Palliative care is a combination ofActivities, the key focus of which is the maintenance of an adequate level of existence of individuals suffering from the incurable, threatening their life activity and seriously passing diseases, at the most accessible to the existing state of a morbidly sick, comfortable for the subject level. The main "vocation" of palliative medicine is to accompany patients to their end.
Today due to the multiplication of the number of oncologicalAnd the global aging of people, the percentage of incurable patients grows annually. Individuals suffering from cancer suffer unbearable alginates, and therefore they need a single medical approach, social support. Therefore, solving the problem of palliative care does not lose its relevance and necessity.
In order to prevent and minimize sufferingPatients by reducing the severity of the manifestation of symptoms of the disease or inhibition of its course, a set of measures is carried out - palliative care.
The concept of supporting (palliative) medicineShould be presented as a systematic approach that improves the quality of existence of incurable patients, as well as their relatives, by preventing and minimizing the painful sensations due to correct assessment of the condition, early detection, adequate therapy. Consequently, palliative care for patients consists in the introduction and carrying out of all kinds of activities aimed at alleviating the symptoms. Similar activities are often carried out to mitigate or eliminate side effects of therapeutic procedures.
Palliative care is aimed at optimizing through any means of quality of life
, Reduction or complete elimination of pain and otherPhysical manifestations, which facilitates the resolution or resolution of psychological or social problems. This type of medical methods of therapy is suitable for patients at any stage of the disease, including, incurable pathologies, inevitably leading to death, chronic illness, old age.
What is palliative care? Palliative care is based on an interdisciplinary approach in helping patients. Its principles and methods are based on joint actions, doctors, pharmacists, priests, social workers, psychologists and other specialists in related professions. Development of a medical strategy and medical assistance in order to facilitate the torment of subjects allows the team of specialists to solve emotionally-spiritual experiences and social problems, to facilitate the physical manifestations that accompany the disease.
Methods of therapy and pharmacopeia drugs,Used to relieve or relieve manifestations of incurable diseases, have a palliative effect, if only relieve symptoms, but do not directly affect pathology or the factor that gave rise to it. Such palliative measures include removal of nausea caused by chemotherapy, or pain syndrome with the help of morphine.
Most modern doctors focusOwn efforts to cure the disease, forgetting about the need for and compulsory support measures. They believe that methods that seek only to alleviate the symptoms are dangerous. Meanwhile, without the psychological comfort of an individual suffering from a serious illness, it is impossible to free him from a distressing illness.
Principles of palliative care include:
- the focus on liberation from painful sensations, dyspnoea, nausea, and other painful symptoms;
- maintenance of life;
- attitude towards demise as a completely natural process;
- lack of focus on accelerating the end or actions to delay death;
- maintaining the working capacity and activity of patients at the usual level, if possible;
- improving the quality of life;
- maintaining the family of an incurable patient in order to help them cope;
- combining the psychological aspects of care and caring for incurable patients;
- application at the debut stage of the disease;
- a combination with other various methods of therapy, focused on the extension of existence (for example, chemotherapy).
The paramount task of palliative therapy is to free patients from suffering, eliminate pain and other unpleasant manifestations, and psychological support.
Aims and objectives of palliative care
Previously, palliative care wasSymptomatic therapy, addressed to the oncological help. This concept today covers patients suffering from any incurable chronic illness at the terminal stage of the pathology. Today, palliative care for patients is the direction of the social sphere and the medical field of activity.
The fundamental goal of palliative careIs to optimize the quality of life of incurable patients, their relatives, families by preventing and removing painful symptoms through early detection, careful assessment of the condition, relief of pain attacks and other unpleasant manifestations from psychophysiology, and also to eliminate problems of a spiritual nature.
One of the key areas of the branch of medicine under consideration is the provision of supportive activities to seriously ill individuals in the conditions of their dwelling and support of the desire to live.
When treatment measures used inHospital, are practically ineffective, the patient remains alone with his own fears, experiences and thoughts. Therefore, first of all, it is necessary to stabilize the emotional mood of the incurable sick individual and relatives.
In view of this, it is possible to single out the primary tasks of the considered variety of medical practice:
- relief of pain;
- psychological support;
- the formation of an adequate view and attitude towards imminent death;
- solving the problems of biomedical ethics;
- satisfaction of needs of a spiritual orientation.
Palliative care is outpatient. Responsibility for the timeliness of its provision rests with the health care system, the state and social institutions.
With most hospitals open cabinets,Whose activities are focused on helping terminally ill subjects. In such offices, the state and general health of subjects are monitored, medicines are prescribed, directions for specialist consultations, inpatient care are given, consultations are conducted, and activities aimed at increasing the patient's emotional state are carried out.
There are three large groups of terminally illIndividuals and subjects in need of individual palliative care: people with malignant neoplasms, AIDS and non-oncological progressive pathologies of chronic course in the last stages.
In the opinion of some physicians, the criteria for selecting those who need supportive activities are, patients, when:
- the expected duration of their existence does not exceed the threshold of 6 months;
- there is the certainty of the fact that all attempts at therapeutic intervention are inexpedient (including the doctors' confidence in the reliability of the diagnosis);
- there are complaints and symptoms of discomfort,Requiring special skills for care, as well as symptomatic therapy. The organization of palliative care needs to be seriously refined. Carrying out its activities is most relevant and appropriate at home at the patient, as most incurable patients wish to spend the remaining days of their own existence at home. However, today the provision of palliative care at home is not developed.
Thus, the fundamental taskPalliative care is not the prolongation or reduction of human being, but the improvement of the quality of existence, so that the remaining time a person could live in the most peaceful state of mind and could use the remaining days most fruitfully for himself.
Palliative care should be providedIncurable patients immediately upon detection of the initial pathological symptomatology, and not exclusively when decompensating the functioning of the body systems. Every individual suffering from an active disease of a progressive nature that brings him closer to death needs support, including many aspects of his being.
Palliative care for cancer patients
To overestimate the importance of palliative supportIncurable patients suffering from oncology, it is rather difficult. Since annually the number of cancer patients is gaining growth at seven-mile rates. At the same time, despite the use of ultra-modern diagnostic equipment, approximately half of the cases come to specialist oncologists at the last stages of the development of the disease, when the medicine is powerless. It is in similar cases that palliative care is indispensable. Therefore, today the doctors are tasked with finding effective tools to combat oncology, helping patients at terminal stages of cancer, and facilitating their condition.
Achieving an acceptable quality of lifeIs an archival task in oncology practice. For patients who have successfully completed treatment, supportive medicine means, mainly, social rehabilitation, a return to work. Incurable patients need to create acceptable conditions for being, because this is, in practice, the only realistic task that supportive medicine is called upon to solve. The last moments of the existence of an incurably diseased subject at home are in difficult conditions, because the individual and all of his relatives know the outcome.
Palliative care for cancer should includeObservance of ethical norms regarding the "doomed" and show respect for the desires and needs of the patient. To do this, it is wise to use psychological support, emotional resources and physical reserves. It is at the described stage that a person especially needs auxiliary therapy and its approaches.
The primary goals and principles of palliative care are, in the first turn, in preventing pain, eliminating pain, correcting digestive disorders,
And rational nutrition.
The majority of oncological patients at the terminal stagedisease experience severe painful algii that prevent the commission of the usual cases, normal communication, making the existence of the patient's unbearable. That is why anesthesia is the most important principle of providing supportive care. Often in hospitals for the purpose of analgesia, irradiation is used, in the home - usual analgesics injectively or orally. The scheme of their appointment is selected by the oncologist or the therapist individually, based on the condition of the diseased and severity of the algias.
The scheme can be approximately the following -The analgesic is given after a certain time, with the subsequent dose of the agent being introduced when the previous one still acts. This method of anesthetics allows the patient not to be in a state where the pain becomes quite noticeable.
Analgesics can also be taken according to the scheme,Called "anesthetic staircase". The proposed scheme consists in the appointment of a more potent analgesic or narcotic drug on the rise of painful symptoms.
Digestive disorders can alsoTo deliver tokobolnym palpable discomfort. They are caused by intoxication of the body due to the countless number of drugs taken, chemotherapy and other factors. Nausea, vomiting is quite painful, so anti-emetic pharmacopoeial drugs are prescribed.
In addition to the described symptoms, eliminationPainful sensations, algies through opioid analgesics, and chemotherapy can provoke constipation. In order to avoid this, the use of laxatives is indicated, and the schedule and nutrition should also be optimized.
Reasonable nutrition for cancer patients is prettya significant role, since it is purposeful at the same time as improving the patient's well-being and mood, as well as correction of vitamin deficiency, lack of trace elements, prevention of progressive loss of weight, nausea and vomiting.
Rational nutrition, first of all,implies a balanced BZHU, adequate calorie content of consumed products, high concentration of vitamins. Patients staying at the terminal stage of the disease, special attention can be paid to the attractiveness of cooked dishes, their appearance, and also to the surrounding atmosphere when eating. Provide the most comfortable conditions for food can only close, so they need to understand the specific features of nutrition of the cancer patient.
Any patient who has encountered this terriblethe word "cancer", needs psychological support. She needs him, regardless of the curability of the disease or not, the stage, the localization. However, the incurable oncological it is especially needed, so often prescribed sedative pharmacopoeia drugs, as well as counseling therapist. In this case, the primary role is still assigned to the next of kin. It depends on the relatives basically how calm and comfortable the remaining life time of the patient will be.
Palliative care for cancer shouldto be carried out from the moment of definition of this awful diagnosis and appointment of therapeutic measures. Timely actions to assist individuals suffering from incurable diseases, will improve the quality of life of the cancer patient.
Having a sufficient amount of data on the progressoncological pathology, the doctor together with the diseased has the opportunity to choose appropriate methods aimed at preventing unwanted complications and fighting directly with the disease. Stopping the choice of a specific treatment strategy, the doctor must simultaneously with the antitumor therapy to connect to her elements of symptomatic and palliative treatment. In this case, the oncologist must take into account the biological state of the individual, his social status, psycho-emotional mood.
Organization of palliative care for cancer patientsincludes such components as advisory support, home and day care. Consultative support includes examination by specialists who are able to provide palliative support and own its methods.
Supportive medicine as opposed to the usualconservative antitumor therapy, which requires the mandatory presence of an oncological patient in a specially designed department of the hospital, provides for the possibility of assisting in one's own abode.
In their turn, day hospitals are formed forproviding assistance to single individuals or patients who are limited in the ability to move independently. Finding a few days in a decade in such a hospital creates the conditions for obtaining "doomed" advisory assistance and qualified support. When the circle of domestic isolation and solitude dissolves, psycho-emotional support becomes very important.
Palliative care for children
The type of medical careis introduced in children's health-improving institutions, in which special cabinets or entire departments are formed. In addition, palliative care for children can be provided at home or in specialized hospices, which include a multitude of services and specialists with maintenance therapy.
In a number of countries, whole hospices for babies have been created,different from similar institutions for adults. Such hospices are an archival link linking care in health care settings with support provided in a familiar home environment.
Palliative pediatrics are considered a varietysupporting medical care, which provides the necessary medical interventions, consultations and examinations, and is aimed at minimizing the torments of incurable babies.
The principle of approach to palliative pediatrics in generaldoes not differ from the direction of general pediatrics. Supportive medicine is based on consideration of the emotional, physical and intellectual state of the crumbs, as well as the level of its formation, based on the maturity of the baby.
Proceeding from this, the problems of palliative carethe children of the population are involved in applying the effort to terminally ill babies who can die before they reach the mature age. With this category of incurable children, most pediatricians and narrow specialists are found. Therefore, knowledge of the theoretical foundations of supporting medicine and the ability to use them practically, is often more necessary for narrow specialists, rather than general pediatricians. In addition, the assimilation by them of the skills of psychotherapy, the elimination of all kinds of painful symptoms, anesthesia is useful in other areas of pediatric practice.
Below are the differences between palliative medicine, aimed at supporting children, from helping adults who are at the terminal stage of oncological pathology.
Fortunately, the number of dying children is small. Due to the relatively small number of deaths among the children, the system of palliative care for babies is poorly developed. In addition, too little research has been carried out to substantiate palliative methods aimed at maintaining the quality of existence of incurable children.
A circle of incurable childhood ailments, invariablyleading to death, is great, which forces to attract specialists from different fields. In adults, irrespective of the etiologic factor of the disease at its terminal stage, experience and scientific confirmation of palliative support in oncology is often successfully applied. In pediatric practice, this is often impossible, because among the incurable pathologies there are many poorly understood. Therefore, it is impossible to disseminate experience acquired in a separate narrow field.
The majority of ailments in children are commonit is impossible to predict, therefore, the forecast remains vague. It is often impossible to predict the exact rate of progression, of fatal pathology. The uncertainty of the future keeps parents and the crumb in constant tension. In addition, it is rather difficult to provide palliative care for children with only one service. Often support for patients suffering from an incurable pathology of chronic course is provided by several services, the activity is intertwined in some areas with each other. Only at the terminal stage of the course of the disease is palliative care gaining the leading importance.
It follows that the methods of supportingmedicine have been developed for the purpose of relieving painful symptoms, alleviating the condition of crumbs, increasing the emotional state of not only the small patient, but also the immediate environment, which includes brothers or sisters experiencing stressful and psychological trauma.
Below are the main principles of activityexperts in palliative pediatrics: the removal of pain and the elimination of other manifestations of the disease, emotional support, close interaction with the doctor, the ability to dialogue with the crumb, relatives and a doctor about adjusting palliative support, according to their desires. The effectiveness of supportive activities is identified by such criteria: 24-hour daily availability, quality, free, humane and continuity.
Thus, palliative care isa fundamentally new level of awareness of the disease. As a rule, the news of the presence of an incurable pathology knocks out the individual from the habitual existence, exerts the strongest emotional impact directly on the sick person and on the nearest environment. Only an adequate attitude to the ailment and the process of its course is able to substantially minimize the stressful impact experienced by relatives. Only family unity can really help to survive difficult times for crumbs and relatives. Specialists should coordinate their own actions with the wishes of the baby and his family so that the help is really effective.
Procedure for Palliative Care
All human subjects are aware of the lethalend, which they ever expect. But to realize the imminence of death begin, being exclusively in its vestibule, for example, in the situation of diagnosing incurable pathology. For most individuals, the expectation of an imminent approaching end is akin to a feeling of physical pain. Simultaneously with the dying, intolerable mental anguish is felt by their relatives.
Although palliative care is aimed atrelief of suffering, yet should not consist only in the use of analgesic and symptomatic therapy. Professionals should not only possess the ability to stop painful conditions and carry out the necessary procedures, but also have a favorable effect on patients with their humane attitude, respectful and benevolent treatment, and competently chosen words. In other words, a person condemned to death should not feel like a "suitcase, with a missing handle". Until the last moment an incurable patient must realize the value of his own person as a person, and also have the resources and resources for self-realization.
Principles of the described varietymedical assistance is realized by medical institutions or other organizations that carry out medical activities. This category of assistance is based on moral and ethical standards, respectful attitude and a human approach to incurable patients, their relatives.
The key goal of palliative care istimely and effective relief from pain and elimination of other severe symptoms for the sake of improving the quality of being of terminally ill subjects before their completion of life.
So, palliative care, what is it? Palliative care is aimed at patients suffering from incurable progressive ailments, among which are: malignant neoplasms, organ failure at the stage of decompensation, in the absence of remission of the disease or stabilization of the condition, progressive pathologies of the chronic course of the therapeutic profile at the terminal stage, irreversible consequences of cerebral blood flow and injury, degenerative diseases of the nervous system, various forms
, including and
Outpatient palliative care is provided in specialized offices or by visiting visiting employees who provide assistance to terminally ill subjects.
Information about the medical institutions involved in the provision of maintenance therapy should be made available to patients with their treating doctors, as well as by posting data on the Internet.
Medical institutions performing functionssupport incurably sick individuals, carry out their own activities, interacting with religious, charitable and volunteer organizations.