Palliative medicine deals with the medical treatment of diseases that can no longer be cured and limit the length of life. The aim is not to prolong life but to improve the patient’s quality of life. All treatments are carried out with the consent of the affected person.
What is palliative care?
Palliative medicine deals with the medical treatment of diseases that can no longer be cured and limit the length of life. The goal is to improve the patient’s quality of life. The development of palliative medicine was the necessary response to the increasing taboo of dying in modern times as a result of individualization, secularization of society and weakening of the family. In 1967, the English physician Cicely Saunders founded St. Christopher’s Hospice in London. Long before that, she repeatedly pointed out the abuses in the care of the seriously ill and dying in hospitals. There, measures were only taken to prolong life, which in no way improved the quality of life of the patients. In its concept, it pursued the goal of enabling terminally ill patients who no longer have a chance of recovery to live in dignity and as far as possible free of symptoms until the end of their lives. In Germany, the development of palliative care began in the 1980s with the founding of the first hospices. It was not until the 1990s, however, that a rapid development in palliative medicine began. The goal of palliative treatment is to ensure quality of life by providing comprehensive medical, nursing, or psychosocial care to those affected and their families.
Treatments and therapies
In palliative care, patients with incurable diseases such as advanced cancer, severe cardiovascular diseases, progressive diseases of internal organs, AIDS, and also fatal neurological diseases (such as ALS) are cared for. Malignant tumors represent the largest proportion in hospital hospices and palliative care departments. Palliative medicine requires the cooperation of different specialists in a team. Thus, medical care on the one hand and nursing as well as psychosocial care of the patients on the other hand must be ensured. Medical care includes symptom control and the alleviation of discomfort through treatment methods that do not place additional stress on the patient. The main symptoms treated in palliative care include pain, weakness, fatigue or breathing difficulties. Pain is usually relieved by medication. For mild pain, level 1 medications such as metamizole are used. High pain intensity also often requires the use of weak or even strong opiates of levels 2 and 3. For shortness of breath and nausea, there are similar graded therapies in drug use. In special crisis situations, such measures as invasive ventilation or palliative surgery are also possible within the scope of possibilities and with regard to the prospects of success for a temporary improvement of the symptoms. It must always be weighed up whether the treatment is necessary or even additionally stressful for the patient. The purpose of the therapy is always aimed at alleviating the symptoms. Physiotherapeutic or physical measures can also often alleviate the discomfort. The other pillar of palliative care is based on nursing and psychosocial care of the patient. This part of the therapy becomes more and more important as the disease progresses. The combination of symptom treatment and psychological care still contributes to a high quality of life even in the last stages of life. It is also important to involve close relatives in the overall treatment concept. In the last phase of life, this is a reassuring feeling for both the patient and his or her relatives.
Diagnosis and examination methods
In palliative care, the principle is to use as little technology as possible. Burdensome diagnostic procedures should be avoided. The patient’s main complaint is known. In the medical field of palliative care, the main concern is symptom control. It is often unreasonable for the patient to undertake causal research when new symptoms arise.In most cases, this is the onset of a new stage of the disease, with additional organs being affected. The multitude of failure symptoms must be treated in such a way that the patient gains quality of life. However, less stressful examinations such as laboratory tests for blood, secretion, stool or urine should be performed. Changes in the blood count or in the other biological samples may provide clues to additional changes that can be managed without burdensome therapies in the context of palliative care. For example, infections can often be reversed with drug treatment. If the mineral balance is derailed, a different composition of the diet or the administration of additional minerals may help. In exceptional cases, imaging may be helpful in health crises to detect sudden changes such as bowel obstruction, urinary retention, or others, and to initiate immediate emergency treatment. However, the main focus is on medical and psychosocial support for the serious underlying condition. In this context, as already mentioned, the goal of palliative care is to maintain quality of life until the end of life despite the severity of the disease. In addition to medical care, the psychosocial component of therapy often plays an even greater role. In this context, some important principles of palliative medicine must be observed. These principles include telling the patient the truth about his or her condition and providing guidance for decision-making. The patient should decide autonomously on treatment measures on this basis. Therapy should not lead to an increase in suffering, even if it is intended to prolong life. Social contact is particularly important in palliative care.
