Translating the World Health Organization definition of palliative care into scientific practice

According to the World Health Organization (WHO), palliative care is concerned with the physical, psychosocial, and spiritual problems of patients with life-threatening illnesses and of their families. This is a tall order for clinical practice, let alone scientific research. Clearly, this task cannot be mastered by one single profession, but requires a cooperation of several disciplines. This has been a hallmark of palliative care teams since the very beginning – Dame Cicely Saunders, who had been trained as a nurse, social worker, and physician, referred to herself jokingly as a “one-woman multi-professional team. ” In clinical practice the exact roles and boundaries within the palliative care team often have to be re-negotiated periodically. The blurring of professional boundaries can be very beneficial for the overall task to be accomplished, but can also lead to misunderstandings and conflicts between team members. Balfour Mount, the great pioneer of palliative medicine, has been quoted as saying: “So you worked in teams? Show me your scars. ” One way to improve this situation is to look at the specificities of each profession when analyzing palliative care service provision in research projects. Another way is to try to integrate the different professional viewpoints in palliative care research and teaching activities. This is easier said than done, though, because the culture, way of interacting, and research methodologies vary greatly among the different profession involved in palliative care. True interdisciplinary research has to start by acknowledging the unique contribution that each profession and discipline brings to the whole. Even more importantly (and difficult for some, especially doctors) is the acknowledgement of the fact that nowadays no single profession has the ultimate say with regard to the primary outcome in palliative care: the quality of life of patients and their families. Rather, a multiperspective approach is required, taking into account the strengths and weaknesses of each discipline and methodology. To achieve this goal, it is necessary to allow for each profession to develop its own scientific standpoint within palliative care research, and to then integrate the various perspectives in an interdisciplinary fashion, without pre-conceived hierarchies. In Europe, this has traditionally not been the case so far. Professorships in clinical subjects at medical faculties are usually strictly limited to physicians, and the focus of clinical research is almost uniformly mono-disciplinary. In some instances, this has led to a problematic evolution in the understanding of palliative medicine as a clinical and scientific discipline. Especially in countries such as Germany and Italy, there is a strong push to define palliative medicine as a kind of sub-discipline of pain therapy, and to focus research in the field almost exclusively on pharmacological pain treatment and symptom control. This approach has the strong backing of the pharmaceutical industry, is easier for the medicalized healthcare system to understand, and is therefore more likely to attract funding. Thus, it represents a significant threat to the holistic approach of palliative care. The only effective counter-measure to such an evolution appears to be a strengthening of palliative care as a self-standing, trans-disciplinary academic subject, with independent chairs and autonomous research programs, in accordance with the WHO definition. In order to achieve this goal, a multiprofessional academic network is required. At the Interdisciplinary Center for Palliative Medicine of the Munich University Hospital, such a network has been created thanks to the generosity of several donors, who have allowed for the establishment of four endowed professorships covering the three main domains of palliative care defined by the WHO (Figure 1):