Circles of care: should community development redefine the practice of palliative care?

TLDR

Historically, specialist palliative care in hospices has focused on cancer patients and relied on a patient‑centred, service‑delivery model that has worked well, but recent developments highlight the need for community‑based approaches due to gaps in integrated policy and resources. This article proposes a model that places the person with illness at the centre of a network of inner and outer communities and service organisations. The model is underpinned by policy development that supports the overall structure of these networks. Adopting this model would enable individuals, communities, service delivery organisations and policymakers to collaborate to provide end‑of‑life care that enhances value and meaning for patients and communities alike.

Abstract

Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. This has mostly been done in the context of a service delivery approach to care whereby services have become increasingly expert in identifying health and social care need and meeting this need with professional services. This model of patient centred care, with the impeccable assessment and treatment of physical, social, psychological and spiritual need, predominantly worked very well for the latter part of the 20th century. Over the last 13 years, however, there have been several international examples of community development approaches to end of life care. The patient centred model of care has limitations when there is a fundamental lack of integrated community policy, development and resourcing. Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.