The somewhat unusual word “palliative” is derived from the Latin “pallium”, that is, “coverlet”, “cloak”. Philosophically, this concept implies protection from adverse effects and ensuring comfort. In reality, palliative care is aimed at creating conditions for seriously ill people in which they can more easily endure their position. 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 their degree of manifestation.
The essence of palliative care
We all know that someday we will die, but we really begin to realize the inevitability of death only at its threshold, for example, when there is no longer any hope of a cure for a serious illness. For many, the feeling of impending demise is no less terrible than physical suffering. Almost always, together with the dying, unbearable mental anguish endures their loved ones. Palliative care is precisely aimed at facilitating the fate of the patient and supporting his relatives through the use of various methods of exposure: medications, moral support, conversations, organization of life-enhancing events, solving social issues, etc. Palliative medical care although focuses on the use of medications that facilitate suffering cannot be completely isolated. Doctors, nurses, carers working with terminally ill patients should be able not only to carry out procedures that relieve pain, but also have a beneficial effect on the patient with their human attitude, treatment, and correctly chosen words. That is, a dying person should not feel a burden, superfluous, no longer needed. Until the very end, he should feel the value of himself as a person and be able to realize himself to the extent that he is able to achieve it.
The procedure for the provision of palliative care
Order No. 187n was issued in Russia, approved on 04/14/2015, which states the procedure for the provision of palliative medical care. A separate paragraph of this order highlights the categories of people who can count on it. The diseases and conditions in which palliative care is provided are as follows:
- oncology;
- chronic diseases in the terminal stage;
- injuries with irreversible consequences, in which the patient needs constant medical care;
- degenerative diseases of the nervous system in the final stages;
- terminal stage dementia (e.g., Alzheimer's disease);
- severe and irreversible disturbances of cerebral circulation.
On the features of assistance to AIDS patients, there is order No. 610 of September 17, 2007.
Each of these diseases has its own peculiarities of the course and requires an individual approach in therapy and patient care.
Palliative care for cancer patients
By the logic of things, the natural process of death should concern people in old age. But unfortunately, there are a number of incurable diseases that affect both the elderly and young, such as cancer. About 10 million earthlings fall ill with cancer each year, not counting the large number of relapses. It is the cancer patient in the last stages of the disease that palliative medical care is provided in the first place.It can be carried out separately or together with radiation and chemotherapy and consists in stopping the pain of the patient with potent drugs.
According to statistics, cancer mainly affects people who have crossed the age limit of 55 years (more than 70% of cases). In old age, as a rule, other ailments (cardiological, vascular, and many others) are diagnosed in patients, aggravating their situation. The organization of palliative 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 for alleviating the patient’s situation, regardless of whether there is a chance of recovery.
Palliative surgery
The idea of providing palliative care for cancer in addition to the use of "Morphine", "Buprenorphine" and other narcotic analgesics consists in the so-called palliative operations. 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 (decaying, bleeding, metastatic), palliative surgery distinguishes two categories. The first emergency is when the patient has an immediate threat to life in the very near future. So, for cancer of the larynx, a tracheostomy is established for surgery, and for cancer of the esophagus, a gastrostomy is sutured. In these cases, they do not remove the tumor, but create conditions under which it will be less harmful to the patient's life. As a result, death can be delayed for an indefinitely long time, sometimes for several years.
The second category of operations is planned, when the tumor is removed and classical treatment is performed.
Help for AIDS
Features of this disease bring great pain to patients. Often HIV-infected people experience emotional, psychological and social problems no less than physical suffering. The nursing staff is also subjected to psychological pressure for fear of infection, although this is extremely rare in the domestic way. AIDS is a progressive and ultimately fatal disease, but unlike cancer, there are periods of remission and exacerbations associated with concomitant infectious diseases. Therefore, with AIDS, palliative medical care is both symptomatic therapy according to indications, and active treatment methods that relieve pain, relieve 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 will be notified immediately. Therefore, it is highly desirable that they take part in the selection of treatment methods and are informed of the results with which it passes.
Help with other diseases
There are many serious ailments. For example, a stroke leads to disability and death in approximately 80-85% of cases. For people who have undergone it, palliative medical care consists in performing the necessary therapeutic procedures that support and, as far as possible, renew the vital functions of the body (for example, the ability to walk). Daily care for such a patient includes the installation of a catheter for the removal of urine, the prevention of pressure sores, feeding through a nasopharyngeal tube or using an endoscopic gastrostomy, exercises to strengthen the patient's muscles and others.
An increasing number of people on the planet are faced with Alzheimer's disease, in which the brain is disturbed, and with it all organs and systems of the body, including mental, speech, motor, and immune functions.Palliative care in this case consists in the medical maintenance of the body, as well as in creating conditions for the patient to ensure (as much as possible) his normal life.
Ambulatory treatment
The organization of palliative care includes outpatient and inpatient care. With outpatients, people can visit medical institutions, but more often doctors themselves go to the patients home (mainly for painkillers). This service should be provided free of charge. In addition to medical procedures, outpatient care consists in teaching relatives the skills of caring for seriously ill patients at home, which includes water procedures (washing, washing), nutrition (oral, enteral using a probe or parenteral, by injecting nutrients by injection), excretion of gases and waste products with the help of catheters, vent tubes, pressure sores prevention and more. Outpatient care also includes the issuance of prescriptions for narcotic and psychotropic drugs, referral of a patient to a hospital, psychological and social assistance to his relatives.
Day hospital
Order No. 187n, which regulates the procedure for the provision of palliative care to adults, separately highlights the possibility of treating patients in day care. This is done in cases where there is no need to conduct round-the-clock monitoring of the patient, but it is required to use hardware and other specific treatment methods, for example, to put droppers, use laser or radiation therapy. Day hospitals for patients who have the opportunity to visit them are an excellent option, since with such treatment a person does not feel isolated from the family and at the same time receives all the necessary procedures that cannot be carried out at home.
Hospices
This is the name of the institution where palliative care is provided to incurable patients in the terminal stage of the disease. Formed the word "hospice" from the Latin "hospitium", which means "hospitality". This is the essence of these institutions, that is, not only, as in hospitals, they provide treatment, but also create the most comfortable living conditions for patients. They fall into hospices mainly shortly before death, when there is no longer any way to stop severe pain at home and provide care. Most hospice patients cannot eat orally, breathe on their own, exercise their physiological needs without specific help, but despite this, they still remain personalities, and their attitude should be appropriate. In addition to the functions of the hospital, hospices must necessarily carry out outpatient treatment of severe patients, as well as work as day hospitals.
Staff
Palliative care is provided not only by medical workers, but also by volunteers, religious figures, public organizations. Not everyone can work with dying people. For example, a palliative care nurse should not only have professional skills in performing procedures (injections, droppers, installing catheters, connecting a patient to devices that support vital functions of the body), but also possess such qualities as compassion, humanity, and be able to be a psychologist who helps patients calmly perceive their position and near death. Squeamish, very impressionable and indifferent to other people's grief categorically can not work with seriously ill. It is also strictly forbidden to accelerate the death of the patient in order to rid him of torment.
It must be understood that the nature of their activity also has a negative effect on the palliative care providers themselves.The constant presence near the dying often leads to depression, nervous breakdowns or develops indifference to someone else's pain, which is a kind of psychological defense.
That is why it is invaluable to regularly conduct training, seminars, and exchange of experiences with all those involved in palliative care.
