The World Health Organisation defines palliative care as "an approach which improves the quality of life of patients and their families facing life threatening illness, through the prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual".

Palliative care aims to relieve physical symptoms and emotional pain and to support patients and their families when they have life-limiting illnesses including those associated with old age.

Palliative care is truly holistic. Its specialists "walk with" the patient and family right through the illness and up to the death of the patient and then they carry on with bereavement support for those closely affected by the loss. They are serious about care. Palliative care is delivered by a team of professionals, doctors, nurses, social workers, physiotherapists, occupational therapists, speech therapists, chaplains and volunteers.

There are times when non-specialists; GPs, community nurses and others are part of the palliative care team and they must understand and use a palliative approach. This approach means that the patient and family are the centre of attention, their myriad concerns are paramount and every effort is made to support them through the often difficult though frequently rewarding time which characterises the end of a person's life. It requires careful attention to detail and regular follow-up.

We should have sufficient palliative care specialists to regularly visit people in their homes, in hospices, acute hospitals and aged-care facilities. They must consult and plan management aimed at keeping patients comfortable. They must have time to teach GPs, generalist nurses and other medical specialists about symptom control and the palliative approach.

Specialist social workers and psychologists should visit to support patients and their families. Every aged care facility must have an end-of-life plan for each patient. GPs and nurses must be trained to recognise the approach of death and must know how to keep the patient comfortable. And the necessary medications must be there when needed. We should all be assured that the quality of care which is currently only available to a fortunate few in the community is available to all.

What can be done? More funding is needed from all governments.

Dr Yvonne McMaster, Retired palliative care specialist

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