By Cara Pearson, MPH & Kelli Stajduhar, RN, PhD
Palliative care is not normally considered a public health issue, but the current prevalence of chronic health conditions indicates that this might be an important connection to make.
Focusing on health promotion opportunities in palliative care, a literature scoping review was conducted. The first step was a systematic search of peer-reviewed literature, which retrieved 36 articles on this topic.
These articles were then thematically analyzed in order to better understand the intersections between health promotion and palliative care.
Four key themes were identified:
1. Health promotion over the life course: It is important to maximize health and well-being, even in the presence of a serious illness; this extends right to the end of life and to the idea of promoting a good death – a notion referred to as health promoting palliative care.
2. Universal, social experiences: Interpersonal social support is vital, particularly for coping during serious illness and for those dealing with bereavement; since people spend most of their time in communities, communities play an important role providing social support.
3. Sharing information and working together: There are benefits to health care service providers who work with the dying when they partner with community organizations. Such collaborations can work to empower citizens to participate more fully in their health care and can provide the impetus to building public dialogue that is more inclusive of people experiencing serious life-limiting illness.
4. Reorientation of health care services: Population aging, increasing chronic disease prevalence and fiscal restraint all necessitate a conceptual shift to the way health care services are offered. Improving earlier (“upstream”) care for people living with life-limiting illness can maximize their current health while aiming to prevent future exacerbation.
These findings indicate the need for more collaboration between public health and health care practitioners working with the dying. Building community capacity for social support is one goal. Another goal of collaboration is to be more inclusive of each practice’s target populations. Palliative care is often targeted toward people with cancer, and is often conflated with end of life care.
There is a need to expand this type of care beyond people who experience cancer illnesses and to consider how the holistic model of palliative care might benefit people earlier in the course of any chronic life-limiting illness. The literature suggests that health promotion efforts have been accused of being death-denying, indicating a potential need to extend health promotion principles throughout the entire life course to avoid excluding people who could benefit from the application of the principles of palliative care.
A third goal of collaboration includes building a public dialogue around serious illness and dying. For some, these are taboo subjects, and as a result people who face these issues may feel left out. Building a dialogue can not only help people feel included, but also can encourage preparation and planning before a personal crisis occurs.
Interestingly, both health promotion and palliative care began in response to the perceived over-medicalization of health. Collaboration between these complementary fields could benefit the health of individuals and communities through a focus on reintegrating serious illness back into its inherent social context.
This scoping review was conducted by Cara Pearson during a practicum placement as part of a Master of Public Health culminating project, under the supervision of a School of Nursing faculty member, Kelli Stajduhar.
From the 2015 Fall Communiqué — Public Health
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