Palliative Care in Chronic Illness and Multimorbidity

Extended chronic phases of life-limiting illness and increasing multimorbidity present growing challenges that require a new approach to healthcare. A population-based approach is needed to harmonize policies, systems, and services relating to chronic and palliative care. Partnerships are needed between different healthcare disciplines and specialties, and between health services and communities. Technology will likely play an increasingly important role in transferring real-time information (including advance care planning), delivering virtual clinical assessment and care, and strengthening care coordination. During periods of stability, people with chronic illness and their families should be actively involved in keeping well and helped to “prepare for the worst while hope for the best” to support sustained coping. A rapid response is needed to clinical events that helps people return to stability and optimal function, and institutes preventative action to reduce the risk of future clinical events wherever possible. Transitions between chronic and end of life phases of illness and different settings (community, residential, and hospital) need focal support to prevent people “falling through the gaps.” The optimal timing of referral to specialist palliative care services is the subject of ongoing debate and research, but there is consensus that referral should be based on need rather than on diagnosis. Consumer advocacy is likely to play an important role in raising awareness about the need for palliative care during the chronic phase of illness and advocating for appropriate resourcing, policy, and legislation.