Stigma about palliative care: origins and solutions

Abstract

Despite high-level evidence demonstrating the benefits of integrating palliative care early in the trajectory of advanced cancer, there remains a stigma surrounding this important discipline. This stigma is rooted in the origins of palliative care as care for the dying and is propagated by misinformation and late referrals to palliative care services. Current official definitions of palliative care emphasise the importance of early identification and treatment of symptoms and provision of care concurrently with treatments aimed at improving survival. However, this model of palliative care is neither widely known by patients and their caregivers nor consistently practiced. Herein, we describe changes that are necessary at the levels of practice, policy and public education to shift the status quo. Change requires palliative care teams that are staffed, trained and resourced to accommodate early referrals; education for referring physicians to provide high-quality primary palliative care, as well as timely referral to specialists; and a public health strategy for timely palliative care that educates and engages policymakers, stakeholders and the public. The hospice movement was directed at improving care for the dying; continued expansion of this movement is necessary so that all patients with advanced cancer may benefit from its principles throughout the course of illness.

Keywords: cancer; health education; health policy; palliative care; public health; social stigma.