BMJ Support Palliat Care doi:10.1136/bmjspcare-2012-000359
  • Features

Circles of care: should community development redefine the practice of palliative care?

  1. Deborah Morris7
  1. 1Department of Palliative Care, Weston Area Health Trust and Weston Hospicecare, Weston-super-Mare, UK
  2. 2Centre for Death & Society, University of Bath, Bath, UK
  3. 3Palliative Care Unit, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
  4. 4Calvary Centre for Palliative Care Research, Australian Catholic University and Calvary Health Care, Canberra, Australia
  5. 5School of Social Science and Psychology, University of Western Sydney, Sydney, New South Wales, Australia
  6. 6Social & Behavioural Sciences, CSIRO Perth, Wembley, Western Australia, Australia
  7. 7Palliative Care Unit, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to: Dr Julian Abel, Department of Palliative Care, Weston Area Health Trust and Weston Hospicecare, C/o Jackson-Barstow House, 28 Thornbury Road, Uphill, Weston-super-Mare, Somerset BS23 4YQ, UK; julian.abel{at}, abelju{at}


Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. This has mostly been done in the context of a service delivery approach to care whereby services have become increasingly expert in identifying health and social care need and meeting this need with professional services. This model of patient centred care, with the impeccable assessment and treatment of physical, social, psychological and spiritual need, predominantly worked very well for the latter part of the 20th century. Over the last 13 years, however, there have been several international examples of community development approaches to end of life care. The patient centred model of care has limitations when there is a fundamental lack of integrated community policy, development and resourcing. Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.

  • Received 9 October 2012.
  • Revision received 2 January 2013.
  • Accepted 3 February 2013.
  • Published Online First 5 March 2013

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