Since its creation in 1997, the Brussels Federation has supported a vision of palliative care integrated into healthcare. The terminology of “continuing care” in its title stresses the importance it accords to a progressive integration of this approach into a continuum of care.
This vision is opposed to the initial concept of palliative care characterised by a division between :
- a curative phase marked by the use of treatments directed against the illness and of all measures to support life ;
- a palliative phase when these are discontinued and morphinics are used.
This latter concept has led the general public and the medical community to equate palliative care with terminal care. The portrayals as a “death sentence” or “abandonment of the patient” have constituted barriers to access to palliative care and explained the often too long delayed recourse to this type of care.
In recent years there has been a growing awareness of the necessity of calling on specialised teams in palliative care early in the trajectory of a serious illness. The objective is to integrate treatments directed against the illness and treatments aiming to improve the quality of life, and to adjust their respective contribution depending on the accurately evaluated needs of the patient (cf. WHO 2002 definition).
More and more numerous studies have shown that the benefits of early and integrated palliative care concern not only the quality of life and patient satisfaction, but also involve a reduction in healthcare costs and even an extension of life expectancy.
At present, it is no longer so much the advantage of early palliative care that is questioned, but rather the way of integrating this vision into medicine. How can the myth of terminal and dichotomous palliative care be countered? Various approaches must be developed simultaneously :
Make the public and caregivers aware of the importance of early and integrated palliative care (paradigm change).
Develop training for caregivers (basic level, intermediate level, specialised level).
Improve the interface between curative care and palliative care (partnership, relationship of trust).
Conduct prospective study of the impact of palliative care on the quality of life, satisfaction, costs, etc. (evidence-based studies, cost-effectiveness, etc.).
Take action at the political and organisational level for efficient allocation of healthcare resources, with financial incentives that encourage early and integrated palliative care.
Change the terminology : this topic is controversial. In Belgium, a different tendency is noted in the north and the south of the country. In Flanders, the idea is to keep the term “palliative care” and change the underlying concept. In Wallonia and Brussels, there are supporters of the terminologies “supportive care” and “continuing care” that promote openness and integration.l
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