Extract from Report on National Strategy for Palliative Care

Coordinated by the Lien Centre for Palliative Care

Besides deaths due to infection, acute coronary events or injuries, most
people will experience a period of progressive disease and disability before death. More than half will have some form of chronic illness before death. This period may extend from days to months to years before death, based on the trajectory of the illness.

Three illness trajectories have been identified:

(a) Progressive cancer trajectory
Patients with progressive cancer have a gradual decline in physical
ability over weeks, months or sometimes years. The patient’s physical
ability declines rapidly during the final days or weeks before death when
the disease overwhelms the patient’s functional reserves.

Despite longstanding WHO recommendations (since 1990) to involve
palliative care from cancer diagnosis, specialist palliative services
traditionally catered to this group of patients only during the last days or
weeks of life. However, as mentioned previously, there is a move
towards initiating palliative care further upstream in the trajectory to
interface with disease-modifying cancer treatment.

(b) Chronic organ failure trajectory
Patients with organ failure, especially heart and lung failure, have a
gradual decline in physical function over many months or years, with
occasional episodes of exacerbation. During these acute exacerbations,
the patient experiences worsening of the symptoms and is often
admitted to the hospital. Each episode may be severe and may result in
death, although the patient often survives many episodes. The timing of
death is often unpredictable and sudden.

Specific needs for patients in this group include empowering patients
and families on how to recognise symptoms and prevent the worsening
of symptoms through the effective use of medications. Patients may
require home oxygen and appropriate home adaptations. Home care
teams can provide treatment at home to reduce the need for hospital
admission.

(c) Dementia and frailty trajectory
Patients in this group start with a low baseline of cognitive and physical
disability due to decreased cognitive ability (such as Alzheimer’s disease
or other forms of dementia), or frailty as a result of decreased reserves in
multiple organ systems. Patients may survive many years and may
succumb to an acute event, such as pneumonia.

Patients in this group require the caregivers at home to meet basic
needs of patients. In the absence of caregivers, these patients will
require quality care in long-term care facilities.

Link:
http://www.lienpallcare.org/sites/default/files/Report_on_National_Strategy_for_Palliative_Care%204Jan2012.pdf