Supportive and palliative care in the age of deferred death: primary care’s central role

Globally, as the number of older people increases due to improved medical interventions, the ageing population is predicted to see an increase in deaths, with causes for death changing significantly. This has already begun, with previously fatal illnesses being tamed or prevented, ultimately deferring death. Both primary and palliative care emphasises comprehensive whole person care, suitable in supporting patient needs at their end of life. A number of facilitators and barriers for primary care practitioner involvement in palliative care exists. Facilitators include ensuring sufficient staff to provide in-depth care, and remuneration that supports adequate time and resources. Barriers include a lack of recognition of primary care clinician’s ability within the specialist community, which can deter specialists from sharing care. To make supportive and palliative care integrated and predominantly primary care-delivered, practitioners should seek out at-risk individuals to anticipate their needs as they approach their end of life. Preparation and planning must then follow, and working across specialist boundaries is essential. Comprehensive system and attitude change must occur to ensure more effective, primary-care delivered end of life care.