Internationally, it is time to bridge the gap between primary and secondary healthcare services for the dying

ABSTRACT

Around two-thirds of people with incurable diseases in economically developed countries wish to die at home, but less than one-third succeed in doing so. Developing primary care-based services for the dying in the community is essential to reach and serve the whole population. Three typical "trajectories" or patterns of decline in the last year(s) of life have recently been described, and each of these may require different models of care to best meet the needs of patients. The palliative care approach must be urgently extended to patients with non-malignant conditions who have comparable concerns to and in some cases even greater and more prolonged unmet needs than cancer patients. Primary care professionals have the potential and ability to provide end-of-life care for most patients, given adequate training, resources and access to care facilities and specialist advice when needed. They are ideally placed to identify patients at diagnosis, hospital discharge or disease progression who might benefit from an early palliative care approach. In the UK, Australia and US, some important initiatives are gaining momentum to facilitate the delivery of primary palliative services. In Singapore, the involvement of family physicians in end-of-life care is very low. A local survey is currently being conducted to identify the challenges in getting more family physicians involved. Given adequate time and resources, community professionals throughout the world can provide effective, equitable, and accessible primary palliative care, and form a solid bridge of communication and support between primary and secondary care.