Information About the Field of Palliative medicine
What is palliative care?
According to the definition by the World Health Organization (WHO), palliative care is the active, holistic treatment of patients with a progressive, advanced disease and limited life expectancy at the time when the disease no longer responds to curative treatment and the management of pain, other symptoms, psychological, social and spiritual problems is the highest priority.
The definition of the European Association for Palliative Care (EAPC) emphasizes that treatment is centered on the quality of life and includes consideration of the needs of the family before and after the patient's death.
When does palliative care begin?
Palliative care often begins much earlier than is commonly assumed, and not just shortly before death. A palliative approach is adopted when, due to an incurable illness, the focus shifts away from curing the disease—often involving treatments with significant side effects that can temporarily reduce quality of life—and toward improving the patient’s quality of life.
This point can even be reached when the patient’s life expectancy is still several years.
Where can I find specialists in palliative care?
The training to become a palliative care specialist is an additional qualification that can be recieved after at least 24 months of experience in direct patient care. It includes a prescribed training period, case seminars, and specialized courses.
Medical specialists, as well as medical residents from various fields, can undergo further training to become palliative care experts. For this reason, specialists in palliative care can be found not only in specialized facilities like hospices and palliative care units in many hospitals but also in outpatient settings. Some general practitioners have also received advanced training in this field.
Pain therapy and symptom control: key skills of palliative care specialists
Alongside pain, a wide range of other symptoms can occur in advanced, serious illnesses that need to be managed to achieve the best possible quality of life. They include, for example:
- shortness of breath
- nausea and vomiting
- depression
- anxiety
- restlessness
- fatigue
- constipation
- cough
- loss of appetite
- thirst
Medications can also lead to a variety of side effects. These medications can often be discontinued in a palliative setting. Side effects are also given special consideration when new medication is prescribed for pain or other symptoms. The symptoms themselves are regularly reassessed and the therapy is adjusted accordingly.
Special challenges in pediatric palliative care: caring for young patients and their families
Palliative care for children involves addressing specific aspects and needs that play little to no role in adult palliative care. These include:
Communication
Parents remain the primary caregivers and are involved in every decision-making process; no information is withheld from them.
Children should participate in decisions according to their age and developmental level.
Education
Whenever possible, children should continue attending school, as they have a right to education.
Opportunities for play and age-appropriate activities must be provided.
Care
Care should primarily take place at home whenever possible.
If admission to a hospital or hospice becomes necessary, care must be provided by pediatric-trained staff in a child-friendly environment, alongside other children at a similar developmental stage.
Family support
Pediatric palliative care includes supporting siblings and parents, as well as providing grief counseling for as long as needed.
Which treatments and therapies are used?
Medications are often used to alleviate pain and other symptoms. In some cases, discontinuing medications that are no longer necessary as part of a palliative therapy can also improve symptoms. Depending on the individual case, various other measures such as mobilization, oxygen administration or physical measures such as the application of heat or cold are also used.
Psychological support for patients and relatives is provided, such as by talking therapy, and sometimes additional medication is prescribed, for example to improve mood. As psychological influences affect the perception of pain, this also helps to alleviate pain.
Additional key aspects include support in organizing appropriate care—whether at home or in an inpatient setting—as well as assistance with questions regarding social benefits, such as health insurance or long-term care insurance. Help is also provided for coping with existential fears or addressing ethical concerns.
Palliative care in the home: support in familiar surroundings
A survey by the German Hospice and Palliative Care Association revealed that most people would like to die at home. Even though it is often not possible to provide care at home until the end, there are more and more outpatient services for palliative care. These include both outpatient nursing services and GP care through home visits, as well as palliative care teams with specialized palliative physicians if care is particularly difficult or pain and other symptoms cannot otherwise be adequately controlled.
Palliative care units and hospices: specialized facilities for the best possible care
Palliative care units in hospitals can stabilize palliative patients in the event of an acute deterioration and are designed to release them back into home care or a nursing home afterwards. The patient is referred by their family doctor.
Where outpatient treatment is no longer possible and neither is hospitalization wanted, inpatient hospices are an option for patients with a very short remaining life expectancy. The staff in these facilities specialize in supporting patients and their relatives during the last phase of their lives.
Where can I find a palliative care specialist or clinic?
At PRIMO MEDICO you will find only experienced specialists and clinics for palliative care in Germany, Austria and Switzerland. You can currently find recognized experts in the following cities: