Terminal Care: Goal Setting — Hospice Philosophy in Practice

Abstract

A variety of services specializing in the care of the dying, dealing mostly with cancer patients, have recently expanded rapidly in the UK and the USA (Lunt and Hillier, 1981; Buckingham and Lupa, 1982). Whilst domiciliary and hospital teams, working in an advisory capacity and supplementing existing provision, continue to multiply (Lunt, in press) further major expansion of inpatient hospice units seems unlikely, at least in the UK. Instead, hospices are urged to disseminate the principles and techniques of terminal care to improve the care provided by other existing services (Wilkes et al., 1980). There has been surprisingly little research to demonstrate the effectiveness of hospice care, though more is under way. All published evaluative studies in Britain refer to St Christopher’s Hospice (Parkes, Part 1 and 2, 1979; Hinton, 1979; Parkes, 1984). Home care services have been subject to even less study (Parkes, 1980). There has to date been no evidence that education and training in terminal care skills for staff in non-specialist settings, by itself produces improvements in care, though recent research at St Christopher’s shows that standards of pain control have improved in nearby hospitals since the hospice opened (Parkes, 1984).