Meeting end-of-life care needs for people with chronic disease: palliative care is not enough

Teresa A Burgess, Annette J Braunack Mayer, Gregory B Crawford and Justin J Beilby
Med J Aust 2013; 198 (4): . || doi: 10.5694/mja12.11058
Published online: 4 March 2013

. . . but what should a system that successfuly combines interventional and palliative approaches look like?

Considerable efforts have been made, both nationally and internationally, to address the growing “epidemic” of chronic disease. Chronic disease accounts for more than half of all Australian deaths,1 treatment of chronic disease in Australia accounts for almost 70% of total health expenditure2 and hospitalisations associated with chronic disease are a major component of this expenditure (see the Box for a definition of chronic disease as used in the context of this article). Systematic processes to prevent and manage chronic disease have been developed, and all incorporate the concept of a continuum of care from prevention and early intervention, through disease management to the end of life.2 While there is a strong focus on systematic care, health education, chronic disease self-management and regular review, comparatively scant attention is paid to the actual care required as people approach the end of their life.

  • University of Adelaide, Adelaide, SA.

Competing interests:

No relevant disclosures.

  • 1. Australian Institute of Health and Welfare. Australia’s health 2010. (AIHW Cat. No. AUS 122.) Canberra: AIHW, 2010. (accessed Sep 2012).
  • 2. National Health Priority Action Council. Health priorities: National Chronic Disease Strategy. Canberra: Australian Government Department of Health and Ageing, 2006.
  • 3. Palliative Care Australia. Palliative and end of life care. Glossary of terms. Edition 1. Canberra: PCA, 2008.
  • 4. Australian Commission on Safety and Quality in Health Care. Patient centred care: improving quality and safety through partnerships with patients and consumers. Sydney: ACSQHC, 2011. (accessed Feb 2013).
  • 5. Australian Government Department of Health and Ageing. National Palliative Care Strategy 2010. Canberra: Commonwealth of Australia, 2010.
  • 6. Callahan D. End-of-life care: a philosophical or management problem? J Law Med Ethics 2011; 39: 114-120.
  • 7. Philip J, Gold M, Brand C, et al. Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals. Intern Med J 2012; 42: 816-822.
  • 8. Crawford G, Brooksbank M, Brown M, et al. The unmet needs of people with end-stage chronic obstructive pulmonary disease: recommendations for change in Australia. Intern Med J 2013; 43: 183-190.
  • 9. Mitchell G, Johnson K, Thomas K, Murray S. Palliative care beyond that for cancer in Australia. Med J Aust 2010; 193: 124-126. <MJA full text>
  • 10. UK Department of Health. End of life care strategy. Promoting high quality care for all adults at the end of life. London: NHS, 2008. (accessed Feb 2013).
  • 11. Kellehear A. Health promoting palliative care. Melbourne: Oxford University Press, 1999.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.