Sheila Payne, Jane Seymour and Christine Ingleton
In this book, we have explored 'palliative care' from many different perspectives, with a view to providing those who work in the field with a broad and critical understanding of the issues surrounding the care of people facing life-limiting illness and their companions. We now face the task of having to draw some conclusions: a daunting task given the complexity of the material that precedes these final words. We propose to proceed by asking some questions and trying to identify the factors that must be taken into account in moving towards the formulation of the answers to them.
Of course, the first question must be, 'do we know what palliative care is?' In asking this, we have moved full circle, since we set out in the Introduction to define palliative care. We do not intend to repeat that discussion, especially since it is revisited at various points in the book (see Chapters 2 and 3), but rather to tease out some of the tensions and common themes that have emerged. Of these, the most obvious tension is that between 'specialist' and 'general' palliative care. This tension is played out clearly in nursing, where debates seem set to continue about the remit, roles and boundaries of specialist nurses in palliative care, their different levels of specialism and exactly what is the 'added value' of specialist nursing care (see, for example, Corner 2003). As Corner notes, nurses in palliative care prioritize emotional and supportive care in their work and, as we have seen in this book (see Chapter 14), these aspects of care are likely to be highly valued by patients and their companions. However, there is no room for complacency: in spite of arguably widespread awareness of the core goals of palliative care and knowledge about how to reach them, too many nurses find it difficult to balance competing priorities and conflicting demands on their time, and work in poorly resourced organizations where these essential aspects of caring continue to be devalued and poorly articulated. Nor should we be deceived into thinking that 'specialists' in palliative care somehow have a monopoly on the skills and attributes that are required to provide good care to people with palliative care needs. Humility and a willingness to collaborate and learn from others, many of whom are experts and specialists in their own fields, can only enhance the quality of palliative and end-of-life care. O'Brien (2003) cites Kearney, who argued some years ago that, in meeting the broad spectrum of need in palliative care, attitudinal change is as important as attention to resource allocation:
Patients with incurable illness must no longer be viewed as medical fail-
ures for whom nothing more can be done. They need palliative care,
which does not mean a handholding second rate option, but treatment
that most people will need at some point in their lives, and many from