Looking at palliative care from a wider perspective

摘要

With an increasing number of patients preferring to die at home, community health-care staff are in a privileged position to examine current practice and consider different ways of offering better palliative care. Such outcomes have implications beyond the person who is dying, as they also shape the nature and profile of bereavement for those left behind. Despite such apparent importance, there seems to be inherent failures in always providing high-quality care to dying patients. A number of reports tell us how palliative and end-of-iife care should be delivered, but there remain disparities in the actual care given. For example, Regmi et al (2009) reported on unequal distribution of resources among the population, the Parekh Report (Runnymede Trust, 2000) highlighted issues of multiculturalism, and Firth (2001) strongly recommended widening access to palliative care services and improving cultural competence. Some progress has been made, but it is not sufficient to cover every person. Palliative care for prisoners, travellers, and the homeless, for instance, still lags behind, thus highlighting some of the disparities that need to be examined.