INTEGRATION OF PALLIATIVE CARE ALONG THE COURSE OF DISEASE AND ACROSS ALL SETTINGS OF CARE

In the evolution of progressive illnesses or conditions with a limited life prognosis, there are several phases, from the initial complex condition, followed by the so-called first transition – when the disease progresses and there is a limit in life prognosis – and the end of life or terminal phase .

Each of these situations has specific characteristics, and there is a need to adapt the clinical, ethical, and organizational goals to their needs and demands, from care more focused on disease-modifying, supportive, rehabilitation, and curative approaches, with active interventions of specialist services, towards the gradual increase in the palliative approach and palliative care from the beginning, with interaction between palliative care and primary care services (Figure 4) .

Figure 4. Adapting the clinical, ethical & organizational perspectives of palliative approach

& palliative care to phases in the evolution of persons with advanced chronic conditions and limited life prognosis

The model of identification and intervention needs to change from a late (last 2-3 months of life), institutional (based on specialist services), reactive to crisis, based on hospitals and emergencies, and fragmented approach towards a model of timely, planned and preventive, community-based care, based on advance care planning and case management, and integrated in all settings with pathways (Figure 5) .

Figure 5. Models of palliative interventions in chronic advanced palliative care

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