Palliative medicine

Doctors in palliative medicine provide holistic, quality-of-life care of patients with serious, advanced progressive illnesses and for whom curative treatment is no longer possible.

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

Nature of the work

Care of dying patients and those close to them is central to this specialty. Doctors in palliative medicine also provide supportive care at earlier stages in an illness, alongside active treatments and interventions.

While most medical professionals have responsibility for good palliative and end of life care, palliative medicine physicians provide support, guidance and expertise to other teams particularly in complex situations.  They have an important role in the education of other professionals and for ensuring high standards of care in the organisations for which they work.

They encounter a range of diagnoses, although most referrals will be for patients with progressing or advanced cancer. An increasing proportion  have other progressing or end stage conditions including heart failure, renal failure, advanced chronic obstructive pulmonary disease (COPD) and neurological conditions.

An in depth knowledge of the pathology and management of these conditions is essential and forms part of the curriculum in specialist training. Some doctors will develop a sub-specialty interest depending on their post and location. In general, palliative care for patients younger than 18 years is provided through paediatric palliative care specialists.

In some care settings, such as specialist inpatient units in hospitals or hospices, the palliative care physician is responsible for the medical management of the patient. However in the community and most hospital settings, the role is one of working alongside different teams and professionals with the GP or another specialist being directly responsible for the care.

They offer care that:

  • strives to achieve the best quality of life for the patient for as long as possible
  • involves managing and anticipating pain and other symptoms
  • addresses the psychological, social and spiritual needs of the patient
  • facilitates multi-professional support in order to provide joined-up care across care boundaries, enabling care at home and fewer avoidable admissions towards the end of life
  • supports anticipatory planning with patients and professionals including advance planning in the last year of life
  • supports end of life care that meets the needs and wishes of the individual and family
  • supports the family and significant others during the patient’s illness and their bereavement

Common procedures/interventions

The tools of the specialty are communication, clinical assessment, decision-making and in depth knowledge of pharmacology.

Some physicians will undertake paracentesis (drawing off fluid form a natural cavity of the body) in hospice or home settings under guidance of portable ultrasound (very high frequency sound waves). They will be familiar with specialist pain techniques including management of epidural infusions (a local anaesthetic procedure for blocking pain) but this would be in conjunction with a pain specialist.

Where do doctors in palliative care work?

Consultants often work across hospice, community and hospital settings but would be based in one of these. There are posts exclusively based in a hospital, working with the multi-professional palliative care team across all wards and clinics which may include seeing patients on medical assessment units or with the acute oncology team that manages malignant diseases.

Posts based in a hospice usually include sessions for home visits and/or at the local acute trust. Outpatient clinics may be provided in hospital or hospice settings. Others may be based primarily with a community palliative care team. Trainees will rotate across all of these to gain different experience. Non-training posts are more likely to be located in one setting, such as a hospice.

In any setting, the role includes provision of palliative care advice to other professionals often by telephone.

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