Table 2

Domains of palliative care as categorised by the National Consensus Project for Quality Palliative Care “Clinical Practice Guidelines”

DomainBrief description
Structure and processes of careThe interdisciplinary team assessment is based on: patient/family goals of care; the diagnosis/prognosis; continuity across the levels of care that a patient needs (e.g. inpatient unit, home); and incorporating quality and safety.
Physical aspects of careThe assessment (validated tools) and multidimensional treatment of physical symptoms such as pain, dyspnoea, nausea/vomiting, fatigue, constipation, performance status, medical diagnoses and medications (add/wean/titrate).
Specific policies for treatment include pharmacological, interventional, behavioural and complementary management.
Psychological and psychiatric aspects of careA collaborative assessment process of psychological concerns and psychiatric diagnoses that includes patient–family communication and treatment options.
Specific concerns assessed include: anxiety, depression, delirium and cognitive impairment; stress, anticipatory grief and coping strategies; pharmacological and non-pharmacological treatment; and patient/family grief/bereavement programmes of care.
Social aspects of careInterdisciplinary collaboration with patients and family/friends focused on communication, interaction, and support to identify patient and family strengths and incorporate the professional social worker.
Caregiver crisis is defined with a goal of prevention.
Spiritual, religious, and existential aspects of careAssessment of spirituality with access to staff collaboration to address spiritual concerns throughout the disease trajectory.
This domain promotes exploration of hopes, fears and forgiveness, and is designed to promote practices for comfort and relief.
Cultural aspects of careCultural competence is defined for the interdisciplinary team, with a view of culture as a source of strength and resilience for patients and families.
Linguistic competence stresses plain language, literacy and linguistically appropriate service delivery.
Care of the patient at the end of lifeCommunication and documentation of signs and symptoms of the process of dying are emphasised.
Management of pain and other symptoms are considered critical to alleviate suffering.
Bereavement support begins with recognition and communication to patient/family about prognosis (e.g. hours to days) and support for anticipatory grieving.
Social, spiritual and cultural care is critical.
Ethical and legal aspects of careThe focus in this domain is on advance care planning with ongoing discussion of goals of care, acknowledgement of the complexity of ethical issues along with the importance of seeking help from ethics councils, and acknowledgement of the complexities of legal and regulatory issues, with access to legal counsel supported.

Information from [20].