This is a palliative patient. Palliative care

The problem of cancer is global. Every year, about 10 million cases of malignant tumors are diagnosed worldwide.

At the same time, about 8 million patients die from cancer. In Russia in 2000, cancer was diagnosed in almost 450 thousand people, and in Moscow - in almost 30 thousand.

In half of patients, cancer is diagnosed in advanced stages, when complete cure is no longer possible. Such patients need palliative care.

The achievements of modern oncology make it possible not only to achieve improved treatment results, but also raise the question of the patient’s quality of life.

If for cured patients the quality of life is of a certain importance in their social rehabilitation, then for incurable (incurable) cancer patients, improving the quality of life is the main and, perhaps, the only feasible task of providing assistance to this difficult category of patients, closely intertwined with the quality of life and healthy family members , relatives, friends surrounding the patient.

In your attitude towards hopeless patients, it is very important to be guided by such ethical considerations as respect for the life of the patient, for his independence, for his dignity.

It is necessary to try to skillfully use the significantly limited physical, mental and emotional resources remaining at the patient’s disposal. The last months of the existence of patients, if they are not in a hospital, but at home, proceed in a very difficult environment.

It is during this period that the patient most needs quite diverse forms of palliative care.

PALLIATIVE CARE: CONCEPT AND MAIN OBJECTIVES

Supportive care is care that provides optimal comfort, functionality and social support to patients (and family members) at all stages of the disease.

Palliative care is care that provides optimal comfort, functionality and social support to patients (and family members) at a stage of the disease when special, in particular antitumor, treatment is no longer possible.

Palliative medicine (palliative treatment) – when antitumor treatment does not allow the patient to radically get rid of the disease, but only leads to a reduction in tumor manifestations.

Increased attention to the problem of providing care to incurable patients until their death has made it possible to identify another direction in this area - care at the end of life.

The possibilities for improving the quality of life of incurable cancer patients are quite large. This problem can be solved using the same treatment techniques that are used in radical antitumor treatment.

The advances achieved in surgery through the use of lasers make it possible to improve the patient’s quality of life, even when the possibilities of radical treatment are almost exhausted.

Radiation therapy techniques currently used allow many patients to avoid the need to resort to surgery while preserving the affected organ, which, of course, affects the patient’s quality of life.

Chemotherapy in many cases is accompanied by nausea and vomiting that is painful for patients, which in some cases is the reason for refusing such necessary treatment. Advances in modern pharmacology have made it possible to successfully combat these symptoms, which has significantly improved the quality of life of patients receiving chemotherapy.

In ensuring an increase in the quality of life for incurable cancer patients and comfort in the last days of life, one should proceed from the fact that every patient has the right to freedom from pain. This right exists on a par with the rights of the patient to be diagnosed and receive treatment. And society is obliged to organize and provide such assistance to the patient.

The main thing in organizing palliative care is the initial task - all types of such care should, if possible, be provided at home.

Workers of this service provide advisory assistance to patients at home, and, if necessary, in hospitals before discharge, while providing appropriate psychological preparation to the patient and his family members. This lays the foundation for the effectiveness of future care and treatment at home.

The patient and his relatives must be sure that outside the hospital walls they will not be left without attention and proper support, first of all, of course, moral and psychological. The psycho-emotional state of the patient and his loved ones is of great importance when carrying out further work. Palliative care centers do not exclude, but even provide for the possibility of patients independently seeking advice and the necessary help and support 2-3 times a week. This greatly simplifies and facilitates the coexistence of the patient and his family members.

The basis for the success of palliative care is long-term professional constant monitoring of the patient. This requires the mandatory participation of health care workers, who, in turn, must be trained to correctly and quickly assess the patient’s condition, his needs and the possibility of meeting them; know what advice should be given to the patient and his family members.

They must know the basic principles of the use of various medications when carrying out symptomatic treatment, in particular, analgesics, including narcotic drugs, to combat pain. They must have the skills of psychological support and assistance to the patient and, importantly, his family members.

The possibility of involving volunteers and neighbors to provide assistance should not be ruled out. However, the main burden of caring for a seriously ill patient falls on his family, who must not forget that their loved one needs specially selected and prepared food that is convenient for consumption. The family should know what drugs and medicines should be given to the patient, how to perform this or that procedure to relieve suffering.

The main goal of palliative care is to maintain a state of well-being, and sometimes improve the general well-being of a patient who is in the terminal stage of the disease.

Palliative care and special antitumor treatment do not exclude, but complement each other, thereby increasing the effectiveness of therapy.

Elements of palliative care should be implemented from the very first days of treatment for the patient. This will improve his quality of life at all stages and provide the doctor with more opportunities to carry out antitumor therapy.

Having sufficient information about the course of the disease, the doctor and the patient can jointly choose rational ways to combat it. When choosing one or another treatment tactic for a cancer patient, the doctor must necessarily include, along with antitumor treatment, elements of palliative and symptomatic treatment, taking into account the biological condition of the patient, his social, psychological and emotional status.

Only by taking into account all these factors can one count on success, on improving the patient’s quality of life, which is the ultimate goal when solving the problem of providing palliative care to cancer patients in the terminal stage of the disease.

The palliative treatment program for cancer patients has the following components:

HELP AT HOME

Unlike antitumor treatment, which requires placing the patient in a specialized hospital, palliative treatment involves providing care mainly at home.

ADVISORY HELP

Provides consultation of patients with specialists who are familiar with the methods of providing palliative care in the hospital and at home.

Day hospitals

They are organized to provide palliative care to lonely and mobility-impaired patients. Staying in a day hospital for one day 2-3 times a week gives the patient the opportunity to receive qualified, including advisory assistance.

Psycho-emotional support is also important when the circle of home loneliness opens. In addition, family caregivers receive a lot of help. Currently, there are 23 day hospitals operating in Russia, and another 10 are at the stage of organization.

Palliative care centers, hospices

Hospitals that provide placement of patients for 2-3 weeks to provide one or another type of symptomatic treatment, including pain relief, when this cannot be done at home or in a day hospital.

Hospice is a state institution intended for incurable cancer patients to provide palliative (symptomatic) treatment, selection of necessary pain therapy, provision of medical and social assistance, care, psychosocial rehabilitation, as well as psychological support for relatives during the period of illness and loss of a loved one (From the provision on the first Moscow hospice of the Moscow Health Committee).

Medical care and qualified care for patients in a hospice are provided free of charge. Subsidies (payment from relatives or patients) are prohibited. Charitable donations are not prohibited.

The hospice is not engaged in commercial, self-supporting or other activities; it is a budgetary institution. The hospice is responsible for creating a service of volunteer assistants who provide free care for patients at home and in the hospital, and their training.

The hospice includes the following services: outpatient department (outreach service and day hospital), hospital, organizational and methodological office.

When providing palliative care, the main thing is not to prolong the patient’s life, but to take measures to make the remaining life as comfortable and meaningful as possible. Palliative care in a hospice is a large range of tasks, among which it is difficult to identify individual components. Medical, social, psychological, spiritual and other tasks facing the patient, his relatives, staff, volunteers are organically connected and flow from each other.

“Hospice is a way to get rid of the fear of suffering that accompanies death, a way to perceive it as a natural continuation of life; This is a house where the highest humanism and professionalism are combined...

Helping others is also important for the person helping. Only active help to others can somehow calm our conscience, which must still be restless.”

Currently, there are 45 hospices operating in Russia, and about 20 more are at the stage of formation.

Palliative care

Palliative care(from fr. palliatif from lat. pallium- blanket, cloak) is an approach to improve the quality of life of patients and their families facing the challenges of life-threatening illness by preventing and alleviating suffering through early detection, careful assessment and treatment of pain and other physical symptoms, as well as psychosocial and spiritual support. support for the patient and his loved ones.

The term "palliative" comes from the Latin "pallium", which means "mask" or "cloak". This determines the content and philosophy of palliative care: smoothing - softening the manifestations of an incurable disease and/or covering with a cloak - creating a cover to protect those who are left “in the cold and without protection.”

Goals and objectives of palliative care

Palliative care:

Goals and objectives of palliative care:

Palliative medicine

Palliative medicine- a branch of medicine whose objectives are to use the methods and achievements of modern medical science to carry out medical procedures and manipulations designed to alleviate the patient’s condition when the possibilities of radical treatment have already been exhausted (palliative operations for inoperable cancer, pain relief, relief of painful symptoms).

Palliative care is different from and includes palliative medicine. Russian Association of Palliative Medicine http://www.palliamed.ru/

Hospice care

Hospice care is one of the options for palliative care - this is comprehensive care for a patient at the end of life (most often in the last 6 months) and a dying person.

Notes

Links

First information/resource site about palliative/hospice care (2006)
Recommendations Rec (2003) 24 of the Council of Europe to member states on the organization of palliative care
Methodological recommendations for organizing palliative care approved. Ministry of Health and Social Development of the Russian Federation 09/22/2008 n 7180-рх)
Brief clinical guide to palliative care for HIV/AIDS. Edited by Doctor of Medical Sciences, Professor G. A. Novikov. Moscow, 2006.

Wikimedia Foundation. 2010.

Pallasovsky district
Pallyu

See what “Palliative care” is in other dictionaries:

Palliative care- 3.4 Palliative care: A direction whose goal is to improve the quality of life of patients and their families facing an incurable (life-threatening) disease, which is achieved by alleviating suffering through early... ...

Palliative medicine- - an area of healthcare designed to improve the quality of life of patients with various nosological forms of chronic diseases, mainly in the terminal stage of development, in a situation where the possibility of specialized treatment... ... Encyclopedia of Newsmakers

Palliative care- 1. Palliative care is a set of medical interventions aimed at relieving pain and alleviating other severe manifestations of the disease, in order to improve the quality of life of terminally ill citizens...… … Official terminology

Children's hospices in Russia and the world- Hospice is the basic structure of palliative medicine to provide care to seriously ill people in a terminal condition (when organ damage is irreversible), who have days and months to live rather than years. Palliative... ... Encyclopedia of Newsmakers

World Hospice and Palliative Care Day- held on the second Saturday of October. In 2013, this day falls on October 12th. The organizer is The Worldwide Palliative Care Alliance (WPCA). The Alliance includes national and regional... ... Encyclopedia of Newsmakers

P:MED

Portal:Medicine- For beginners · Community · Portals · Awards · Projects · Queries · Assessment Geography · History · Society · Personalities · Religion · Sports · Technology · Science · Art · Philosophy ... Wikipedia

SP 146.13330.2012: Gerontological centers, nursing homes, hospices. Design Rules- Terminology SP 146.13330.2012: Gerontological centers, nursing homes, hospices. Design rules: 3.1 Gerontological center (hereinafter referred to as GRC): A social and medical institution intended for permanent, temporary (for up to ... Dictionary-reference book of terms of normative and technical documentation

Books

Infectious diseases with a course on HIV clinic treatment palliative care Textbook, Pak S.. Training of specialists who can competently organize work to prevent the spread of infectious diseases not only in an infectious diseases hospital, but also in any medical…

What is palliative care?
The term "palliative" comes from the Latin "pallium", which means "mask" or "cloak". This defines what palliative care essentially is: smoothing over the manifestations of a terminal illness and/or providing a cloak to protect those left “cold and unprotected.”
While previously palliative care was considered the symptomatic treatment of patients with malignant neoplasms, now this concept extends to patients with any incurable chronic diseases in the terminal stage of development, among whom, of course, the bulk are cancer patients.

Currently, palliative care is a direction of medical and social activity, the goal of which is to improve the quality of life of incurable patients and their families by preventing and alleviating their suffering, through early detection, careful assessment and relief of pain and other symptoms - physical, psychological and spiritual.
Palliative care is defined as:

affirms life and views death as a normal, natural process;

has no intention of extending or shortening its lifespan;

tries to provide the patient with an active lifestyle for as long as possible;

offers assistance to the patient's family during his serious illness and psychological support during the period of bereavement;

uses an interprofessional approach to meet all the needs of the patient and his family, including the organization of funeral services, if required;

improves the patient’s quality of life and can also positively influence the course of the disease;

with sufficiently timely implementation of measures in combination with other treatment methods, it can prolong the patient’s life.

Goals and objectives of palliative care:
1. Adequate pain relief and relief of other physical symptoms.
2. Psychological support for the patient and caring relatives.
3. Developing an attitude towards death as a normal stage in a person’s journey.
4. Satisfying the spiritual needs of the patient and his loved ones.
5. Solving social and legal issues.
6. Solving issues of medical bioethics.

You can select three main groups of patients requiring specialized palliative care at the end of life:
patients with stage 4 malignant neoplasms;
patients with AIDS in the terminal stage;
patients with non-oncological chronic progressive diseases in the terminal stage of development (stage of decompensation of cardiac, pulmonary, hepatic and renal failure, multiple sclerosis, severe consequences of cerebrovascular accidents, etc.).
According to palliative care specialists, the selection criteria are:
life expectancy no more than 3-6 months;
the obviousness of the fact that subsequent treatment attempts are inappropriate (including the firm confidence of specialists in the correctness of the diagnosis);
the patient has complaints and symptoms (discomfort), which require special knowledge and skills to carry out symptomatic therapy and care.

Inpatient palliative care institutions are hospices, palliative care departments (wards), located on the basis of general hospitals, oncology clinics, as well as inpatient social protection institutions. Home care is provided by specialists from a mobile service, organized as an independent structure or a structural unit of a stationary institution.
The organization of palliative care can be different. If we take into account the fact that most patients would like to spend the rest of their lives and die at home, then providing care at home would be most appropriate.
To meet the patient's needs for comprehensive care and various types of assistance, it is necessary to involve various specialists, both medical and non-medical specialties. Therefore, the hospice team or staff usually consists of doctors, nurses with appropriate training, a psychologist, a social worker and a priest. Other specialists are involved in providing assistance as needed. The help of relatives and volunteers is also used.

The somewhat unusual word “palliative” is derived from the Latin “pallium”, that is, “blanket”, “cloak”. Philosophically, this concept implies protection from adverse influences and provision of comfort. In reality, palliative care is aimed at creating conditions for seriously ill people in which they can more easily endure their situation. Palliative care is a system of measures aimed at improving the quality of life of patients with incurable, severe, life-threatening diseases. It consists in the use of drugs and techniques that relieve pain syndromes or minimize the degree of their manifestation.

The essence of palliative care

We all know that we will die someday, but we really begin to realize the inevitability of death only on its threshold, for example, when there is no longer any hope of a cure for a serious illness. For many, the feeling of approaching death is no less terrible than physical suffering. Almost always, together with the dying person, their loved ones endure unbearable mental anguish. Palliative care is precisely aimed at alleviating the plight of the patient and supporting his relatives through the use of a variety of methods of influence: medications, moral support, conversations, organizing activities that raise vitality, solving social issues, etc. Palliative care, although focused on the use of medications that alleviate suffering cannot be completely isolated. Doctors, nurses, and caregivers working with terminally ill patients must be able not only to carry out procedures that relieve pain, but also to have a beneficial effect on the patient with their human attitude, treatment, and correctly chosen words. That is, a dying person should not feel like a burden, superfluous, no longer needed. Until the very end, he must feel the value of himself as an individual and have the opportunity to self-realize to the extent that he succeeds.

The procedure for providing palliative medical care

In Russia, Order No. 187n was issued, approved on April 14, 2015, which talks about the procedure for providing palliative medical care. A separate paragraph of this order identifies the categories of people who can count on it. The diseases and conditions for which palliative care is provided are the following:

oncology;
chronic diseases in the terminal stage;
injuries with irreversible consequences in which the patient requires constant medical care;
degenerative diseases of the nervous system in the final stages;
end-stage dementia (eg Alzheimer's disease);
severe and irreversible cerebrovascular accidents.

There is order No. 610 dated September 17, 2007 on the specifics of assistance to AIDS patients.

Each of these diseases has its own characteristics and requires an individual approach to therapy and patient care.

Palliative care for cancer patients

Logically, the natural process of death should affect people in old age. But unfortunately, there are a number of incurable diseases that affect both old and young, for example, cancer. About 10 million earthlings fall ill with cancer every year, not counting the large number of relapses. It is to cancer patients in the last stages of the disease that palliative medical care is provided first. It can be carried out separately or in conjunction with radiation and chemotherapy and consists of relieving the patient’s pain with potent drugs.

According to statistics, cancer mainly affects those over the age of 55 years (more than 70% of cases). In old age, as a rule, patients are diagnosed with other ailments (cardiological, vascular and many others), which aggravate their situation. The organization of palliative medical care should be carried out taking into account factors aggravating the underlying disease. In this case, it is necessary to use all methods available to science to alleviate the patient’s situation, regardless of whether there is a chance of recovery.

Palliative operations

The idea of providing palliative care for cancer, in addition to the use of Morphine, Buprenorphine and other narcotic analgesics, is the so-called palliative surgery. They involve surgical intervention in cases where the doctor knows in advance that the patient will not recover, but his condition will improve for a short or long period. Depending on the location of the tumor and its type (disintegrating, bleeding, metastasizing), palliative operations are divided into two categories. The first emergency is when the patient has an immediate threat to life in the very near future. Thus, for laryngeal cancer, a tracheostomy is installed during surgery; for esophageal cancer, a gastrostomy is sewn in. In these cases, the tumor is not removed, but conditions are created under which it will harm the patient’s life less. As a result, death can be postponed indefinitely, sometimes by several years.

Help for AIDS patients

The peculiarities of this disease bring great suffering to patients. Often, people living with HIV experience emotional, psychological and social problems as much as physical suffering. Caregivers are also subject to psychological pressure due to fear of becoming infected, although this happens extremely rarely through domestic means. AIDS is a progressive and ultimately fatal disease, but unlike cancer, there are periods of remission and exacerbations associated with concomitant infectious diseases. Therefore, in case of AIDS, palliative medical care is both symptomatic therapy according to indications and active treatment methods that relieve pain, alleviate the patient’s condition with fever, skin and brain lesions, and other painful conditions. If cancer patients are not informed of their diagnosis, then HIV-infected people are informed immediately. Therefore, it is very desirable that they take part in the choice of treatment methods and are informed about the results of the treatment.

Help for other diseases

There are many serious illnesses. For example, a stroke leads to disability and death in approximately 80-85% of cases. For people who have suffered it, palliative care consists of performing the necessary therapeutic procedures to maintain and, if possible, restore the vital functions of the body (for example, the ability to walk). Daily care for such a patient includes installing a catheter to drain urine, preventing bedsores, feeding through a nasopharyngeal tube or using an endoscopic gastrostomy tube, exercises to strengthen the patient’s muscles, and others.

An increasing number of people on the planet are faced with Alzheimer's disease, which disrupts the functioning of the brain, and with it all organs and systems of the body, including mental, speech, motor, and immunoprotective functions. Palliative care in this case consists of medicinal support of the body, as well as creating conditions for the patient that ensure (as much as possible) his normal functioning.

Ambulatory treatment

The organization of palliative care includes outpatient and inpatient treatment. With outpatient care, people can visit medical institutions, but more often doctors themselves go to patients’ homes (mainly for pain-relieving procedures). This service should be provided free of charge. In addition to medical procedures, outpatient care consists of training relatives in the skills of caring for seriously ill patients at home, which includes water procedures (washing, washing), nutrition (orally, enterally with a tube or parenterally, by injecting nutrients), removing gases and waste products using catheters, gas tubes, prevention of bedsores and much more. Outpatient care also includes the issuance of prescriptions for narcotic and psychotropic drugs, referral of the patient to a hospital, psychological and social assistance to his relatives.

Day hospital

Order No. 187n, which regulates the procedure for providing palliative medical care to the adult population, separately highlights the possibility of treating patients in day hospitals. This is done in cases where there is no need to monitor the patient around the clock, but it is necessary to use hardware and other specific treatment methods, for example, installing IVs, using laser or radiation therapy. Day hospitals for patients who have the opportunity to attend them are an excellent option, since with such treatment a person does not feel cut off from his family and at the same time receives all the necessary procedures that cannot be carried out at home.

Hospices

This is the name of institutions where palliative medical care is provided to incurable patients in the terminal stage of the disease. The word “hospice” is derived from the Latin “hospitium”, which means “hospitality”. This is the essence of these institutions, that is, here they not only provide treatment, as in hospitals, but also create the most comfortable living conditions for patients. People usually end up in hospice shortly before death, when there is no longer any way to relieve severe pain or provide care at home. Most hospice patients cannot eat orally, breathe independently, or fulfill their physiological needs without specific help, but despite this, they still remain individuals, and they should be treated accordingly. In addition to the functions of a hospital, hospices must provide outpatient treatment for seriously ill patients, and also operate as day hospitals.

Staff

Palliative care is provided not only by medical workers, but also by volunteers, religious leaders, and public organizations. Not everyone can work with dying people. For example, a palliative care nurse must not only have professional skills in performing procedures (injections, IVs, installing catheters, connecting the patient to devices that support vital body functions), but also have such qualities as compassion, philanthropy, and be able to be a psychologist who helps patients calmly perceive their situation and imminent death. People who are squeamish, highly impressionable and indifferent to the grief of others should absolutely not work with seriously ill people. It is also strictly forbidden to hasten the death of a patient in order to save him from suffering.

It is necessary to understand that the nature of their work also has a negative impact on palliative care providers themselves. Constant presence next to dying people often leads to depression, nervous breakdowns, or develops indifference to other people's pain, which is a kind of psychological defense.

That is why it is invaluable to regularly conduct training, seminars, and experience exchange meetings with everyone involved in palliative care.

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People suffering from incurable, life-threatening and severe illnesses require special care. Palliative (supportive) medicine combines medical, psychological and social care. This is a whole set of measures that are aimed at maintaining the most comfortable level of existence for terminally ill patients.

Today, the percentage of incurable (incurable) patients who suffer from severe pain and depression is increasing. Therefore, palliative care remains relevant, as it helps alleviate physical and mental suffering.

What is palliative medicine

Palliative care is a set of treatment measures that help prevent and reduce the severity of pain by reducing the severity of the disease or slowing its progression. The efforts of doctors are aimed at:

To alleviate the condition of seriously ill patients, as well as their loved ones. To minimize painful symptoms, doctors try to correctly assess a person’s condition and conduct competent therapy.
To provide the patient with psychological and social assistance. Such treatment methods are used to improve the condition of people with incurable pathologies that inevitably lead to death, as well as in chronic diseases and old age.

The principles and methods of supportive therapy are based on the interaction of doctors, social workers and psychologists.

Specialists together develop treatment tactics to alleviate the patient’s physical, emotional and spiritual condition. During therapy, medications are used that stop or reduce the severity of the symptoms of the disease, but do not affect its cause.

For example, the patient is given medications that eliminate nausea after chemotherapy or relieve severe pain with morphine.

Palliative medicine consists of 2 important components:

Improving the quality of life of patients throughout the entire period of the disease;
Providing medical care and psychological support.

Palliative medical care is not only about getting rid of painful symptoms, but also about proper communication. Professionals should give the person the opportunity to know the truth about their condition, but at the same time respect their hope for a favorable outcome.

Goals and objectives of maintenance therapy

Previously, palliative care was provided mainly to cancer patients; now all patients with chronic diseases at the last stage are entitled to it. Palliative therapy has the following tasks and goals:

Reduce pain and other painful symptoms due to early diagnosis, careful assessment of the condition;
Develop an attitude towards death as a completely natural process;
Provide psychological and spiritual support their loved ones who are sick;
Provide the most comfortable and active living conditions for the rest of your life.

One important task of palliative medicine is to support the desire to live in a seriously ill person. To achieve this, auxiliary measures are taken to stabilize the emotional state of the patient and his family.

Symptomatic treatment helps combat pain and other somatic manifestations. For this purpose, palliative care physicians must correctly assess the nature of pain, create a treatment plan and provide ongoing care to the patient. Medications are used to relieve or relieve symptoms.

Who receives palliative care?

Most medical institutions have palliative care rooms, staffed by specialists who provide care to seriously ill people. They monitor the condition of patients, prescribe medications, issue referrals for consultations with doctors, and inpatient treatment.

The following groups of incurable patients require palliative care:

Patients with malignant tumors;
People who have been diagnosed with AIDS;
Persons with non-oncological pathologies with a chronic course (last stage) that progress rapidly.

According to doctors, patients who were diagnosed with an incurable disease no later than six months ago need palliative treatment. People who have been diagnosed with diseases that cannot be treated also need support (this fact must be confirmed by a doctor).

Palliative care is organized for patients with painful symptoms that require special care.

Maintenance treatment is carried out urgently immediately after the detection of pathological symptoms, and not at the stage of decompensation, which inevitably leads to death.

Forms of palliative care

There are the following forms of providing palliative support to hopelessly ill patients:

Hospice is a medical institution where doctors with related education work. These clinics have created all the conditions to alleviate the suffering of incurable patients;
End of life care– supportive treatment in the last months of a person’s life;
Weekend help– palliative service workers take on responsibilities for caring for the patient on certain days, thus helping his relatives;
Terminal help– palliative support for patients whose life expectancy is limited.

The decision on the choice of treatment form is made by doctors together with the relatives of the incurable patient.

Hospice

Hospice staff take care of the patient as a whole person. They help solve many problems:

Relieve painful symptoms of an incurable disease;
Provide housing;
Meet the patient's emotional, spiritual and social needs.

These goals can be achieved through the efforts of staff and volunteers.

Hospice provides treatment in inpatient and outpatient settings. Inpatient departments can work only during the day or around the clock. Patient care can be provided by a visiting team.

Incurable patients are admitted to a hospice as prescribed by a doctor; registration requires medical documents that confirm the diagnosis.

Patients suffering from severe pain that cannot be controlled at home can receive palliative support from a hospice. People with deep depression and people who have no one to care for them also need supportive treatment.

End of life care

Typically, this term refers to an extended period of 2 years to several months during which the disease will inevitably lead to death. Previously, it was used to provide assistance only to cancer patients, but now all incurable patients can receive “end-of-life care.” This term also refers to maintenance therapy in non-specialized medical institutions.

Weekend help

This term refers to the provision of rest to the relatives of a terminally ill patient for a short period of time. This is necessary if loved ones who constantly care for the patient at home feel nervous and physical strain. It is enough to simply contact the appropriate service so that the patient and his family have the opportunity to rest. This type of medical care is provided in a day or 24-hour hospital, or with the participation of special mobile services.

Terminal

Previously, this concept was used to refer to palliative support for patients with malignant tumors whose life expectancy is limited. Later, “terminal care” was defined as symptomatic treatment of patients not only in the final stages of an incurable pathology.

Palliative care departments

Palliative support for incurable patients can be provided in different types of medical institutions. Maintenance treatment can be carried out in specialized and non-specialized clinics. This is due to the fact that there are still too few highly specialized institutions, so their functions are often taken over by ordinary hospitals.

Non-specialized institutions

Non-specialized organizations include:

District nursing services;
General hospitals;
Outpatient nursing services;
Nursing home.

Today, palliative support is most often provided by non-specialized services.

However, the problem is that medical personnel do not have specialized training. To solve this problem, clinic staff should contact palliative care specialists to consult with them at any time.

Some non-specialized services (for example, the surgery department) have quite limited resources, which is why there are queues for treatment. However, incurable patients need immediate assistance. Therefore, it was decided to provide palliative support to incurable patients out of turn.

Specialized institutions and centers

The list of specialized medical institutions includes:

Palliative care unit in a supportive care hospital;
Inpatient hospice;
Palliative support advisory teams working in hospitals;
Outreach palliative support services at home;
Hospice day hospital;
An outpatient clinic is a medical facility that provides care to patients at the reception and at home.

Every year, private hospices and palliative support departments are opened in different regions of Russia.

In order for terminally ill patients to receive quality care, specialists from different fields must collaborate.

Methods of maintenance treatment

There are 3 types of maintenance treatment: inpatient, outpatient, and at home. In the first case, therapy is carried out in an inpatient setting, in the second, the patient visits special rooms and a day hospital, and in the third, treatment is carried out at home. Home palliative care is possible if specialized departments or hospices have a visiting nursing service.

Stationary

Palliative support in inpatient settings is provided in specialized departments, homes and nursing departments, and hospices. Incurable patients are hospitalized in the following cases:

There is severe pain that cannot be relieved at home;
The pathology is severe and requires symptomatic treatment;
The need for detoxification therapy;
Choosing a treatment regimen to continue treatment at home;
The need for medical procedures that cannot be performed at home (punctures, installation of stents, drainages, etc.).

Palliative care is provided by healthcare workers with special training.

The department has created all the conditions for family visits to the patient. If desired, loved ones can stay in the medical facility to support the patient. The decision to refer incurable patients (except for cancer patients) is made by the medical commission, taking into account the diagnosis and research results.

Outpatient

All necessary treatment measures to alleviate the patient’s condition on an outpatient basis are carried out in palliative care rooms. Supportive therapy can also be provided by visiting nursing services.

Patients can visit medical facilities themselves, but doctors often visit them at home (often to perform pain-relieving procedures).

In addition to therapeutic manipulations, outpatient care consists of teaching relatives of an incurable patient the skills to care for him at home. Also, employees of palliative departments issue prescriptions for narcotic and psychotropic drugs, refer the patient to a hospital, and provide psychological and social assistance to the patient’s relatives.

Palliative care at home

Recently, “Hospice at Home” services, created on the basis of medical institutions, have become very popular. This is explained by the fact that most incurable patients want to spend their last days among their relatives.

The decision to choose a place for maintenance treatment (in a medical facility or at home) is made by the doctor, nurse, the patient himself and his relatives.

Palliative support for patients with terminal illnesses is provided by a palliative care doctor, a nurse and an auxiliary nurse. In addition, these specialists work closely with a representative of social services and a psychologist.

Mobile patrol services provide the patient with physical, psychological and comprehensive medical and social assistance. Specialists are trying to prevent the exacerbation of chronic pathologies and teach the patient’s loved ones the skills to care for him.

What is palliative care in oncology

Almost all cancer patients at the terminal stage suffer from severe pain. That is why pain relief is the most important point of palliative support. In medical institutions, radiation is used for this purpose, and at home, analgesics are used in the form of tablets or injections.

The decision on the choice of medications is made by the oncologist or therapist for each patient individually.

Cancer patients often suffer from digestive disorders. This is due to intoxication of the body with chemicals. Antiemetic medications will help relieve nausea and vomiting. Opioid analgesics and chemotherapy can cause constipation. To normalize stool, doctors prescribe laxatives to patients.

A proper daily routine and reasonable nutrition will help increase the effectiveness of drugs. To improve overall well-being, compensate for the lack of nutrients, normalize weight and get rid of digestive disorders, it is recommended to adjust your diet. Your doctor will advise you in more detail about nutritional rules.

To improve the psycho-emotional state of an incurable patient, he is prescribed drugs with a sedative effect.

In addition, a psychologist works with him. Much depends on the patient’s relatives, who must provide him with their love and support. The treatment strategy for a cancer patient should include methods that will help prevent unwanted complications.

Antitumor therapy is necessarily complemented by symptomatic and palliative treatment.

Specialists must regularly examine an incurable patient and provide assistance to him at home and in a day hospital.

The procedure for providing palliative medical care in Russia

According to Article 41 of the Constitution of the Russian Federation, all citizens with an appropriate diagnosis have the right to free palliative treatment. Supportive treatment is provided in outpatient and inpatient settings by health workers who have undergone special training.

A whole range of therapeutic measures are carried out to help get rid of pain and other painful symptoms and improve the quality of life of incurable patients. In this case, the patient has the right to independently choose a medical institution.

To get a referral to medical organizations that provide palliative support, you need to contact a therapist or specialist.

Most often, palliative support is provided on an outpatient basis or in a day hospital. The decision to send a patient to a hospital is made by doctors. If it is not possible to carry out maintenance therapy on an outpatient basis or in a day hospital, the patient is sent to a medical institution that includes a palliative care department or center.

Incurable patients can receive free medical care within a certain period of time. Emergency assistance is always provided immediately.

Planned hospitalization is carried out no later than 2 weeks (for Moscow) from the moment the doctor issues the referral. In other regions, waiting times for hospital care can reach 30 days.

Thus, supportive medical care is provided to palliative patients who suffer from incurable, rapidly progressing pathologies:

Malignant tumors;
Functional failure of internal organs at the stage of decompensation;
Chronic diseases at the terminal stage, Alzheimer's disease.

Outpatient treatment is carried out in specialized rooms or carried out by visiting patronage services.

Inpatient palliative care is provided in hospices, homes and nursing units, and specialized departments. Medical institutions that support terminally ill people interact with religious, charitable and volunteer organizations.