GPAtlas🧭 When to suspect (and when to start a palliative approach)
The World Health Organization (WHO) defines palliative care as an approach that improves quality of life for people facing a life-threatening illness by preventing and relieving suffering – physical, psychological, social and spiritual.
• Palliative care is not only for the end of life.
• It can and should run alongside disease-directed treatment.
• It applies to non-malignant disease (heart, lung, renal, neurological) as much as to cancer.
A person is generally considered to be approaching the end of life when they are likely to die within the next 12 months.
• The central primary-care skill is to identify these patients early, so that goals can be explored and support put in place before a crisis.
• Late identification, rather than lack of treatment, is the commonest failing in community palliative care.
| When to consider a palliative approach | Why it matters |
|---|---|
|
• Advanced, progressive, incurable condition (metastatic cancer, end-stage organ failure, advanced neurodegenerative disease) |
A palliative approach runs alongside active treatment, not only after it stops. |
|
• General frailty and multimorbidity with functional decline |
• Non-malignant disease is under-recognised • These patients have palliative needs too |
|
• Repeated unplanned admissions or a sustained fall in performance status |
Marks the transition where advance care planning becomes urgent. |
|
• Persistent burdensome symptoms – pain, breathlessness, nausea, fatigue, low mood |
Symptom control is core palliative work and need not wait for the terminal phase. |
|
• The person or family raises dying, or wishes to stop active treatment |
A cue to explore goals, prognosis and what matters most. |
|
🧠 Clinical pearl • Ask yourself the “surprise question”: “Would I be surprised if this patient died within the next 12 months?” • If the answer is no, add them to the practice palliative/supportive care register. • Act on it: start advance care planning, complete an SR1 for benefits, hand over to out-of-hours, and prescribe anticipatory medicines once deterioration is expected. • Validated tools such as the Gold Standards Framework (GSF) and the Supportive and Palliative Care Indicators Tool (SPICT) structure this identification. |
Source: NICE NG142 · GMC
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