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Palliative care – what is it?

by Josephine Andrews
Published: Last Updated on 122 views

Saying goodbye to life is hard. Palliative medicine aims to make life easier for people with incurable diseases. The focus is not on giving life more days, but more life on the days.

Palliative medicine begins at the latest when the medical options for curing an illness have been exhausted and life expectancy is only limited. The most important goal of palliation is to alleviate the patient’s symptoms and give them the best possible quality of life. This also includes, in consultation with the patient, to refrain from possibly life-prolonging therapy if this would be accompanied by disproportionate suffering.

What does “palliative” mean? The term palliative care comes from the Latin word “palliare”, meaning “to enclose with a cloak”. He is aiming at the protective, nurturing thought that palliative medicine originates from. Palliative thinking means affirming life in principle and yet accepting death as a natural process

More than terminal care

Palliative medicine / palliative care is not limited to the last phase of life. Even if a seriously ill person may live for years to come, palliative principles can help them to have a better quality of life and as little pain and anxiety as possible from the time of diagnosis. In many cases, however, it is also possible to use palliative approaches alongside a (curative) therapy aimed at healing.

Alleviate and accompany pain

An essential part of palliative medicine is the best possible alleviation of physical symptoms – for example through sophisticated pain therapy and alleviation of nausea or shortness of breath. In this regard, palliative care has made significant advances in recent years.

Just as important as physical care is the psychosocial and often also the spiritual support of patients in the context of palliative medicine. Here the caregivers help the patient to accept the inevitable, to make peace with their own destiny and to get a grip on the fear of pain and dying.

Palliative care is always teamwork. Doctors, nurses, social workers, psychologists, physical therapists and chaplains work together to provide comprehensive care for the sick. They are often supported by volunteers who are specially trained in terminal care.

Patients’ worries about their relatives also have a place in palliative care. For example, how the family can get along without them – mentally, but maybe also financially. Concrete offers of help can relieve the patient and his relatives.

Palliative medicine supports patients to live their lives as actively as possible until death. In a broader sense, palliative medicine also includes enabling positive experiences . Just look at the sky. Feel the sun and wind on your skin . Listen to a favorite piece of music. Cuddle with the cat. Say goodbye to a loved one.

relatives in palliative care

Relatives are also given palliative care. After all, this also helps the patient – the psychological stability of the relatives is important for the well-being of the patient. Palliative medicine supports relatives during the patient’s illness, during the dying phase and in the bereavement period. Ideally, the relatives will be able to accept dying as a natural process and part of life.

care in the dying phase

When death becomes foreseeable, it is the task of palliative medicine to enable the patient to die peacefully and with dignity. Even in the last phase of life, it is important to control the symptoms and to keep the suffering to a minimum.

And, of course, palliative care is also about providing emotional support to family members during the farewell phase. For example, it is important for them to be prepared for the changes that may occur in the dying process .

Inpatient palliative care

In hospices and palliative care units in hospitals, people with advanced, life-limiting illnesses receive inpatient care. The aim is to place patients in the hands of carers who are familiar with the current standards of palliative care. In some clinics, so-called counseling services have also been set up, which provide palliative care for the sick on the respective wards. In many cases it is possible to stabilize the patients to such an extent that they can be treated on an outpatient basis again – and then die at home. If this is not possible, end-of-life care is provided in the clinic.

Outpatient palliative care

Most people wish to be able to die in a familiar environment and with their loved ones. This is made possible in the context of outpatient palliative medicine. Doctors in private practice, outpatient nursing services and voluntary helpers usually look after the patients. This is often even possible when the patients require particularly complex and intensive care. In so-called specialized outpatient palliative care (SAPV), doctors and nursing services work together in a palliative care team (PCT). They are specially trained in palliative care and coordinate the treatment around the clock. In this way, pain and stressful symptoms can be controlled even in more complex cases.

development of palliative medicine

Palliative medicine is considered a comparatively young discipline. There are reports of a “cura palliativa” as early as the 16th century. Around 1800, the term “palliative cure” was used colloquially. In the 19th century, the first hospice-like inpatient facilities that looked after the dying were established in some European cities. The first important representatives of modern palliative care were the psychiatrist Elisabeth Kübler-Ross, who examined the dying process psychologically, the nurse, social worker and doctor Dame Cicely Saunders, who founded a hospice for the dead in London in 1967, and the doctor Balfour Mount, who opened a palliative care ward in London in 1975 Montreal set up.

Palliative care in Germany today

Palliative medicine has expanded significantly in Germany in recent years. However, coverage is not yet universal. On average, around 40 beds per one million inhabitants are currently available in inpatient hospices and palliative care units in Germany. Experts estimate that at least 50 beds are needed for every million inhabitants. International studies even assume a need for palliative care of 80 to 100 beds (per million residents).

There are currently around 330 palliative care units in hospitals, 1500 outpatient hospice services, 230 inpatient hospices for adults and 17 inpatient hospices for children, adolescents and young adults nationwide.

There are also still gaps in outpatient palliative care, particularly in the area of ​​specialized outpatient palliative care. The supply also varies from state to state and is particularly problematic in rural areas.

In recent years, the legislature has tried to take this into account – for example with the 2015 law to improve hospice and palliative care. Since then, palliative care has been part of the standard care in statutory health insurance (which covers 95 percent of the eligible costs for inpatient undertake hospice care).

However, the topic of palliative care will remain topical and urgent – as people are getting older and the number of cancer cases is increasing, for example, even more beds for palliative care will be needed in the future.

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