VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk

Most of us associate the care of a palliative medicine doctor with malignant neoplasms in the terminal stage, but palliative care is not only about malignant neoplasms. Which patients most often go to the palliative ward? What does a palliative medicine clinic do, and what does the home hospice team do? It's worth finding out more about this important topic.

Palliative medicine doctors take care of patients in the terminal stage of an incurable disease. Patients under the care of palliative medicine do not promise a permanent cure. These are, for example, patients with malignant neoplasms who are no longer eligible for causal treatment, such as chemotherapy or radical surgery.

The goal of palliative medicine is not to reverse the effects of a disease or heal the patient, but to improve its quality and standard of living. Activities in this field are primarily focused on relieving the symptoms of the disease, and in particular on the treatment of pain. Palliative medicine focuses not only on the physical symptoms, but also helps the patient with mental and spiritual problems.

What is the organization of palliative care in our country?

Depending on the patient's needs, it is possible to visit a palliative medicine clinic, a home hospice and a palliative medicine ward. What can a patient get in each of these entities? When is hospitalization in the ward necessary?

Palliative medicine clinic - consultations and visits

Palliative medicine clinics employ both palliative medicine doctors, nurses and very often psychologists who watch over the patient's psyche. In such a clinic, the patient may obtain specialist consultation, but the entity may also carry out home visits at the patient's place of residence.

Palliative medicine clinics look after patients in stable condition who are able to come to a doctor's office. This clinic is often a support for family doctors who refer to a specialist with a specific question or problem of a palliative patient. It should be emphasized that cooperationpalliative medicine specialists with family doctors is very important in providing the patient with the best possible care.

Who is the home hospice for?

In a situation where the patient's condition worsens and he requires more frequent visits by the doctor - it is advisable to take care of him by a home hospice. Hospice care allows for more frequent visits to the patient's home than at the clinic. What's more, home hospice gives the patient a chance to stay at home, which, as we know, has a very good effect on both the physical and mental condition of the patient.

Being cared for by a home hospice, the patient's family gains enormous support in caring for the patient. It is possible to rent the necessary medical devices (for example inhalers, strollers or walking sticks), as well as rehabilitation of the patient.

The minimum frequency of visits by a home hospice doctor is two visits a month, and a nurse's visits two visits a week. Of course, the number of these visits can be increased depending on the individual situation of the patient.

Palliative care unit - for which patients is this type of care recommended?

If the patient's condition is unstable and the care of the clinic and home hospice is not enough, then hospitalization in a palliative care unit is necessary.

The indications for referring the patient to the palliative medicine ward include:

  • severe pain that cannot be controlled in an outpatient setting,
  • severe shortness of breath,
  • vomiting and nausea that cannot be treated,
  • arousal difficult to control at home,
  • occurrence of complications from an incurable underlying disease (such as, for example, superior vena cava syndrome, where the tumor places pressure on the superior vena cava, causing symptoms such as redness and swelling of the face and neck, shortness of breath, and visual disturbances) .

Palliative medicine department - only for patients with advanced cancer?

You should be aware that palliative medicine does not only deal with patients in the terminal stage of neoplastic disease. Other diseases whose advanced, non-prognostic stages are indications for palliative care (including care in a palliative ward) include:

  • inflammatory diseases of the central nervous system,
  • advanced stages of HIV disease (AIDS),
  • multiple sclerosis - a chronic disease of the central nervous system, the essence of which is damage to the brain and spinal cord resulting from the atrophy of the myelin sheaths of nerve fibers (this process is calleddemyelination),
  • respiratory failure,
  • advanced cardiomyopathies - these are diseases that affect the heart muscle, which lead to its malfunction and often to its failure,
  • chronic, difficult to heal wounds and bedsores,
  • systemic primary atrophy involving the central nervous system.

Pain management in the palliative medicine unit

Finally, it is worth mentioning the most important goal of palliative medicine, which is relieving the pain associated with a terminal illness. The cause of pain in cancer is the disease itself (infiltration of the cancer causes pain) and oncological treatment (chemotherapy can lead to neuropathy).

The basis of pain treatment is pharmacotherapy, i.e. the use of appropriate medications. However, it doesn't start right away with powerful substances like morphine.

According to the analgesic ladder (i.e. the scheme of using painkillers), the treatment of low-intensity pain should begin with the use of non-opioid drugs, i.e. paracetamol and non-steroidal anti-inflammatory drugs (such as ibuprofen or ketoprofen).

If, despite the use of such medications, the pain persists or increases, it is necessary to start using weak opioids (including tramadol, codeine).

If the patient still feels pain - the next step is to use strong opioids (i.e. morphine, oxycodone, fentanyl or buprenorphine).

As long as possible, the oral route of drug administration should be preferred. You should also remember about the regular times of administering drugs and adjusting the analgesic therapy to the individual situation of the patient.

Palliative care - summary

To sum up, a patient is admitted to a palliative medicine ward when he cannot be treated at home and outpatient anymore, i.e. when the patient is unstable.

Detailed laboratory and imaging tests can be performed on the ward to determine the cause of clinical deterioration and further treatment.

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