The concept of rehabilitation may seem paradoxical in palliative care, especially for patients with an advanced illness who are approaching death. However, the World Health Organization identified that palliative care offers a support system to help patients live as actively as possible until death. In this context, rehabilitation becomes an essential component of palliative care rather than an additional luxury. It is an approach to care that focuses on setting goals, re-enabling patients, and in helping them to adapt to their changed circumstances so that they may live fulfilling lives. Maximizing an individual’s psychological and physical potential should be realistic objective for all patients at all stages of their illness.

Cancer patients are now being referred earlier to specialist palliative care in their disease trajectory and are often in receipt of concomitant active therapies. Increasing numbers of patients with non-malignant conditions are being referred for palliative care advice. Palliative care has both welcomed and embraced these changes. As palliative care continues to diversify, it is likely that specialists will care for an increasing number of patients who have disabilities as a result of either their disease process or their treatment. These specialists have developed appropriate skills in multidisciplinary teamworking and patient-centred care and are ideally placed to develop further key skills in goal-setting and in helping patients to readapt. The change in the pattern of referral to palliative care has significant implications for services that adopt a rehabilitative model. Whether the provision of rehabilitation for patients with progressive disease should be the preserve of specialist palliative care clinicians is the subject of ongoing debate. There is scant evidence that such expertise is currently being provided by specialists outside of palliative care. We suggest that Specialist Palliative Care needs to be proactive in supporting patients with both palliative and rehabilitative care needs, and the emerging picture of cancer as a chronic illness makes this provision all the more imperative. These individuals require a multiprofessional approach to their care that addresses their complex and varied needs. The rehabilitative approach acknowledges these issues and, in doing so, enhances quality of life. It enables patients to find positive meaning in situations that may previously have been perceived as hopeless and, when appropriate, enables patients to prepare for their approaching death.

Related Articles