People are living longer with serious and complex illnesses, with the advancement of medical science. But today’s fragmented health care system makes it difficult to effectively provide holistic care. Palliative care offers the opportunity for people living with a serious illness to receive medical care through a connected multi-disciplinary approach. Simply defined, palliative care is care that is responsive to the needs of patients. It focuses not just on the disease (curable, chronic or life-threatening) but addresses how the disease is impacting the physical, social and emotional wellbeing of patients as well as that of the family. Research studies have shown that the earlier palliative care is introduced, the better is the quality of life for both patients and their caregivers. Palliative care specialists work together with the patient’s treating physician to:

• Manage complex physical & emotional symptoms, including but not limited to pain, anxiety, fatigue, breathlessness, constipation, nausea, loss of appetite and difficulty sleeping.
• Listen and communicate what to expect in the future to ensure that care is matched to the goals and priorities of the patient and the family.

Why is early integration critical to ensure holistic and responsive care to people with serious illnesses? Palliative care means responsive care, to respond to an individual’s needs. Early integration of palliative care can empower patients and their families. Early integration is important to provide holistic and responsive care for the simple reason that it improves outcomes for patients and caregivers. There has been robust evidence to suggest that when quality palliative care is introduced earlier, patients and their caregivers are less distressed, more likely to adhere to their treatment protocols and have a better health-related quality of life. Palliative care puts the patient at the centre, not the disease. This approach is empowering for the patient and the family to better cope with the disease treatment and improves communication between healthcare professionals and themselves. Early integration of palliative care is more effective when patients with serious illnesses have a multi-pronged approach to their care plan to help improve their quality of life at every stage of their treatment.  This requires a team approach, bringing in different skills of a doctor, nurse, physiotherapist, and other therapists, nutritionist and medical social worker to assess and support each person and their family based on their own unique needs.

Hospice care and palliative care are often viewed in the same light. Like palliative care, hospice care is focused on a person’s overall comfort, including their emotional, physical, and spiritual well-being. However, the two have different indications and purposes and are often provided in different settings. The main difference between palliative and hospice care is when each type of care is offered. Palliative care may be offered at the beginning of the diagnosis, and at the same time as treatment. Hospice care is provided when an illness is no longer responding to treatment and the patient is nearing their end-of-life.  Palliative care could transition to hospice care if the doctor believes the person is likely to die within six months or less, which can be difficult to determine ^[1]. It supports patients and their families while focusing on symptom relief and comprehensive comfort.

According to the World Health Organisation, when palliative care forms part of a treatment plan, patients tend to have less severe symptoms in the case of pain - and therefore a better quality of life ^[2]. Moreover, early integration of palliative care assists patients and their families by:

• Putting the patient’s desires, goals, and decisions first
• Helping patients and families understand treatment plans
• Providing pain and symptom control
• Reducing unnecessary hospital admissions and the use of health services
• Focusing on overall well-being (body, mind, and spirit)
• Reducing depression and stress burden of family caregivers

While some patients in palliative care have terminal illnesses, it does not mean they are in their final stages of life because some patients can recover from their illnesses ^[3]. It also helps patients stay on track with their health care goals. The principal aim of palliative care is to control pain and other symptoms so that the patient can remain as comfortable and enjoy a good quality of life as much as their illness will allow. It can be performed along with the care received from primary healthcare providers. Palliative care may also be a good option if the illness has prompted multiple hospitalisations or emergency room visits.

Stage One: Stable

The first phase of palliative care involves planning and creating a treatment plan suitable for the patient. The patient and their family will work closely with the care team to identify the physical and medical needs of the patient.

Stage Two: Unstable

During this time, either existing symptoms may get worse or new medical problems may arise. Usually, these unexpected symptoms were not anticipated during stage one, requiring the care team to make urgent adjustments. This is also the time when the palliative care team offers mental, emotional, and spiritual support.

Stage Three: Deteriorating

Overall health and body function gradually decline in this stage due to worsening symptoms. There’s also a tendency for severe medical problems to develop, requiring periodic assessment of the plan of care. During this time, the patient and their family may experience physical and mental distress due to the worsening situation.

Stage Four: Terminal

This stage indicates that death may be imminent within days. Physical and medical care may still be provided in the patient’s home, but the patient or family can opt for a hospital setting so extensive medical care may be provided. During this stage, patients may exhibit terminal symptoms, such as:

• Becoming bedridden or experiencing severe mobility problems
• Decrease or loss of appetite
• Difficulty in swallowing medications
• Requiring daily medical interventions

Stage Five: Bereavement

Unfortunately, this is the stage where the patient has died. During this time, the plan of care focuses on providing support to bereaved loved ones and carers. Some of the bereavement services that family members may receive include emotional, spiritual, and psychological support to help cope with grief.