Julie’s Corner(ジュリー寄稿欄)No. 2 November 2019

This month the focus is on revisiting our understanding of the definition of palliative care. Ensuring we have a good understanding of when to discuss palliative care will ensure that our patients wishes for end of life are more likely to occur. According to the Japan Health Ministry survey earlier this year only around 13.2% of people currently die at home. Compared to the 1950’s where 80% of people died at home.

We need to think about why these changes have occurred and our contribution to improving patients preferred place of death. I often talk about taking “baby steps”, we cannot change everyone’s practice overnight. However, we can think about our own practice and what may be the one thing that we can change that will make a difference for palliative care patients journeys in the health system. Put simply, palliative care is a focus on quality of life, ensuring peoples personal goals are achieved where possible, symptoms are managed to the best of our ability using best practice strategies, preventing unnecessary admissions to hospital and families and friends are well supported.

Palliative care philosophy is patient centred and holistic in approach using a multidisciplinary team where possible. Care of the dying is the final phase of palliative care. We can improve patient’s quality of life for months, if not years before they die, if we can better recognise when to commence discussions about palliative care. For this to occur we need to be comfortable about having these discussions and have a good knowledge of what palliative care has to offer. There is an opportunity to present palliative care as a positive outcome for patients, that is we are focussing on their quality of life, preventing unnecessary admissions to hospital, we will ensure their symptoms are well controlled, supporting family and friends, and we can work together on helping the patient and their family achieve their personal goals important to them.
We need to remind ourselves palliative care is not limited to patients with a cancer diagnosis but also for patients diagnosed with Dementia, Heart disease, COPD, Parkinson’s disease and many other chronic conditions. The deciding time is when the patient is starting to talk to you or hinting they are considering areas such as quality of life, poor symptom control, not wanting to come back to hospital, treatment fatigue. All of these triggers are an opportunity to have a discussion within the patients’ health care team and with the patient and their families. Our very important role as patient advocates is to ensure we do not miss the opportunity to have these discussions with patients to explore this further with them.
Here are a few links that may assist your reflections in this area:
– WHO definition of palliative care
– UK Gold Standards Proactive Identification Guidance – 6th edition 2016 – excellent guide in assisting earlier identification of patients leading to more proactive care and prediction of needs, and away from challenges of specific clinical prognostication tools that can sometimes hamper this approach.
If you have any particular areas you would like additional information on please forward your request to and we will ensure that this is discussed. Please let me know how you are going as we would enjoy sharing your thoughts and experiences on palliative care so that we can continue to learn from each other.
I am looking forward to our next month’s catch up. Take care Julie

Julie’s Corner: No. 2 NOV/2019   <日本語版>
日本語版監修:木下佳代子 ジェックス参与






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