Palliative care. Palliative care for cancer patients

Tens of millions of people die in the world every year. And many of them suffer 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 area of health care does not aim to achieve long-term remission or prolong life, but it does not shorten it either. The ethical duty of health workers is to alleviate the suffering of a sick person. Everyone who has an active progressive disease and is approaching life's milieu is given palliative care. The main principle: no matter how serious the disease, you can always find a way to improve the quality of life in the remaining days.

To the question of euthanasia

Palliative care does not accept euthanasia through the mediation of a doctor. If the patient asks about this, then he is in great pain and needs better care. All actions are just aimed at alleviating physical pain and eliminating psychosocial problems, against which such requests often arise.

Goals and objectives

Palliative care affects many aspects of the life of terminally ill people: psychological, medical, cultural, social, spiritual. In addition to stopping the pathological symptoms and easing the pain, the patient still needs moral and psychosocial support. Help is needed and relatives of the patient. The term "palliative" comes from the Latin word pallium, which means "cloak", "mask". This is the whole point. Palliative care for cancer patients, people with other serious ailments is aimed at smoothing, concealing, masking manifestations of an incurable disease, figuratively speaking, cover with a cloak, cover and thus protect.

History of development

The group of experts in the seventies of the last century organized under the control of WHO the movement for the development of palliative care. In the early 1980s, WHO began to develop a global initiative to introduce measures that would ensure the availability of apoids and adequate analgesia for cancer patients around the world. In 1982, the definition of palliative care was proposed. This is a comprehensive support for patients whose treatment problems are no longer amenable, and the main goal of such support is to stop pain and other symptoms, as well as solve the psychological problems of the patient. Soon this area of public health took the status of an official discipline with its own clinical and academic positions.

The modern approach

Palliative care in the definition of 1982 was interpreted as support for those patients to whom radical treatment is no longer applied. This formulation narrowed this area of health care to the assistance provided only in the last stages of the disease. But today it is generally recognized that support of this nature should apply to patients with any incurable diseases at the terminal stage. The change was due to the understanding that the problems that arise at the end of a patient's life actually begin in the early stages of the ailment.

In 2002, in connection with the spread of AIDS, the continuing increase in the number of cancer patients, and 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 help is now not only the patient, but also his family, who after the death of a person will need support to survive the severity of the loss. So, palliative care now is the 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.

Basic principles

According to the definition, palliative care for cancer patients and people with other incurable diseases:

• Affirms life, but he regards death as a normal, legitimate process;
• Is designed to provide the patient with an active lifestyle for as long as possible;
• Has no intention to shorten or prolong life;
• Offers support to the family of the patient both in the course of the course of his illness and during the period of experiencing a severe loss;
• Aims to meet all the needs of the patient and his family, including ritual services, if necessary;
• Uses an interprofessional approach;
• Improves the quality of life and positively influences the course of the patient's illness;
• Can prolong life with timely carrying out of measures together with other methods of treatment.

Directions

Palliative care is provided in two ways:

1) ease the patient's suffering during 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 from what does suffering develop? This is pain, and inability to self-service, and the limitation of life, and the inability to move, and feelings of guilt, and the fear of death, and a sense of helplessness, and bitterness due to unfulfilled obligations and unfinished business. The list can be continued for a long time ... The task of specialists is to develop a patient's attitude towards death as a normal (natural) stage of the human path.

Organization of palliative care

Following the definition of WHO, assistance should begin from the moment the incurable disease was diagnosed, which in the foreseeable future will inevitably lead to death. The more correct and quicker the support is provided, the more likely 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 turns out to be the doctors involved in the treatment process.

Direct hospice care is required when radical treatment has already been performed, 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 who are told by doctors: "Unfortunately, we can not help you". At this time, the same hospice support is required, in other words - help at the end of life. But it is only necessary for those patients who are suffering. Although it is difficult to imagine a dying person who does not worry about it at all. But, perhaps, there are such ...

Groups of patients needing help

• People with malignant formations of the fourth stage;
• AIDS patients in the terminal phase;
• People with non-oncological progressive chronic diseases having a terminal stage of development (pulmonary, renal, cardiac, hepatic insufficiency 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 treatment attempts are no longer appropriate when the patient experiences symptoms that require special care and symptomatic therapy with special knowledge and skills.

Forms of support

The procedure for providing palliative care can be different. Each country is developing its own plan. WHO recommends support in two versions: in-patient and at home. Specialized institutions, where palliative care is provided, are hospices and departments based on oncological dispensaries, general hospitals, and social protection hospitals. Support at home is done by specialists from outreach services, acting as independent structures or as units of medical institutions.

Since most people prefer to spend the rest of their lives at home, developing a second option for palliative care seems more appropriate. However, in Russia the overwhelming majority of such patients die in hospitals, because at home relatives can not create conditions for their maintenance. In any case, the choice remains with the patient.