In 1990 the World Health Organization defined palliative care as ‘The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families’. These words describe how modern palliative care has developed from the passive accompanying of dying patients, to a more dynamic multidisciplinary approach which attempts to address priorities from an individual's perspective. It recognizes that patients deserve to receive such care even at early stages of their illness and that palliative care is relevant to patients both with cancer and other diseases. It emphasizes the need to support the family and carers and to continue that support into bereavement. The overarching concept is that of enabling people to ‘live well’ despite having a fatal diagnosis (Table 48.1).

Specialist palliative care requires a team approach to identify and address the issues that have a negative impact on the patient's quality of life. Specialist palliative care teams are now available as a resource to most hospitals, primary care teams and specialist inpatient units or hospices. Here, in addition to doctors and nurses, a wide range of disciplines with specialist expertise are collected.