Palliative Care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

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Palliative Care
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What Is Palliative Care?
Palliative Care is an approach that improves the quality of life of patients and their families facing
the problem associated with life-threatening illness, through the prevention and relief of su ering
by means of early identi cation and impeccable assessment and treatment of pain and other
problems, physical, psychosocial and spiritual.
Services
Palliative Care are for those people su ering from advanced life limiting conditions, including:
 Cancer
 Heart Failure
 Lung Disease
 Liver Failure
 Kidney Failure
 Multi Organ Failure
 AIDS
These services are provided by registered nurses, carers, physiotherapists, counsellors and social
workers.
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Service Provided For These Conditions
Condition Referral Criteria
Congestive Cardiac
Failure
Symptoms despite maximal medical therapy disabling sob at rest (nyha iv) ≥5
admissions in past 6 months other associated organ involvement
Chronic Obstructive
Pulmonary Disease
Disabling SOB at rest (NYHA class IV)
≥5 admissions in past 6 months
Associated cardiac failure
Renal Failure
Not suitable/declined for dialysis
End-stage renal disease (GFR <15 ml/min)
(stage 5 CKD)
Symptoms of renal failure (anorexia, nausea,
pruritus, intractable uid overload, decreased
functionality)
Stroke
Severe disabling;
Severe dysphagia
Recurrent fever and sepsis
Cancer
Stage IV malignancy (metastatic)
Not for (further) de nitive treatment
Spends >50% of time in bed
AIDS
Stage III or IV disease with dementia, cachexia,
neoplasm or failure of HAART
Other
Intracranial haemorrhage not for surgical
management/on ventilator
Post cardiopulmonary arrest
with CNS damage
SOB – Shortness of breath
GFR – Glomerular ltration rate
HAART – Highly active antiretroviral therapy
NYHA – New York Heart Association
CKD – Chronic kidney disease
CNS – Central nervous system

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Admission Criteria For Service
 Patient not expected to live longer than 6 months.
 Active treatments such as chemotherapy discontinued.
Case Study
A study (Van Niekerk, L and Raubenheimer, PJ: South African Medical
Journal 2014, April, Volume 2, 138-141) conducted in Cape Town during
November 2011 and January and February 2012, reviewed note of about 1,
500 patients in 11 government hospitals, and deduced from the medical
notes that 16.6% of all patients were in fact receiving palliative care (end
of life care). Palliative care was de ned as patients who were not
expected to live more than 12 months, and who were su ering from one
of these end stage conditions: end stage cardiac failure, renal failure, lung
disease, stroke, cancer, AIDS, intracranial bleed un t for surgery, or were
post cardiac arrest.
The above studies also demonstrate the great number of patients
receiving palliative care in hospital. The majority could receive care at
home. Indeed, palliative care patients want to be cared for during those
lasts weeks and months in the comfort and dignity of their own homes.
This is clearly demonstrated by review of a data base of 58 studies
involving 13 countries and one and a half million patients: the majority
wanted to be cared for at home, most especially when functional status
was low, home care services were available and intense, patients were
living with relatives, and patients wished to be at home (Gomes, B and
Higginson, IJ 2006: British Medical Journal, 332515-521).

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