In a total sense of the response to these levels of differentiation of care, the basic requests required are the professional’s training, the advanced planning, the continuity and availability of these types of care as well as the attention for the relative preference to the local where the patient wants to be cared [41, 42].

In concrete, when it comes to services of palliative care that are specialized, these are developing all over the world. Initially focused to the oncology patients, but nowadays they are also for other terminal illnesses [43].

Looking to give answers to the desires and patients’ preferences, relatively to the local where they’d like to receive care and where they’d prefer to die, it is necessary various ways of typologies of specialized resources, organized under a network of palliative care . These typologies can be under the form of unity of palliative care, hospital team of support in palliative care, palliative care team of household and day centers [41].

An Palliative Care Unit (PCU) gives care to hospitalized patients, being that a service who is specifically destined to treat and care of the palliative patient, being able to be on a acute patients’ hospital, non-acute patients, on a ward on the inside or an adjacent structure to that hospital. It can be completely autonomous of an hospital’s structure. It should always work in a perspective of an early discharge with transference to another typology of care, unless it is dedicated to an unity like an hospice, where the patient will remain, if he desires or if he has to, until he dies. It is estimated that this need of typology of resources in 80–100 beds per million of habitants, being that each unity must have rather 8–12 beds [41].

The Hospital Palliative Care Support Team provides counseling in palliative care and support to every structure of the hospital, patients, family and caregivers in hospital environment. It also provides education formal and informal and interlocks with other services in and out of the hospital [41]. It gets better with the given care, and decreases the number of unities of intensive care’s use and the probability of patients dying there, as well as other services’ costs, although that it facilitates the transferences between household and hospital. On the other hand, it allows a better use of opiates as well as a better documentation of objectives and patients’ preferences, being the intervention well noted by the patient and their family and it constitutes as an important strategy to the better quality of care [41, 44]. It is estimated that the need of 1 team per hospital is at the minimum 1 per each hospital with 250 beds [41].

The Home Palliative Care Team provides care to patients that need to be cared by household caregivers, in their homes and they also support their family members and caregivers of the patients. They also provide counseling to general clinics, family doctors and nurses that are household caregivers [41].

The Day Care Centres are spaces in hospitals, in unities of palliative care or in the community, specially conceived to promote therapeutic activities and recreative of palliative patients. They offer to patients the possibility to participate in activities that are not possible in other structures, including in their homes, plus clinical supervision and this way, to allow the relief of overcharge of the families and caregivers. It is estimated that the need of 1 day center per each 150,000 habitants [41].

According Gómez-Batiste [45], the answer to the needs of different groups of patients with severe and terminal illness goes by the development of a network enlarged and integrated in services that covers since the household until the care in unities of hospitalized care specified incorporated or not in acute hospitals. The articulation on the diverse services becomes this way fundamental to assure the continuity of cares and their respective quality (Fig. 42.2).

Also the International Association for Hospice and Palliative Care through their document “Guidelines and Suggestions for those Starting a Hospice/Palliative Care Service”, [46] refer that there isn’t an unique and ideal model for palliative care , since that these shouldn’t be determined based on the local needs and resources. Meanwhile, it is recommended the existence of a reference service, with dedicated teams exclusively to this type of care – unities of internment and household – being that it is consensual that the team must possess education in a way that they acquire competences within palliative care to implant basic palliative measures, generals, as well as palliative actions.

The creation of new services of palliative care must phased develop, evolving progressively with various typologies. They must implant teams of support – home and hospital teams – as responses to the palliative needs because they evolve less technical resources, they have costs relatively lows and they can develop their activity in a gradual and controlled way [41] (Fig. 42.3).

The complexity of evaluation of the impact of palliative care is bigger than in other fields of medicine, since the principal outcome is the improvement of quality of life, which leads to an evaluation much more difficult, in the last days of life, because of the lack of instruments to this phase and at the end of the process happening the death of the patient [47]. The quality of life can be improved without measure, meanwhile, measuring has a big role in the improvement of the patient, helping promoting change [48, 49]. On the other hand, near to the end of the life, the clinical priorities change, as in the evaluation measures must adjust to these new objectives [50].