[Approaching patients who require palliative care]

Abstract

The aim of palliative medicine is the best possible quality of life. Based upon literature and clinical experience we address factors of importance for the meeting between the palliative patient and the physician. Family and network, personality and behaviour vary between palliative patients and have effect upon their coping; these factors should be reflected in the meeting between the physician and the patient. Communication with a palliative patient also aims at a systematic assessment of his or her various symptoms and the physician should have a broad armamentarium of communications skills. The optimal way to assess symptoms is by use of clinical interviews supplemented with standardized measurements. Instruments such as the Edmonton Symptom Assessment System are very useful in the assessment of the commonest symptoms. The assessments should include patients' perspectives and what priority they give to relevant interventions. Treatment should be evaluated systematically in order to avoid ineffective treatments and to reduce side effects and interactions. The aim is to give patients as good and as long a time as possible in the place in which they want to spend the last part of their lives. Palliative medicine often combines the art of medicine with new technology. The focus on quality of life and the patient perspective is paramount, and the approach to the patient should reflect this.