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Palliative cancer care - general issues - Management
What sources of help and advice are available in primary care?
- Ongoing day-to-day care of people with advanced cancer, by health and social care professionals, should be based on locally agreed protocols and guidelines, delivered within the context of a managed system or pathway.
- Health and social care professionals providing day-to-day care should know when to seek advice from, or refer to, specialist palliative care services.
- Discussion with the local specialist palliative care service (community, hospice, or hospital-based, as appropriate) should allow joint decisions to be made on whether further involvement by the specialist team is required at this point in the patient pathway.
Clarification / Additional information
- The multidimensional nature of problems in palliative care requires a multidisciplinary approach.
- Both the GP and district nurse should be involved as early as possible after diagnosis and can contact their local specialist palliative care team for support or advice.
- After clinical assessment, if there is a specialist need, referral to the specialist palliative care team may be necessary.
- The palliative care team may include any or all of the following specialities:
- Palliative medicine consultants and doctors
- General practitioner
- Palliative care nurses, including:
- Palliative care nurse specialist/Macmillan nurse
- Marie Curie nurse
- Palliative care pharmacist
- Physiotherapist
- Occupational therapist
- Counsellor (particularly bereavement counsellors) or psychologist
- Dietitian
- Social worker
- Spiritual adviser
- Benefits adviser
- Complementary therapists
- Macmillan nurses provide support and information to people with cancer and their families [Macmillan Cancer Relief, 2004].
- They do not usually provide 'hands-on' care, but give advice to the primary care team, including advice regarding medication for symptoms (e.g. pain, nausea, vomiting).
- The person and their family can self-refer to the Macmillan nursing team.
- Marie Curie Cancer Care provides nurses who care for terminally ill people and give them the choice of dying at home supported by their families [Marie Curie Cancer Care, 2007].
- Marie Curie nurses can provide hands-on care at home through the day or night.
- Marie Curie and Macmillan nursing services are free of charge to the person and their family and their services can be accessed via the person's GP or district nurse.
- Communication between professionals within multidisciplinary teams and other service providers caring for the person is important. Continuity of care should be achieved, possibly by nominating a 'key-worker' for individual people [NICE, 2004].
Basis for recommendation
- This recommendation is based on guidance from the National Institute for Health and Clinical Excellence [NICE, 2004].
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