Journal of Palliative Care & Medicine
Open Access

Palliative care; Patient-centered healthcare; Informed decision-making; Cancer; End-of-life care; Rural healthcare; Remote areas; Emotional support; Psychological support; Equitable care; Holistic care

Introduction

Facilitating informed decision-making: A hallmark of palliative care is its dedication to empowering patients, a principle that sets it apart as a comprehensive and patient-centered approach to healthcare. Beyond the essential aspects of providing relief from pain and emotional support, palliative care places a strong emphasis on facilitating informed decision-making. This philosophy recognizes that patients are not passive recipients of medical care but active participants in their healthcare journey [1]. In palliative care, patients are encouraged to engage in open and honest discussions about their treatment options, pain management strategies, and even their endof- life preferences. These conversations are not just informative but also deeply collaborative, involving patients, their families, and the healthcare team. The goal is to ensure that every decision made aligns with the patient's values, preferences, and individual goals [2]. One of the key elements of this patient-centered approach is the empowerment of patients to take an active role in their healthcare. This empowerment extends to various aspects of their care, including:

Treatment choices: Palliative care allows patients to explore and choose from a range of treatment options. Whether it's continuing with aggressive treatments, transitioning to more comfort-focused care, or considering clinical trials, patients are provided with the information and support needed to make decisions that resonate with their unique circumstances [3].

Pain management: Pain is a common and distressing symptom in serious illnesses like cancer. Patients are actively involved in determining the most effective approaches for managing their pain, whether through medication adjustments, physical therapies, or alternative therapies.

End-of-life preferences: Palliative care also includes discussions about end-of-life preferences and advance care planning. Patients are encouraged to express their desires regarding life-sustaining treatments, hospice care, and other aspects of their final days [4]. This proactive approach ensures that the patient's wishes are respected and followed. In the midst of the uncertainties and challenges posed by a serious illness like cancer, palliative care provides patients with a profound sense of agency and control over their healthcare decisions. This empowerment is not only valuable in terms of respecting the patient's autonomy but also in promoting their overall well-being.

By actively involving patients in their care, palliative care not only addresses their physical needs but also attends to their emotional and psychological well-being. It acknowledges that the experience of illness is deeply personal and that patients should have a say in how their healthcare journey unfolds. This approach fosters a sense of dignity, autonomy, and resilience, allowing patients to navigate the complexities of their illness with a greater sense of control and purpose. In essence, palliative care is a testament to the power of patient-centered healthcare, where the patient's voice and choices are central to their care and quality of life [5].

Not synonymous with end-of-life care

It's crucial to draw a clear distinction between palliative care and end-of-life care, as they serve different but equally important purposes in the realm of healthcare. While both concepts share the goal of enhancing the well-being of individuals facing serious illnesses, palliative care is a broader and more versatile approach that extends beyond the final stages of an illness. Palliative care encompasses a comprehensive set of services dedicated to improving the quality of life for patients dealing with serious and often life-threatening conditions. Contrary to a common misconception, it is not restricted to end-of-life situations. Palliative care can initiate at any point along the trajectory of a serious disease, from the time of diagnosis through treatment and beyond [6 ]. One of the remarkable aspects of palliative care is its ability to complement and coexist with curative treatments. In other words, patients do not have to choose between receiving palliative care or seeking treatments aimed at curing or controlling their illness. Instead, they can benefit from both simultaneously. This integrated approach acknowledges that serious illnesses like cancer bring not only physical challenges but also emotional, psychological, and existential concerns. By offering palliative care early in the illness trajectory, patients gain access to a range of supportive services that can significantly impact their well-being. These services can include pain and symptom management, emotional and psychological support, assistance with complex decision-making, and help in managing the practical aspects of daily life while dealing with a serious illness [7]. Early engagement with palliative care can have profound benefits. It can alleviate physical discomfort, enhance emotional resilience, and promote a sense of control and agency over one's healthcare journey. Additionally, by addressing the holistic needs of patients and their families, palliative care can foster a higher overall quality of life, regardless of the stage of the illness.

In summary, while palliative care certainly encompasses end-oflife considerations and provides essential support during that phase, its scope is much broader. It is a flexible and patient-centered approach that can commence at any stage of a serious illness, offering support that complements curative treatments [8 -10 f]. This proactive approach aims to improve the patient's overall well-being, promote informed decisionmaking, and provide comfort and dignity throughout the entire healthcare journey. Recognizing this distinction is crucial in ensuring that individuals facing serious illnesses receive the comprehensive care they need and deserve.

The vital role of palliative care in rural and remote areas: In rural and remote areas, where the challenges of accessing specialized medical facilities are magnified, the significance of palliative care becomes even more pronounced. These regions, often characterized by vast geographical distances, limited healthcare infrastructure, and resource constraints, create formidable barriers to the delivery of healthcare services, particularly for cancer patients. In such remote and underserved areas, palliative care emerges as a lifeline for these patients and their families, offering invaluable support to navigate the intricate physical and emotional challenges posed by cancer. Palliative care is especially vital in these remote regions because it addresses not only the physical symptoms of the disease but also the emotional and psychological toll it takes on patients and their loved ones. In the face of geographic isolation and limited access to specialized medical resources, the holistic approach of palliative care becomes paramount. It provides a comprehensive support system that encompasses pain and symptom management, emotional and psychological support, assistance with decision-making, and an emphasis on enhancing the overall quality of life [11]. One of the key roles of palliative care in rural and remote areas is to empower patients and their families with the information and resources necessary to make informed decisions about their care. This empowerment is particularly crucial when dealing with serious illnesses like cancer, where treatment options can be complex and emotionally charged. Palliative care professionals create a safe and empathetic space for patients to express their fears, concerns, and hopes, helping them navigate the emotional burden that often accompanies a cancer diagnosis. Furthermore, palliative care recognizes that geographic isolation should not be a barrier to accessing quality healthcare. It promotes the concept of equitable care, ensuring that individuals in remote areas receive the same level of compassionate and comprehensive support as those in urban settings. Through innovative solutions like telepalliative care, communitybased programs, and mobile palliative care units, patients in rural and remote areas can connect with palliative care specialists, receive expert guidance, and access essential services without the need for long and arduous journeys to distant medical facilities [12]. In essence, palliative care is not merely about alleviating physical symptoms; it is a compassionate and holistic approach to healthcare. It transcends the boundaries of geography and resource constraints to provide patients and their families with the support they need when facing serious illnesses like cancer. Its flexibility and unwavering commitment to enhancing the quality of life underscore its vital role in the healthcare landscape, ensuring that all individuals, regardless of their location, receive the care and support that aligns with their values, preferences, and goals. Ultimately, palliative care embodies the principle that every patient deserves dignity, comfort, and compassionate care, regardless of the challenges posed by their surroundings.

Discussion

Palliative care is about much more than just pain management and symptom control. It extends its compassionate reach to encompass the profound emotional and psychological challenges that often accompany a cancer diagnosis. These emotional aspects can be as debilitating as the physical symptoms, and their impact on a patient's overall well-being should not be underestimated.

The Emotional Toll of Cancer: A cancer diagnosis can be an overwhelming and emotionally distressing experience. Feelings of fear, anxiety, sadness, and grief can become all-consuming for patients and their families. The uncertainty of the future, the fear of pain, and the prospect of losing control over one's life can create a heavy emotional burden. Palliative care professionals are uniquely trained to address these emotional challenges. They serve as a crucial source of psychological and emotional support, offering patients and their families a safe space to express their fears, anxieties, and hopes. This support is not merely a secondary aspect of care but an integral part of the palliative care approach.

Conclusion

Palliative care stands as a beacon of patient-centered healthcare, offering a profound testament to the power of empowerment, compassion, and holistic support in the face of serious illnesses like cancer. It is a philosophy that recognizes patients as active participants in their healthcare journey, valuing their autonomy and individuality. Palliative care's hallmark is the facilitation of informed decision-making, fostering open and collaborative dialogues about treatment choices, pain management, and end-of-life preferences. This patient-centric approach extends beyond the physical aspects of care, delving into the realm of emotional and psychological well-being. It acknowledges the emotional toll of cancer and provides a safe haven for patients and their families to express their fears and hopes. Palliative care professionals serve as pillars of support, ensuring that the profound emotional challenges are met with empathy and understanding. Furthermore, palliative care transcends geographical boundaries, playing a vital role in rural and remote areas where healthcare access challenges are magnified. In these underserved regions, it serves as a lifeline, addressing not only physical symptoms but also the emotional and psychological toll of cancer. The empowerment it provides to patients and families is a beacon of hope, ensuring that informed decisions can be made despite complex treatment options. Crucially, palliative care is not synonymous with end-of-life care but instead encompasses a comprehensive set of services that can commence at any stage of a serious illness. Its integrated approach, which complements curative treatments, has the potential to significantly impact the overall well-being of patients and their families. In summary, palliative care embodies the principle that every patient, regardless of their circumstances or location, deserves dignity, comfort, and compassionate care. It is a holistic approach that transcends the boundaries of illness, geography, and misconceptions, and its unwavering commitment to enhancing the quality of life remains at the forefront of patient-centered healthcare. Ultimately, palliative care serves as a reminder that, in the face of adversity, humanity's greatest strength lies in its ability to provide unwavering support and care to those in need.

Acknowledgement:

Not applicable.

Conflict of interest:

Author declares no conflict of interest.

1. Notenboom K, Beers E, van Riet-Nales D, Egberts T, Leufkens H, et al. (2014) Practical Problems with Medication Use that Older People Experience: A Qualitative Study. J Am Geriatr Soc 62:2339-2344.

Indexed at, Google Scholar, Crossref

2. Orlu-Gul M, Raimi-Abraham B, Jamieson E, Wei L, Murray M, et al. (2014) Public engagement workshop: How to improve medicines for older people? Int J Pharm 459:65-69.

Indexed at, Google Scholar, Crossref

3. Currow DC, Stevenson JP, Abernethy AP, Plummer J, Shelby-Jones TM (2007) Prescribing in Palliative Care as Death Approaches. JAGS 55:590-595.

Indexed at, Google Scholar, Crossref

4. Bowers B, Ryan R, Kuhn I, Barclay S (2018) Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis. Palliat Med 33:160-177.

Indexed at, Google Scholar, Crossref

5. O’Connor M, Pugh J, Moyez J, Hughes J, Fisher C (2011) The palliative care interdisciplinary team: Where is the community pharmacist? J Palliat Med 14:7-11.

Indexed at, Google Scholar, Crossref

6. Sheehy-Skeffington B, McLean S, Bramwell M, O’Leary N, O’Gorman A (2014) Caregivers Experiences of Managing Medications for Palliative Care Patients at the End of Life: A Qualitative Study. Am J Hosp Palliat Med 31:148-154.

Indexed at, Google Scholar, Crossref

7. Wilson E, Caswell G, Turner N, Pollock K (2018) Managing Medicines for Patients Dying at Home: A Review of Family Caregivers’ Experiences. J Pain Symptom Manag 56:962-974.

Indexed at, Google Scholar, Crossref

8. Pollock K, Wilson E, Caswell G, Latif A, Caswell A, et al. (2021) First Look Summary: Managing Medicine for Patients with Serious Illness Being Cared for at Home. NIHR.

Google Scholar

9. Ogi M, Campling N, Birtwistle J, Richardson A, Bennett MI, et al. (2021) Community access to palliative care medicines-patient and professional experience: Systematic review and narrative synthesis. BMJ Supportive Palliat Care 2021.

Indexed at, Google Scholar, Crossref

10. Latter S, Campling N, Birtwistle J, Richardson A, Bennett MI, et al. (2020) Supporting patient access to medicines in community palliative care: On-line survey of health professionals’ practice, perceived effectiveness and influencing factors. BMC Palliat Care 19:148.

Indexed at, Google Scholar, Crossref

11. Turner M, King C, Milligan C, Thomas C, Brearley SG, et al. (2016) Caring for a dying spouse at the end of life: ‘It’s one of the things you volunteer for when you get married’: A qualitative study of the oldest carers’ experiences. Age Ageing 45:421-426.

Indexed at, Google Scholar, Crossref

12. Maidment ID, Aston L, Moutela T, Fox CG, Hilton A (2017) A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist. Health Expect 20:929-942.

Indexed at, Google Scholar, Crossref