**3. Palliative care levels**

#### **3.1 Basic palliative care approach**

It is a system where palliative care principles are applied by all health professionals and clinicians [4, 22]. Most patients with severe and progressive diseases are cared for by these clinicians in the hospital. Thus, this system focuses on the principle that all clinicians should have good knowledge and skills about the palliative care approach [23]. Therefore, these clinicians should be able to meet the healthcare needs of these patients who need palliative care [4, 22, 23].

#### **3.2 General palliative care**

At this level palliative care will be provided to the patients and their families by non-palliative care physicians and nurses who have palliative care experience. This understanding is defined as an intermediate level of palliative care, and a full-time palliative care is provided at this level [4]. These services can be provided in private centers or nursing homes. On certain days of the week and at certain times, a physician reviews the palliative care requirements at the care center where these patients are staying. He/she plans symptomatic therapy. Nurses work for limited hours in these centers. Other auxiliary health personnel also help with palliative care [23]. When complex cases occur at the level of general palliative care, these cases are referred to centers providing palliative care at a more advanced care level. This team also works as a local resource and training group [1, 17].

#### **3.3 Specialist palliative care**

This level of palliative care approach requires patient and family care and support depending on patient needs and available resources. There is a multidisciplinary approach to health care [1, 23]. This is the branch of specialization whose primary training and service area is palliative care. This branch deals with complex patients who require more time and need more care and require higher education and more staff and resources [4]. Palliative care specialists and other healthcare professionals trained in palliative care serve complex patients who need more care in hospitals or palliative care centers and hospices. In developed western countries, physicians who complete their education as an assistant in palliative care or palliative medicine departments in medical faculties are entitled to receive a palliative care certificate. Palliative care professionals are assigned to palliative care services of university hospitals or other hospitals or may work as a consultant in these services. Palliative care specialists may be consulted for patients in the ICU or other departments [23]. This team also works as a national resource and training group [1, 17].

#### **4. Palliative care delivery models**

Palliative care is delivered to the patients via four main models [1, 17].

#### **4.1 Ambulatory palliative care clinics**

This care for outpatient patients can be delivered in inpatient units, nursing homes, or other units, and patients can visit these places for 1 or several days a week for palliative care. These services include services such as medical support such as blood transfusion, pain treatment, symptomatic treatment, social services such as shower and bath, physiotherapy/vocational training, rehabilitation, massage, or psychosocial and spiritual support [4]. These centers offer low-cost care; hence, these centers have come to the forefront in recent years. In these clinics, services such as symptom control and nutritional support are provided, and patients and their families are supported psychosocially and morally. Families of patients are also trained in care [4, 15, 17].

#### **4.2 Home-based palliative care**

Healthcare professionals or nonprofessional caregivers provide care to the patient in their homes. In this way, hospital-level palliative care is provided at the

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*Palliative Care Services from Past to Present DOI: http://dx.doi.org/10.5772/intechopen.88990*

**4.3 Inpatient palliative care units**

met adequately [1, 17].

**4.4 Inpatient consultation services**

**5. Palliative care practices in the world**

patient's home. Home-based palliative care is based on traditional medical care and a supportive institutional model (hospital) [1, 13]. The patient can reach the palliative care support 24 hours a day, 7 days a week. In the home-based palliative care model, symptom control and terminal care services and basic needs of cancer

These are the units in a hospital where the primarily responsible official is an internal medicine specialist or general surgeon and recommendations and support are frequently received from specialized palliative care staff [4]. In recent years, an increased number of hospital-based palliative care programs have been available to palliative care patients. General patient services in these clinics may not be appropriate for cancer patients with specific physical and psychosocial problems and who require a specialized approach. When a patient's care at home becomes harder in the advanced stage of the disease, palliative care centers accept the patient and support both the patient and his/her family in terms of pain relief, nutrition, psychological and social support, care, and training of the family [1, 4]. These units have improved care quality and reduced care costs for complex, high-risk patients who suffer from pain and other symptoms and whose basic needs are not

Providing services through consultancy is the most frequently used information method from past to present. Consulting services are an on-demand evaluation and management service [8, 10]. Clinical care may be requested by clinical physicians or other health professionals according to the care needs of inpatients. In palliative care, inpatient counseling services are provided by an interdisciplinary team. The team includes social workers, priests, psychologists, volunteers and therapists, and primarily doctors and nurses trained in palliative care services [4, 24]. This system provides uninterrupted service every day and every hour of the week. It is advantageous for it to be cost-effective because it contains fast, low-resource applications [4, 8, 24].

Throughout the history of humanity, all societies have endeavored to provide adequate care, support, and respect to patients and the dead. In this historical process, as a result of the ever-increasing innovations in drug therapy since the 1950s and the better understanding of the dying patient's psychosocial and spiritual needs, the foundation of palliative care principles was laid [4]. Hospices were first established at the beginning of Christianity during the Roman Empire. In the fourth century AD, these places were transferred to religious institutions. Although this tradition was tried to be kept alive in the middle ages, many of the hospices were closed or converted into monasteries during the Reform period. This continued until the nineteenth century until Jeanne Garnier opened the first hospice center

The first modern hospice named "Saint Christopher," founded by Dr. Cicely Saunders in London in 1967, laid the foundations for palliative care in the world and inspired other countries and people. With this hospice, protocols for palliative care of terminal patients were identified, and the number of palliative care providers increased rapidly in the United Kingdom and other European countries [25]. America and other

(Calvaire) in France in 1842, dedicated to terminal patients [11].

patients are available through palliative care units at hospitals [17].

#### *Palliative Care Services from Past to Present DOI: http://dx.doi.org/10.5772/intechopen.88990*

*Palliative Care*

**3.2 General palliative care**

**3.3 Specialist palliative care**

**4. Palliative care delivery models**

**4.1 Ambulatory palliative care clinics**

trained in care [4, 15, 17].

**4.2 Home-based palliative care**

At this level palliative care will be provided to the patients and their families by non-palliative care physicians and nurses who have palliative care experience. This understanding is defined as an intermediate level of palliative care, and a full-time palliative care is provided at this level [4]. These services can be provided in private centers or nursing homes. On certain days of the week and at certain times, a physician reviews the palliative care requirements at the care center where these patients are staying. He/she plans symptomatic therapy. Nurses work for limited hours in these centers. Other auxiliary health personnel also help with palliative care [23]. When complex cases occur at the level of general palliative care, these cases are referred to centers providing palliative care at a more advanced care level. This team

This level of palliative care approach requires patient and family care and support depending on patient needs and available resources. There is a multidisciplinary approach to health care [1, 23]. This is the branch of specialization whose primary training and service area is palliative care. This branch deals with complex patients who require more time and need more care and require higher education and more staff and resources [4]. Palliative care specialists and other healthcare professionals trained in palliative care serve complex patients who need more care in hospitals or palliative care centers and hospices. In developed western countries, physicians who complete their education as an assistant in palliative care or palliative medicine departments in medical faculties are entitled to receive a palliative care certificate. Palliative care professionals are assigned to palliative care services of university hospitals or other hospitals or may work as a consultant in these services. Palliative care specialists may be consulted for patients in the ICU or other departments [23]. This team also works as a national resource and training group [1, 17].

Palliative care is delivered to the patients via four main models [1, 17].

This care for outpatient patients can be delivered in inpatient units, nursing homes, or other units, and patients can visit these places for 1 or several days a week for palliative care. These services include services such as medical support such as blood transfusion, pain treatment, symptomatic treatment, social services such as shower and bath, physiotherapy/vocational training, rehabilitation, massage, or psychosocial and spiritual support [4]. These centers offer low-cost care; hence, these centers have come to the forefront in recent years. In these clinics, services such as symptom control and nutritional support are provided, and patients and their families are supported psychosocially and morally. Families of patients are also

Healthcare professionals or nonprofessional caregivers provide care to the patient in their homes. In this way, hospital-level palliative care is provided at the

also works as a local resource and training group [1, 17].

**96**

patient's home. Home-based palliative care is based on traditional medical care and a supportive institutional model (hospital) [1, 13]. The patient can reach the palliative care support 24 hours a day, 7 days a week. In the home-based palliative care model, symptom control and terminal care services and basic needs of cancer patients are available through palliative care units at hospitals [17].
