Extending palliative care to patients with respiratory disease

The founders of palliative medicine always intended that their knowledge, skills and resources would be made available to all those who needed them regardless of diagnosis. As Sykes et al (2004) describe, palliative care started outside the NHS but it was always hoped that once established the science, practice and philosophy of the speciality would improve the care of patients in hospitals. residential and nursing care and those at home. Despite this, palliative care services have been designed around the needs of people living with cancer who, Eve et al (1997) report, have formed 95% of patients receiving the care from community specialist palliative care nurses and hospices. The growing recognition within palliative care, from clinicians caring for patients with non-malignant disease and the general public, that patients and families were not receiving an equitable service has increased interest in investigating the needs of patients with respiratory disease. Patients with respiratory disease form a large component of the general medical case load and emergency take. Gore et al (2000) and Shee and Green (2003) studied patients with chronic obstructive pulmonary disease and found that people with chronic respiratory disease are perceived to have lengthy admissions, inappropriate readmissions without objective evidence of deterioration and to have hasty decisions made about their care when they themselves arc in extremis. Fitzsimons et al (2007) report clinicians' concerns about the disparity of services available to their patients with chronic respiratory disease compared with those for patients with lung cancer: patients have also noted the inequity of treatment.