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Six factsaboutpalliativecare

Most of the healthcare professionals will deal with people who suffer from life-threatening diseases during their practice. The role of palliative care is to improve the quality of life of these patients and of their families.

The following six facts should be known to all physicians and nurses.

Palliative care is not about death, it is about the life before death.

Palliative care specialists don't help people die, they help people live the days that remain as well as possible. This care begins with the first appearance of the disease.

Many people think that palliative care is focused on the end of life only. Though caring for the dying is an important part of palliative care, its scope is in fact much broader.

Paliativní péče začíná v momentě diagnózy a končí podporou rodiny během zármutku.
Paliativní péče začíná v momentě diagnózy a končí podporou rodiny během zármutku..

Research data show that even patients undergoing curative treatment can significantly benefit from palliative care.

For that reason many professional health associations recommend the integration of palliative care into the therapeutic process of all patients in advanced phases of disease.

Palliative care is not addressed exclusively to cancer patients. It is a developing field in all medical specialties that deal with chronic diseases.

    Sources

  • Smith TJ, et al. (2012). American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of Clinical Oncology, 10(30):880-887.
  • Boersma I, et al. (2014). Palliative care and neurology: Time for a paradigm shift. Neurology, 83(6):561-567.
  • Lanken PN, et al. (2008). An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. American Journal of Respiratory and Critical Care Medicine. 177(8):912-927.
  • Selecky PA, et al. (2005). Palliative and end-of-Life care for patients with cardiopulmonary diseases: American College of Chest Physicians position statement. CHEST, 128(5):3599-3610.

Not all diseases can be cured, but that does not mean there is nothing to be done for patients suffering from incurable diseases.

Palliative care is focused on improving the quality of life of patients with incurable diseases and their families.

Palliative care specialists accompany the patients and their families until the very last moment and they help to relieve pain, breathlessness, anxiety and other problems affecting patients.

Palliative care is provided by a multidisciplinary team taht includes a doctor, a nurse, a social worker, a psychologist and a chaplain. Together with the patient and his family the team works out the best options, so as to provide the best quality of life possible in any given situation. In cooperation with specialists from various medical specialties, the palliative care team helps patients cope with physical, psychological and spiritual problems, and thus offers comprehensive care.

This care may be provided in hospices, hospitals, at home, nursing homes or anywhere else, where it best suits the patient.

For palliative care, the cooperation of family, patient and multidisciplinary team is fundamental.
For palliative care, the cooperation of family, patient and multidisciplinary team is fundamental…

    Sources

  • Definition and goals of palliative care on the EAPC website:
    http://www.eapcnet.eu/Corporate/AbouttheEAPC/Definitionandaims.aspx
  • El-Jawahri A, et al. (2011). Does palliative care improve outcomes for patients with incurable illness? A review of the evidence. Journal of Supportive Oncology, 9(3):87-94.
  • Zimmermann C, et al. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930):1721-1730.
  • Blackhall LJ. Amyotrophic lateral sclerosis and palliative care: Where we are, and the road ahead. Muscle Nerve. 2012;45(3):311-8.
  • Gomes B, et al. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews, Issue 6, Art. No. CD007760.

Discussion with patients approaching the end
of their life cannot
be avoided.
Be ready for it.

Whether you are a surgeon, an oncologist, a dentist or an opthalmologist, you are almost sure to meet in your practice with patients suffering from advanced chronic diseases that cannot be cured.

In hospitals there are at every given moment approximately 30% of patients who have before them less than one year of life.

According to research by the University of Glasgow, in hospitals there are at any given moment approximately 30% of patients who have less than one year of life ahead of them.

Even if you only have a marginal role in caring for these patients, knowledge of general palliative care principles can be of great help in care planning and in communication with the patients and their families.

    Sources

  • Quill TE, Abernethy AP (2013). Generalist plus specialist palliative care - creating a more sustainable model. New England Journal of Medicine, 368(13):1173-1175.
  • Clark D, et al. (2014). Imminence of death among hospital inpatients: Prevalent cohort study. Palliative Medicine, 28(6):474-479.

Contact with a palliative care specialist does not mean that death is imminent.

Patients given the option of benefitting from palliative care have a better chance of living longer than patients who have no access to palliative care.

The study from Harvard Medical School has shown that thanks to palliative care the chance of survival of patients with advanced lung cancer was prolonged by 24%.
The study from Harvard Medical School has shown that thanks to palliative care the chance of survival of patients with advanced lung cancer was prolonged by 24%.

Research data refute the myth that initiating palliative care amounts to delivering a death sentence for the patient. The data do not prove that with the initiation of palliative care, patients live shorter than without it.

On the contrary, research data imply the opposite effect. In some studies patients who benefitted from palliative care lived longer than patients who received only standard treatment, while at the same time it was possible to preserve a higher quality of life, better symptom control and to achieve greater satisfaction with the care provided to them and to their families.

    Sources

  • Higginson IJ, et al. (2014). An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. The Lancet Respiratory Medicine, 2(12):979-987.
  • Temel JS, et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363(8):733-742.
  • Connor SR et al. (2007). Comparing hospice and nonhospice patient survival among patients who die within a three-year window. Journal of Pain and Symptom Management. 33(3):238-246.
  • Bakitas M, et al. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. 302(7):741-749.

The importance of palliative care is growing.

Chronic diseases are the major health threat in Europe – more than 80% of people aged 65 and over suffer from them and they cause 86% of all deaths.
Palliative care is an indispensable component in dealing with this problem in the future.

The World Health Organization, health ministers of the European Union as well as governments from all over the world consider palliative care as a key element of the health care system in dealing with chronic diseases.

In the light of demographic trends and rapidly ageing populations it is important to have appropriate tools to ensure the accessibility of care that responds to both the needs and the wishes of patients.

Prognóza: podíl lidí starších 65 let v ČR.
Prognosis: rate of population older than 65 years in the Czech Republic. (source)

Palliative care is a modern and rapidly growing field to which top world institutions are committed.

Harvard, Yale, Johns Hopkins. The world’s best medical schools have their palliative care departments, which as well as undertaking clinical work with patients also develop research and innovative forms of education for their students.

For some people, palliative care is only associated with non-profit and charity organizations and enthusiastic volunteers. But palliative care is a regular part of modern medicine.

In Germany, palliative care is a compulsory subject in all medical schools; in the USA more than 80% of hospitals have their own palliative care departments, and in England even paediatric palliative care specialisation is available. Scientific articles about the impact and benefits of palliative care are published in the most influential medical journals like the New England Journal of Medicine, JAMA or The Lancet.

    Sources

  • HMS Center for Palliatve Care
    http://www.hms.harvard.edu/pallcare/
  • Yale School of Medicine - Palliative and End-of-Life Care Education
    http://palliativecare.yale.edu
  • Quill TE, Abernethy AP. (2013). Generalist plus Specialist Palliative Care – Creating a More Sustainable Model. New England Journal of Medicine, 368(13), s.1173-1175.
  • Parikh RB et al. (2013). Early Specialty Palliative Care – Translating Data in Oncology into Practice. New England Journal of Medicine, 369(24), s.2347-2351.