becoming an essential part of the armamentarium of palliative care and one that addresses issues of quality of life on a number of fronts. Rehabilitative Palliative Care contextualises symptom control in the wider setting of a patient’s function, goals and priorities. The approach actively supports improvement in patients’ symptoms (through nonpharmacological interventions), while enablement-focused approaches to care provision can improve patients’ functional ability.

Loss of function provides a departure point from which patients can be supported to explore the other losses that are commonly felt towards the end of a person’s life, such as loss of independence, role, sense of control or the impending leave-taking from their loved ones that they must accomplish. Ultimately the therapeutic relationship can provide ‘space’(2) in which to allow the meanings of his or her suffering to be thought about and possibly reframed. By seeking to “integrate biological realities with profound human needs for meaning, comfort and direction”(3) a rehabilitative approach is, in my view, not only entirely consistent with the aims of palliative care, but adds a new and exciting avenue to achieving its aims.

References

  1. George R. Suffering and healing – our core business. Palliative Medicine. 2009; 23:385-387.
  2. George R, Martin J. Non-physical pain: suffering in action. In Hoy A, Finlay I, Miles A (eds). Effective prevention and control of symptoms in cancer. London: Aesculapius Medical Press; 2004.
  3. Kaldjian L, Curtis A, Shinkunas A, Cannon K. Goals of care toward the end of life: a structured literature review. American Journal of Hospice & Palliative Care. 2009; 25:501-511.
Dr Jonathan Martin, Consultant in Palliative Medicine, Central and North West London NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust

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