BOX 7-1

The World Health Organization Definition of Palliative Care

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. Palliative care:

  • Provides relief from pain and other distressing symptoms;

  • Affirms life and regards dying as a normal process;

  • Intends neither to hasten or postpone death;

  • Integrates the psychological and spiritual aspects of patient care;

  • Offers a support system to help patients live as actively as possible until death;

  • Offers a support system to help the family cope during the patient’s illness and in their own bereavement;

  • Uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;

  • Will enhance quality of life, and may also positively influence the course of illness;

  • Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

SOURCE: WHO (2002).

else for cancer exists. It can become the organizing principle for expanding cancer services. In either case, some official recognition of the need for and the requirements of palliative care are almost certain to be essential for progress. Ideally, medical, nursing, and social work students (and other relevant health care workers) will receive training in palliative care and practitioners will incorporate palliative care into routine practice. The starting point in each country for each of these aspects is likely to be somewhat different, depending on existing services and circumstances.

The starting point for this chapter is an overview of palliative care in Africa, the continent with the least developed programs. Because pain control is so central to palliative care, much of the remainder of the chapter is devoted to understanding the role of pain control in palliative care for



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