Table 4.

PC—Resulting Definition From Phase 3

PC is the active holistic care of individuals across all ages with SHS (suffering is health related when it is associated with illness or injury of any kind. Health-related suffering is serious when it cannot be relieved without medical intervention and when it compromises physical, social, spiritual, and/or emotional functioning. Available from http://pallipedia.org/serious-health-related-suffering-shs/) because of severe illness (severe illness is a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments, or caregiver stress. Available from http://pallipedia.org/serious-illness/) and especially of those near the end of life. It aims to improve the quality of life of patients, their families, and their caregivers

PC:

• Includes, prevention, early identification, comprehensive assessment, and management of physical issues, including pain and other distressing symptoms, psychological distress, spiritual distress, and social needs. Whenever possible, these interventions must be evidence based

• Provides support to help patients live as fully as possible until death by facilitating effective communication, helping them, and their families determine goals of care

• Is applicable throughout the course of an illness, according to the patient’s needs

• Is provided in conjunction with disease-modifying therapies whenever needed

• May positively influence the course of illness

• Intends neither to hasten nor to postpone death, affirms life, and recognizes dying as a natural process

• Provides support to the family and caregivers during the patients’ illness, and in their own bereavement

• Is delivered recognizing and respecting the cultural values and beliefs of the patient and family

• Is applicable throughout all health care settings (place of residence and institutions) and in all levels (primary to tertiary)

• Can be provided by professionals with basic PC training

• Requires specialist PC with a multiprofessional team for referral of complex cases

To achieve PC integration, governments should:

• Adopt adequate policies and norms that include PC in health laws, national health programs, and national health budgets

• Ensure that insurance plans integrate PC as a component of programs

• Ensure access to essential medicines and technologies for pain relief and PC, including pediatric formulations

• Ensure that PC is part of all health services (from community health-based programs to hospitals), that everyone is assessed, and that all staff can provide basic PC with specialist teams available for referral and consultation

• Ensure access to adequate PC for vulnerable groups, including children and older persons

• Engage with universities, academia, and teaching hospitals to include PC research and PC training as an integral component of ongoing education, including basic, intermediate, specialist, and continuing education

PC = palliative care; SHS = serious health-related suffering.