Tens of millions of people die every year in the world. And many of them experience monstrous suffering. Palliative care is designed to improve the quality of life of people suffering from various forms of chronic diseases in the terminal stage, when all the possibilities of specialized treatment have already been exhausted. This field of he althcare does not aim to achieve long-term remission or prolong life, but it does not shorten it either. The ethical duty of he alth workers is to alleviate the suffering of a sick person. Palliative care is available for anyone who has an active progressive disease and is approaching a lifeline. The main principle: no matter how severe the disease, you can always find a way to improve the quality of life of a person in the remaining days.
On the issue of euthanasia
Palliative care does not accept physician-mediated euthanasia. If the patient asks for this, it means that he is experiencing great suffering and needsimproved care. All actions are precisely aimed at relieving physical pain and eliminating psychosocial problems, against which such requests often arise.
Goals and objectives
Palliative care affects many aspects of the lives of terminally ill people: psychological, medical, cultural, social, spiritual. In addition to the relief of pathological symptoms and pain relief, the patient also needs moral and psychosocial support. Help is also needed for the relatives of the patient. The term "palliative" comes from the Latin word pallium, which means "cloak", "mask". This is where the whole point lies. Palliative care for cancer patients, people with other serious illnesses is aimed at smoothing out, hiding, masking the manifestations of an incurable disease, figuratively speaking, covering with a cloak, a cover and thus protecting.
Development history
A group of experts in the 1970s organized a movement for the development of palliative care under the supervision of WHO. In the early eighties, WHO began to develop a global initiative to implement measures that would ensure the availability of apioids and adequate pain relief for cancer patients around the world. In 1982, a definition of palliative care was proposed. This is a comprehensive support for patients whose diseases are no longer amenable to treatment, and the main goal of such support is to relieve pain and other symptoms, as well as to solve the psychological problems of the patient. Soon, this area of he alth accepted the status of an officialdisciplines with their own clinical and academic positions.
Modern approach
Palliative care, as defined in 1982, was interpreted as support for those patients for whom radical treatment is no longer applied. This formulation narrowed this area of he alth care to care provided only in the last stages of illness. But today it is a generally accepted fact that support of this nature should be extended to patients with any incurable diseases in the terminal stage. The change came from the realization that the problems that arise at the end of the life of the patient actually originate in the early stages of the disease.
In 2002, due to the spread of AIDS, the continuing increase in the number of cancer patients, the rapid aging of the world's population, WHO expanded the definition of palliative care. The concept began to spread not only to the patient himself, but also to his relatives. The object of care is now not only the patient, but also his family, which, after the death of a person, will need support in order to survive the severity of the loss. So, palliative care is now a direction of social and medical activity, the purpose of which is to improve the quality of life of terminally ill patients and their families by alleviating and preventing suffering through the relief of pain and other symptoms, including psychological and spiritual ones.
Guidelines
As defined, palliative care for cancer patients and peoplewith other incurable diseases:
- affirms life, but at the same time considers death as a normal natural process;
- designed to provide the patient with an active lifestyle as long as possible;
- has no intention of shortening or prolonging life;
- offers support to the family of the patient, both during the course of his illness and during the period of bereavement;
- aims to meet all the needs of the patient and his family members, including the provision of funeral services, if necessary;
- uses an interprofessional approach;
- improves the quality of life and positively affects the course of the patient's illness;
- may prolong life with timely interventions in conjunction with other treatments.
Directions
Palliative care is delivered in two ways:
1) ease the suffering of the patient in the course of the disease;
2) show support in the last months and days of life.
The leading components of the second direction are the provision of psychological assistance to the patient himself and his family members, the formation of a special philosophy. As we have said more than once, palliative care is the deliverance of a dying person from suffering. And what is the essence of suffering? This is pain, and the inability to serve oneself independently, and limitation of life, and the inability to move, and guilt, and the fear of death, and the feelinghelplessness, and bitterness over unfulfilled obligations and unfinished business. The list can be continued for a long time… The task of specialists is to develop in the patient an attitude towards death as a normal (natural) stage of the human path.
Organization of palliative care
According to the WHO definition, care should begin from the moment a terminal illness has been diagnosed that will inevitably lead to death in the foreseeable future. The more correctly and quickly support is provided, the more likely it is that its main goal will be achieved - the quality of life of the patient and his family members will improve as much as possible. As a rule, at this stage, palliative care for children and adults is provided by doctors involved in the treatment process.
Directly hospice care is required when radical treatment has already been carried out, but the disease progresses and acquires a terminal stage. Or when the disease was discovered too late. That is, we are talking about those patients to whom doctors say: “Unfortunately, we can’t help in any way.” It is at this time that the same hospice support is required, in other words, help at the end of life. But it is necessary only for those patients who experience suffering. Although it is difficult to imagine a dying person who does not worry about this at all. But maybe there are some…
Groups of patients in need of help
- people with stage 4 cancers;
- end-stage AIDS patients;
- people with non-oncological progressive chronic diseases that have an end-stage development (lung, kidney, heart, liver failure in the stage of decompensation, complications of circulatory disorders in the brain, multiple sclerosis).
Hospice care is provided to those whose life expectancy does not exceed three to six months, when it is obvious that attempts at treatment are no longer appropriate, when the patient experiences symptoms that require special care and symptomatic therapy using special knowledge and skills.
Support Forms
Palliative care delivery varies. Each country develops its own plan. WHO recommends two types of support: in hospital and at home. Specialized institutions providing palliative care are hospices and departments based on oncology dispensaries, general hospitals, and social protection hospitals. In-home support is provided by field service specialists, who act as independent structures or are part of medical institutions.
Since most people prefer to spend the rest of their lives at home, the development of a second option for palliative care seems more appropriate. However, in Russia the vast majority of such patients die in hospitals, because at home relatives cannot create conditions for their maintenance. In any case, the choice ispatient.
