Palliative medicine is a branch of medicine that aims to care for seriously ill, dying people. Here, the focus is not on curing the patient’s disease, but on relieving pain and trying to maintain the individual’s quality of life for as long as possible. The WHO (World Health Organization) defines palliative care as follows: “Palliative care is the active, holistic treatment of patients with progressive (advancing), far-advanced disease and limited life expectancy at the time when the disease is no longer responsive to curative treatment and the control of pain, other disease symptoms, psychological, social and spiritual problems is the highest priority.”
The procedure
Palliative medicine (Latin pallium: mantle) protects the patient and centrally pursues the preservation of well-being. Conventional curative medicine places the cure (lat. curare: to heal) of the disease above the patient’s well-being, while accepting the reduction in quality of life caused by the therapy and its side effects. Palliative medicine sees dying as part of life and thus as a normal, natural process that should neither be hastened nor delayed. Active euthanasia is clearly rejected. The European Association for Palliative Care (EAPC) provides the following definition: “Palliative care is the active and comprehensive care of patients whose illness does not respond to curative treatment. Control of pain and other symptoms, as well as social, psychological, and spiritual problems, is a priority. Palliative care is interdisciplinary and includes the patient, family, and community in its approach. In a sense, palliative care is the most basic form of care, providing for the needs of patients without regard to location, both home and hospital. Palliative care affirms life and accepts dying as a normal process; it does not seek to hasten or delay death. The goal is to maintain the best possible quality of life until death.” Palliative medicine bases its actions completely on the needs of the patient. Wishes, goals, the need to arrange affairs as well as spiritual questions, such as the question of the meaning of life or dying, are at the top of the list. The following elements of palliative care are central:
- Education of the patient and his relatives
- Holistic treatment by an interdisciplinary team of physicians, chaplains, nurses, social workers and physiotherapists.
- Fulfillment of physical, psychological, spiritual and social needs.
- Excellent pain and symptom control
- Quality of life is the focus of every measure
- The patient’s will has the highest importance
- Inclusion of the social network, especially the relatives.
- Accompanying the relatives even after the death of the patient.
- Acceptance towards the dying
Of central importance is the environment in which palliative care takes place, care is divided into inpatient, outpatient and home settings:
- Home setting:
- Home care service
- Family practice/specialist practice
- Outpatient setting:
- Day clinic
- Outpatient hospice service
- Special outpatient clinics such as pain outpatient clinic
- Tumor aftercare
- inpatient area:
- Palliative care unit
- Consultation service
- Hospice
The goal of palliative care is primarily to relieve symptoms that reduce the quality of life. This includes not only physical discomfort, but also psychological problems such as anxiety and depression. The main symptoms in palliative care include [S3 guideline]:
- Dyspnea (shortness of breath)
- Fatigue (tiredness; about 90% suffer from it).
- Anxiety – panic disorders, phobias, generalized anxiety disorder (GAS).
- Pain
- Bleeding
- Nausea (nausea)/emesis (vomiting)
- Obstipation (constipation)
- Malignant gastrointestinal obstruction (MIO) – clinical and imaging gastrointestinal obstruction (gastrointestinal obstruction) caused by an incurable (“incurable”) intra-abdominal tumor (“abdominal tumor”) or intraperitoneal metastasis (tumor metastasis to the peritoneum).
- Malignant wounds (prevalence (disease incidence): 6.6-14.5%).
- Sleep-related disorders – insomnia (sleep disturbances), daytime sleepiness or drowsiness, sleep disordered breathing (SBAS), restless legs syndrome, circadian rhythm disorders (e.g., reversal of the day-night rhythm), and parasomnias (undesirable and inappropriate behavioral abnormalities that occur predominantly from sleep)
- Death wishes (8-22% of patients).
While the rapid development of medicine in the 20th century caused a focus on the elimination of disease and the search for the cause, the relief of symptoms and the accompaniment of the dying took a back seat. The death of a patient was and still is perceived by physicians as a defeat. It was not until the hospice movement that this task, the care of the terminally ill, was brought back into the consciousness of society. Palliative care is based on the following objectives:
- Relief of physical symptoms and pain.
- Psychological and social assistance
- Improvement and preservation of the quality of life of the patient and his relatives.
- The prolongation of life takes a back seat
Palliative care is a necessary and indispensable component of medical care.
