General palliative care is appropriate for the majority of patients with advanced heart failure and should be incorporated into routine clinical care.
General palliative care includes provision of:
- information for patients and carers, with ‘signposting’ to relevant services
- accurate holistic assessment of patient needs
- co-ordination of care teams in and out of hours and across boundaries of care
- basic levels of symptom control
- psychological, social, spiritual and practical support
- open and sensitive communication with patients, carers and professional staff
- referral for specialist palliative care when necessary.
Referral for specialist palliative care
For people with complex needs specialist palliative care is provided by members of multi-professional palliative care teams, including consultants in palliative medicine, clinical nurse specialists, chaplains, social workers, pharmacists and appropriate allied health professionals. Specialist palliative care teams are available to advise colleagues in primary and secondary care as well as offering a specialist assessment or direct involvement in patient care if appropriate. In all care settings, an awareness of when to seek advice or refer can be crucial in ensuring that the palliative care needs of patients and families are met appropriately. Referral to specialist palliative care should not be regarded as ‘handing over’ the patient, but as an opportunity for the palliative care team to provide additional support to patients and carers and to their usual healthcare team as and when necessary at crucial points in the disease trajectory36. It has been estimated that no more than 10% of people with palliative care needs, including those with heart failure, are likely to require specialist palliative care.
Following referral to specialist palliative care the service may offer:
- a ward consultation by a palliative care doctor or clinical nurse specialist
- a visit for assessment or a short period of intervention by the specialist team in a hospital or community setting
- assessment in a specialist palliative care symptom control outpatient clinic
- assessment at a specialist palliative care day unit
- a short admission to an inpatient specialist palliative care or hospice unit.
Referral for a specialist palliative care assessment should be considered for the following:
- patients with difficult symptom control and / or complex physical or psychological family or social needs
- patients and families needing additional support with issues relating to end of life care including advance care planning and decisions about treatment and care.
Reference: Scottish Partnership for Palliative Care.
Pulse point
For the majority of patients, generalist palliative care will be provided effectively within their care. Accessing your local general palliative care pathways can support the care management of your patients.
Further information on criteria for referral to Specialist Palliative Care services should be sought in your area.
Page last reviewed: 29 Jul 2020
