Palliative care in non-malignant disease

A lack of access to specialist palliative care (SPC) has led to a lack of clinicians’ skills, knowledge and attitudes pertinent to the management of patients with end-stage heart failure, chronic obstructive pulmonary disease (COPD) and renal failure. Recognition of the ‘end-stage’ itself remains a key challenge. This article discusses how a palliative care approach can be incorporated into standard active treatment for patients with organ failure and outlines the management of important symptoms. The problems experienced by patients with chronic neurodegenerative disease are discussed, and swallowing and respiratory difficulties are explored in the context of potential loss of mental capacity or ability to communicate. Finally, an overview is provided of the management of the most prevalent gastrointestinal symptoms found in patients with HIV/AIDS: a condition which may return to inpatient care if increases in drug resistance continue. The importance of excellent communication skills is highlighted in particular regard to advanced planning for end-of-life issues.