Palliativ Care

1. What palliative care is and what services it carries out

Palliative care is entirely focused on patients, who suffer from heavy and far advanced diseases. Basically it is not the extension of the patients life that is to achieve under all circumstances, but moreover an improvement of the quality of life has priority. This is to be achieved by the alleviation and prevention of discomforts, as e.g. pain, confusion and short-windedness.

In addition psychological, spiritual and emotional needs are strived to be covered. Of equal importance are socio medical and legal questions (e.g. advance directive, care and treatment issues). Palliative care is also concerned with the needs of the patients’ relatives.

Apart from doctors and nurses, it is incredibly important to be stocked with several other professional groups, amongst which physiotherapists, community workers, transition caregivers, psychologists, pastors, general practitioners, volunteers).

While in the hospital, the stabilisation of the patients’ health condition is the most central aspect, aiming to be able to release the patient to a familiar surrounding as soon as possible.

If by the time the patient already is at home, in an ideal situation palliative care could contribute to the patient living in decent conditions, surrounded by family and friend, which will help both the patients and his relatives handle the situation and support in all areas.

2. At what point palliative care should be taken into consideration

Firstly the patients’ prognosis has to be explained to himself and his relatives by the medicating doctor. Then the patient may decide to contact a palliative specialist to avoid current or estimated complaints, such as pain. An early approach has the advance of being able to put a network together before needed, which then facilitates the situation to the family, when the time comes. Expected problems can already be talked about and prepared before a situation of crisis occurs.

Mental needs, which usually appear when confronted with a incurable disease, need surveillance, why the service of a psychologist or a religious guide may be useful. It is nearly impossible to cope with this extreme situation all by oneself and therefore highly recommended to take professional support into consideration.

3. Whether palliative care implicates that there is no hope

It is a inevitable fact that everyone needs to  take farewell at some point, but that doesn’t mean that one has to give up hope. However it is the duty of the doctor to inform his patients honestly, when there is no cure to be expected. Handling the situation honestly is particularly important to be able to sustain a viable bond of trust.

As a patient one should be able to consider that chemotherapies, radiotherapies and surgery sometimes might cause greater harm than good. Therapies straining the patient, rather than to help him, should be avoided. This again does not implicate the patient being left alone or not taken care of, instead one is dedicated to alleviate the burdens.

Notably in these situations a comprehensive care of the patient is crucial, to be able to keep the life quality as high as possible. This is a demanding task for everyone, indeed.

4. Tumour treatment during palliative care

Palliative care does most certainly not exclude tumour treatment. The well-being of the patient, by means alleviating complaints and increasing the quality of life, is of primary concern, which is why every opportunity within the boundaries of modern medicine is considered.

5. How outpatient palliative care works

Within the scope of palliative care palliative patients are taken care of in a domestic environment. It is therefore the General Outpatient Palliative Cares’ (germ.: AAPV) specific goal to ensure the patients quality of life within his personal comfort zone as long as possible, to improve and to promote it (def.: German Palliative Care Society (DGP)). Medical and care support is givenby licensed general practitioners and medical specialists, such as mobile nursing services.

Whenever the given treatment methods do no longer suffice, there are special part time or permanent additional palliative physicians or a palliative team, who can be sought as a part of the services offered. However the necessity of this special treatment only occurs in very few cases.

In addition to the mentioned services there are special palliative care offers such as counselling and the possibility to reach contact support at any time.

This kind of care services are called Specialised Outpatient Palliative Supplies (germ.: SAPV). In emergency cases patients hereby have the opportunity to dial an emergency number to get immediate help. Every patient is equipped with a folder were all emergency numbers, as well as the latest medical report and medication information (special consumption guidelines).

This very useful system enables doctors, if needed, to gain a quick, but detailed overview and is further able to arrange measures with colleagues. Crisis situations are thereby easier to handle and do no longer stand in the way of caring for patients at home. As a consequence redundant hospitalisations remain evitable, which usually is in the interest of the patient.

A high standard ambulant care system for patients and their relatives facilitates a humane supply for the affected, which renders it possible for them to stay at home and to die in decent conditions.

Dr. Jorge Riera-Knorrenschild, Haematology and Oncology Clinic, Marburg