Nevertheless, efforts to lengthen life or to comfort are not necessarily mutually exclusive. Many patients who receive palliative care feel better and live longer than expected.
The boundary between "cure" and "care" is cultivated by eligibility rules for hospice benefits established by the federal government and private insurers to limit expenditures for palliative care. Confining palliative care to those who are expected to live no longer than six months creates pointless misery for many patients. It also unjustifiably weighs down clinicians who, in several circumstances, cannot precisely and truthfully calculate whether a seriously ill patient will live three months, six months, a year, two years, or even longer. This rigid division between cure and care likewise discourages suffering patients from requesting palliative care.
Based on the model definition of the Canadian Palliative Care Association, the term palliative care has been characterised as "a philosophy of care and combination of therapies intended to support persons living with life-threatening illness. Palliative care strives to meet physical, psychological, social, and spiritual needs, while remaining sensitive to personal, cultural, and religious values. Palliative care may be needed at any time in the disease trajectory, and bereavement. It may be combined with therapies aimed at reducing or curing the illness or it may be the total focus of care. Care is delivered through the collaborative efforts of an interdisciplinary team including the individual, family, and others involved in the provision of care. Where possible, palliative care should be available in the setting of personal choice" (Ferris and Cummings 1995, p.12). As it is, palliative care does not end with the death of the patient. Although not all families require sophisticated follow-up, a palliative care program must offer bereavement counseling. Physicians and oncology nurses trained to deal with families in distress can help them link up with the palliative care group (McDonald 1998, p. 1710).
Early implementations of palliative care for patients with chronic, critical, or multiple illnesses reduce the need for crisis-oriented services. Early palliative care affords a basis for predicting and preparing for the inconvenience intrinsic in the treatment and care of such individuals. In certain situations, especially those children with serious diseases, early palliative care can prepare the patient for life-prolonging treatments such as chemotherapy and make the treatments more acceptable and certainly more bearable.
"Quality of Life" As mentioned, a major objective of palliative care is to achieve the best quality of life for patients and their families and this aim is often evaluated by measures of quality of life. However, the concept of quality of life, is complicated and quite tricky to define, being both individual and multidimensional and, although many instruments exist which attempt to quantify it, measurement is difficult. In the