Paleontological assistance. Palliative care

What is palliative care

Palliative care- this is rendering medical care or treatment for the purpose of relieving or preventing suffering of patients by reducing the severity of the symptoms of a disease or slowing its progress, rather than by providing a cure.

The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illnesses by preventing and relieving suffering through early detection, appropriate assessment, treatment of pain and other problems - physical, psychosocial and spiritual." The term palliative care can refer to any care that alleviates symptoms, regardless of whether there is hope of cure through other means. Thus, palliative treatments may be used to alleviate side effects medical procedures.

Life expectancy of patients, which due to the prevalence of the tumor process are denied specialized antitumor therapy, varies and ranges from several weeks to several years. Even a person who does not have personal experience of experiencing severe physical and mental suffering does not need to explain that in such a state any time interval seems like an eternity. Therefore, it is obvious how great the importance of organizing effective care for this category of patients is. And in the WHO program to combat cancer, this is the same priority as primary prevention, early detection and treatment of patients with malignant tumors.

Responsibility for building an effective palliative care system assistance to cancer patients is provided by the state, public institutions and health authorities.

Plays an important role in the implementation of palliative care Code of rights of a cancer patient. Its main provisions are as follows:

• right to medical care
• right to human dignity
• right to support
• right to relief of pain and suffering
• right to information
• right to one's own choice
• right to refuse treatment

The fundamental provisions of the code justify the need to consider the patient as a full-fledged participant in making decisions about the treatment program for his disease. The patient's participation in choosing an approach to the treatment of the disease can only be complete if he is fully informed about the nature of the disease, known treatment methods, expected effectiveness and possible complications. Most importantly, the patient has the right to know how his illness and treatment will affect his quality of life (QOL), even if he is terminally ill, the right to decide what quality of life he prefers, and the right to determine the balance between the length and quality of his life.

By patient's decision right to choice of treatment method Maybe be delegated to a doctor. Discussion of treatment methods can be psychologically difficult for medical workers and requires absolute tolerance and goodwill on the part of doctors and nursing staff.

Responsibility for the implementation of the patient’s rights to preserve human dignity and support (medical, psychological, spiritual and social) goes beyond the competence of the doctor and extends to many institutions of society.

During development cancer Pathological symptoms inevitably arise, which significantly affect the patient. Main tasks symptomatic therapy are the elimination or weakening of the main pathological symptoms.

The term palliative care increasingly used for diseases other than cancer, such as chronic progressive pulmonary disease, kidney disease, chronic heart failure, HIV/AIDS, and progressive neurological diseases.

Services aimed specifically at children with serious illnesses are a rapidly growing segment pediatric palliative care. The volume of such services required is increasing every year.

What is palliative care aimed at?

Palliative care is aimed at improving the quality of life, reducing or eliminating pain and other physical symptoms, which allows the patient to alleviate or solve psychological and spiritual problems.

Unlike hospice, palliative care is suitable for patients at all stages of illness, including those being treated for curable illnesses and people living with chronic diseases, as well as patients who are approaching the end of life. Palliative medicine uses an interdisciplinary approach to patient care, relying on the support of doctors, pharmacists, nurses, clergy, social workers, psychologists and other allied health professionals in developing a treatment plan to relieve suffering in all areas of the patient's life. This integrated approach allows the palliative care team to address physical, emotional, spiritual and social problems that arise along with diseases.

Medicines and treatments are said to have palliative effect, if they relieve symptoms, but do not have a therapeutic effect on the underlying disease or its cause. This could include treating chemotherapy-related nausea, or something as simple as morphine to treat a broken leg or ibuprofen to treat flu-related pain.

Although the concept of palliative care is not new, most doctors have traditionally focused on getting the patient better. Treatment to relieve symptoms is seen as dangerous and is seen as a relief from addiction and other unwanted side effects.

Palliative medicine

• Palliative medicine provides relief from pain, shortness of breath, nausea and other distressing symptoms;
• supports life and views death as a normal process;
• does not intend to either hasten or delay death;
• integrates psychological and spiritual aspects of patient care;
• offers a support system to help patients live as actively as possible;
• offers a support system to help the family cope;
• allows you to improve the quality of life;
• used in the early stages of the disease, in combination with other treatments that are aimed at prolonging life, such as chemotherapy or radiation therapy.

While palliative care offers wide range services, the goals of palliative treatment are specific: relief from suffering, treatment of pain and other painful symptoms, psychological and spiritual assistance.

Palliative care is active, comprehensive care for a patient suffering from an illness that cannot be cured. The main task Palliative care is the management of pain and other symptoms, as well as the solution of social, psychological and spiritual problems. The patient himself, his family and the public are involved in the process of providing palliative care. In a sense, the basic concept of palliative care is to meet the needs of the patient wherever he receives such care, at home or in hospital. Palliative care supports life and creates an attitude towards death as a natural process, has no intention of either delaying or hastening the onset of death, its task is to ensure, as far as possible, best quality patient's life.

The need for primary care arises at the last terminal stage of the disease, when the patient, due to a severe physical condition or the nature of the disease, needs effective and timely relief from pain and other manifestations, maintaining an acceptable quality of life. These patients include patients with incurable progressive diseases and conditions, which include:

• various shapes malignant neoplasms;
• chronic diseases in the terminal stage of development;
• severe irreversible consequences of violation cerebral circulation, injuries;
• various forms of dementia (acquired dementia) in the terminal stage;
• degenerative diseases nervous system at a late stage of development;
• a number of other diseases and disorders indicated in the order of the Ministry of Health No. 187n.

The demand for primary care is steadily increasing due to demographic trends and due to the growing number of patients who are able to receive treatment and prolong life with other types of medical care. Maintaining the best possible quality of life for the patient is achieved by:

• prescribing pain medications, treating symptoms and preventing their occurrence;
• providing psychological and social assistance to patients and their loved ones;
• providing patient care.

Depending on the severity of the patient’s condition, the wishes of the patient and his family, household and a number of other factors, primary care can be provided in various conditions:

• outpatient – ​​in primary care offices (patient’s visit to the doctor, relative’s visit to the doctor, doctor’s visit to the patient);
• day hospital in the primary care center;
• hospital at home - mobile service of hospice centers;
• hospital - in a hospice, center, palliative care departments in the City Clinical Hospital;
• in social institutions - a psychoneurological boarding school, a nursing home or a social boarding house.

To organize outpatient visits to patients, medical organizations create palliative care rooms where a primary care physician receives patients. PHC offices provide assistance to those patients who are not yet assigned to a hospice/center. The doctor of the primary care office, in addition to seeing the patient and relatives directly in the office, can make visits to the patient at home, but this is an exceptional case. Today there are about 50 offices in Moscow. In hospitals, primary care departments with a capacity of 10–30 beds are organized. The number of branches in Moscow is 19, of which 5 are located in the city center.

PHC at home is provided by field services and by organizing necessary conditions to maintain the patient’s quality of life at home.

If it is impossible to create conditions at home or at the joint request of the patient and relatives, the patient can be sent to a hospice - a specialized institution for the provision of primary care or to the primary care department of a medical organization.

There are 8 hospices in Moscow with a capacity of 30 beds each. The hospice network is supplemented by the State Budgetary Healthcare Institution " Scientific and practical center specialized medical care for children named after V.F. Voino-Yasenetsky Department of Health of the City of Moscow" (30 beds) and the State Budgetary Institution "Center for Palliative Medicine of the Department of Health of the City of Moscow" (200 beds).

The somewhat unusual word “palliative” is derived from the Latin “pallium”, that is, “blanket”, “cloak”. Philosophically, this concept implies protection from adverse influences and provision of comfort. In reality, palliative care is aimed at creating conditions for seriously ill people in which they can more easily endure their situation. 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 the degree of their manifestation.

The essence of palliative care

We all know that we will die someday, but we really begin to realize the inevitability of death only on its threshold, for example, when there is no longer any hope of a cure for a serious illness. For many, the feeling of approaching death is no less terrible than physical suffering. Almost always, together with the dying person, their loved ones endure unbearable mental anguish. Palliative care is precisely aimed at alleviating the fate of the patient and supporting his relatives through the use of the most different methods influence: medications, moral support, conversations, organizing events that raise vitality, solving social issues, etc. Palliative medical care, although focused on the use of medications that alleviate suffering, cannot be completely isolated. Doctors, nurses, and caregivers working with terminally ill patients must be able not only to carry out procedures that relieve pain, but also to have a beneficial effect on the patient with their human attitude, treatment, and correctly chosen words. That is, a dying person should not feel like a burden, superfluous, no longer needed. Until the very end, he must feel the value of himself as an individual and have the opportunity to self-realize to the extent that he succeeds.

The procedure for providing palliative medical care

In Russia, Order No. 187n was issued, approved on April 14, 2015, which talks about the procedure for providing palliative medical care. Separate item This order identifies categories of people who can count on it. The diseases and conditions for which palliative care is provided are the following:

• oncology;
• chronic diseases in the terminal stage;
• injuries with irreversible consequences in which the patient requires constant medical care;
• degenerative diseases of the nervous system in the final stages;
• end-stage dementia (eg Alzheimer's disease);
• severe and irreversible cerebrovascular accidents.

There is order No. 610 dated September 17, 2007 on the specifics of assistance to AIDS patients.

Each of these diseases has its own characteristics and requires an individual approach to therapy and patient care.

Palliative care for cancer patients

Logically, the natural process of death should affect people in old age. But unfortunately, there are a number of incurable diseases that affect both old and young, for example, cancer. About 10 million earthlings fall ill with cancer every year, not counting the large number of relapses. It is for cancer patients late stages diseases, palliative care is provided first. It can be carried out separately or in conjunction with radiation and chemotherapy and consists of relieving the patient’s pain with potent drugs.

According to statistics, cancer mainly affects those over the age of 55 years (more than 70% of cases). In old age, as a rule, patients are diagnosed with other ailments (cardiological, vascular and many others), which aggravate their situation. The organization of palliative medical 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 to alleviate the patient’s situation, regardless of whether there is a chance of recovery.

Palliative operations

The idea of ​​providing palliative care for cancer beyond the use of Morphine, Buprenorphine and others narcotic analgesics consists of 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 (disintegrating, bleeding, metastasizing), palliative operations are divided into two categories. The first emergency is when the patient has an immediate threat to life in the very near future. Thus, for laryngeal cancer, a tracheostomy is installed during surgery; for esophageal cancer, a gastrostomy is sewn in. In these cases, the tumor is not removed, but conditions are created under which it will harm the patient’s life less. As a result, death can be postponed indefinitely, sometimes by several years.

Help for AIDS patients

Peculiarities of this disease bring great suffering to patients. Often, people living with HIV experience emotional, psychological and social problems as much as physical suffering. Caregivers are also subjected to psychological pressure due to fear of becoming infected, although this happens extremely rarely through domestic means. AIDS is a progressive and ultimately fatal disease, but unlike cancer, there are periods of remission and exacerbations associated with associated infectious diseases. Therefore, in case of AIDS, palliative medical care is both symptomatic therapy according to indications and active treatment methods that relieve pain, alleviate 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 are informed immediately. Therefore, it is very desirable that they take part in the choice of treatment methods and are informed about the results of the treatment.

Help for other diseases

There are many serious illnesses. For example, a stroke leads to disability and death in approximately 80-85% of cases. For people who have suffered it, palliative care consists of performing the necessary therapeutic procedures, supporting and, as far as possible, restoring the vital functions of the body (for example, the ability to walk). Daily care for such a patient includes installing a catheter to drain urine, preventing bedsores, 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, which disrupts the functioning of the brain, and with it all organs and systems of the body, including mental, speech, motor, and immunoprotective functions. Palliative care in this case consists of medicinal support of the body, as well as creating conditions for the patient that ensure (as much as possible) his normal functioning.

Outpatient treatment

The organization of palliative care includes outpatient and inpatient treatment. On an outpatient basis, people can visit medical institutions, but more often doctors themselves go to patients’ homes (mainly for pain-relieving procedures). This service should be provided free of charge. Besides medical procedures outpatient care consists of training relatives in the skills of caring for seriously ill patients at home, which includes water treatments(washing, washing away), nutrition (orally, enterally using a tube or parenterally, by injecting nutrients), removing gases and waste products using catheters, gas outlet pipes, prevention of bedsores and much more. Outpatient care also includes issuing prescriptions for narcotic and psychotropic drugs, referral of the patient to a hospital, psychological and social assistance to his relatives.

Day hospital

Order No. 187n, which regulates the procedure for providing palliative medical care to the adult population, separately highlights the possibility of treating patients in day hospitals. This is done in cases where there is no need to monitor the patient around the clock, but it is necessary to use hardware and other specific treatment methods, for example, install IVs, use laser or radiation therapy. Day hospitals for patients who have the opportunity to attend them are an excellent option, since with such treatment a person does not feel cut off from his family and at the same time receives all the necessary procedures that cannot be carried out at home.

Hospices

This is the name of institutions where palliative medical care is provided to incurable patients in the terminal stage of the disease. The word “hospice” is derived from the Latin “hospitium”, which means “hospitality”. This is the essence of these institutions, that is, here they not only provide treatment, as in hospitals, but also create the most comfortable living conditions for patients. People end up in hospices mainly shortly before death, when it is no longer possible to stop treatment at home. severe pain and provide care. Most hospice patients cannot eat orally, breathe independently, or fulfill their physiological needs without specific help, but despite this, they still remain individuals, and they should be treated accordingly. In addition to the functions of a hospital, hospices in mandatory must implement outpatient treatment severe patients, and also work as day hospitals.

Staff

Palliative care is provided not only medical workers, but also volunteers, religious figures, public organizations. Not everyone can work with dying people. For example, nurse palliative care must not only have professional skills in performing procedures (injections, IVs, installing catheters, connecting the patient to devices that support vital body functions), but also have qualities such as compassion, philanthropy, and be able to be a psychologist who helps patients calmly perceive them situation and imminent death. People who are squeamish, highly impressionable and indifferent to the grief of others should absolutely not work with seriously ill people. It is also strictly forbidden to hasten the death of a patient in order to save him from suffering.

It is necessary to understand that the nature of their work also has a negative impact on palliative care providers themselves. Constantly being around dying people often leads to depression, nervous breakdowns or develops indifference to other people's pain, which is a kind of psychological defense.

That is why it is invaluable to regularly conduct training, seminars, and experience exchange meetings with everyone involved in palliative care.

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Palliative care is a set of activities, the key focus of which is to maintain an adequate level of existence for individuals suffering from incurable, life-threatening and severe illnesses, at the maximum level available given the existing condition of the terminally ill patient, a level that is comfortable for the subject. The main “vocation” of palliative medicine is to accompany patients to their end.

Today, due to the increase in the number of cancer patients and the global aging of people, the percentage of incurable patients is growing every year. Individuals suffering from cancer experience intolerable pain, and therefore need a unified medical approach, social support. Therefore, solving the problem of palliative care does not lose its relevance and necessity.

Palliative care

In order to prevent and minimize the suffering of patients by reducing the severity of the symptoms of the disease or slowing down its course, a set of measures is carried out - palliative medical care.

The concept of supportive (palliative) medicine should be presented as a systematic approach that helps improve the quality of life of incurable patients, as well as their relatives, by preventing and minimizing painful sensations thanks to correct assessment of the condition, early detection, and adequate therapy. Consequently, palliative medical care for patients consists of introducing and carrying out all kinds of measures aimed at alleviating symptoms. Similar activities are often carried out in order to mitigate or eliminate side effects of therapeutic procedures.

Palliative care is aimed at optimizing, by any means, the quality of life, reducing or completely eliminating pain and other physical manifestations, which contributes to relief or resolution by patients psychological problems or social. This type of medical therapy is suitable for patients at any stage of the disease, including incurable pathologies that inevitably lead to death, chronic diseases, and old age.

What is palliative care? Palliative medicine relies on an interdisciplinary approach to providing care to patients. Its principles and methods are based on the joint actions of doctors, pharmacists, priests, social workers, psychologists and other specialists in related professions. The development of a treatment strategy and medical assistance in order to alleviate the suffering of subjects allows a team of specialists to solve emotional and spiritual experiences and social problems, and alleviate the physical manifestations that accompany the disease.

Therapy methods and pharmacopoeial drugs used to relieve or alleviate the manifestations of incurable diseases have a palliative effect if they only relieve symptoms, but do not directly affect the pathology or the factor that gave rise to it. Such palliative measures may include relief from nausea caused by chemotherapy, or pain syndrome with the help of morphine.

Most modern doctors focus their efforts on curing the disease, forgetting about the need and obligation to carry out supportive measures. They believe that methods aimed only at alleviating symptoms are dangerous. Meanwhile, without the psychological comfort of an individual suffering from a serious illness, it is impossible to free him from the tormenting disease.

The principles of palliative care include:

Focus on relief from painful sensations, shortness of breath, nausea, as well as other painful symptoms;

Life support;

Treating death as a completely natural process;

Lack of focus on hastening the end or actions to delay death;

Maintaining patients’ performance and activity at the usual level, if possible;

Improving the quality of life;

Supporting the family of a terminal patient to help them cope;

Integrating the psychological aspects of care and care for incurable patients;

Use at the onset of the disease;

Combination with other various therapies that focus on prolonging survival (for example, chemotherapy).

The primary task of palliative therapy is to relieve patients from suffering, eliminate pain and other unpleasant manifestations, and provide psychological support.

Goals and objectives of palliative care

Previously, palliative support was considered symptomatic therapy aimed at helping cancer patients. This concept today covers patients suffering from any incurable chronic disease at the terminal stage of the pathology. Today, palliative care for patients is a direction in the social sphere and medical field activities.

The fundamental goal of palliative care is to optimize the quality of life of incurable patients, their relatives, and families by preventing and relieving painful symptoms through early detection, careful assessment of the condition, relieving attacks of pain and other unpleasant manifestations of psychophysiology, as well as eliminating problems of a spiritual nature.

One of the key areas of the branch of medicine under consideration is the provision of auxiliary measures to seriously ill individuals in their living conditions and support of the desire to live.

When therapeutic measures, used in a hospital, turn out to be practically ineffective, the patient is left alone with his own fears, experiences and thoughts. Therefore, it is necessary, first of all, to stabilize the emotional mood of the most incurable sick individual and relatives.

In view of this, we can highlight the priority tasks of the type of medical practice under consideration:

Pain relief;

Psychological support;

Formation of an adequate view and attitude towards imminent death;

Solving problems of biomedical ethics;

Satisfying spiritual needs.

Palliative care is provided on an outpatient basis. Responsibility for the timeliness of its provision lies with the healthcare system, the state and social institutions.

Most hospitals have offices whose activities are focused on helping terminally ill patients. In such offices, supervision of the condition and general health subjects, medications are prescribed, referrals are issued for specialist consultations, inpatient treatment, consultations are held, and measures are taken to improve the patient’s emotional state.

There are three large groups of terminally ill individuals and subjects in need of individual palliative care: people suffering from malignant neoplasms, AIDS and non-oncological progressive chronic pathologies in the final stages.

According to some doctors, the selection criteria for those in need of supportive measures are patients when:

The expected duration of their existence does not exceed the threshold of 6 months;

There is no doubt about the fact that any attempts at therapeutic intervention are inappropriate (including doctors’ confidence in the reliability of the diagnosis);

There are complaints and symptoms of discomfort that require special skills for care, as well as symptomatic therapy.

The organization of palliative care needs serious improvement. Carrying out its activities is most relevant and advisable at the patient’s home, since most incurable patients want to spend the remaining days of their existence at home. However, today the provision of palliative care at home is not developed.

Thus, the fundamental task of palliative care is not to prolong or shorten a person’s existence, but to improve the quality of existence so that the person can live the remaining time to the fullest. calm state spirit and was able to use the remaining days most fruitfully for myself.

Palliative care should be provided to incurable patients immediately when initial pathological symptoms are detected, and not exclusively when the functioning of body systems is decompensated. Each individual suffering from an active, progressive disease that brings him closer to death requires support that includes many aspects of his life.

Palliative care for cancer patients

It is quite difficult to overestimate the importance of palliative support for incurable patients suffering from oncology. Since every year the number of cancer patients is growing at a rapid pace. At the same time, despite the use of state-of-the-art diagnostic equipment, approximately half of patients come to oncologists in the last stages of the development of the disease, when medicine is powerless. It is in similar cases that palliative care is indispensable. Therefore, today doctors are faced with the task, along with finding effective tools to combat oncology, to help patients in the terminal stages of cancer, to alleviate their condition.

Achieving an acceptable quality of existence is an extremely important task in oncological practice. For patients who have successfully completed treatment, supportive care means primarily social rehabilitation, return to work. Incurable patients need to create acceptable living conditions, since this is, in practice, the only realistically feasible task that supportive medicine is designed to solve. The last moments of the existence of a terminally ill subject at home take place in difficult conditions, because the individual himself and all his relatives already know the outcome.

Palliative care for cancer must include ethical considerations for the “doomed” and show respect for the wishes and needs of the patient. To do this, you should wisely use psychological support, emotional resources and physical reserves. It is at this stage that a person especially needs auxiliary therapy and its approaches.

The primary objectives and principles of palliative care are, first of all, to prevent pain, pain relief, correction of digestive disorders, and rational nutrition.

Most cancer patients at the terminal stage of the disease experience severe painful pain, which prevents them from doing their usual things, normal communication, and makes the patient’s existence simply unbearable. This is why pain management is the most important principle in providing supportive care. Radiation is often used in medical institutions for the purpose of analgesia; at home, conventional analgesics are used either by injection or orally. The scheme for their prescription is selected individually by an oncologist or therapist, based on the condition of the patient and the severity of algia.

The scheme may be approximately as follows - an analgesic is prescribed after a certain time, while the next dose of the drug is administered when the previous one is still in effect. This use of painkillers allows the patient not to be in a state where the pain becomes quite noticeable.

Analgesics can also be taken according to a regimen called the pain ladder. The proposed scheme consists in prescribing a more potent analgesic or narcotic drug as painful symptoms increase.

Digestive disorders can also cause significant discomfort for cancer patients. They are caused by intoxication of the body due to the countless number of drugs taken, chemotherapy and other factors. Nausea and vomiting can be quite painful, so antiemetic drugs are prescribed.

In addition to the described symptoms, the elimination of painful sensations, algia with opioid analgesics, and chemotherapy can provoke constipation. To avoid this, the use of laxatives is recommended, and your routine and diet should also be optimized.

Reasonable nutrition for cancer patients plays a rather significant role, since it is targeted simultaneously with improving the patient’s well-being and mood, as well as for correction vitamin deficiency, lack of microelements, prevention of progressive weight loss, nausea and vomiting.

Rational nutrition, first of all, implies a balanced diet, adequate calorie content of consumed foods, and a high concentration of vitamins. Patients who are at the terminal stage of their illness may pay special attention to the attractiveness of the prepared dishes, their appearance, as well as on the surrounding atmosphere when eating. Only loved ones can provide the most comfortable conditions for eating, so they need to understand the nutritional characteristics of a cancer patient.

Any patient who is faced with this terrible word “cancer” needs to receive psychological support. He needs it, regardless of whether the disease is curable or not, stage, location. However, incurable cancer patients need it especially urgently, so sedative pharmacopoeial drugs are often prescribed, as well as consultations with a psychotherapist. At the same time, the primary role is still assigned to the closest relatives. It is the relatives that mainly determine how calm and comfortable the remaining time of the patient’s life will be.

Palliative care for cancer should be carried out from the moment this frightening diagnosis is determined and therapeutic measures are prescribed. Timely actions to provide assistance to individuals suffering from incurable diseases will improve the quality of life of a cancer patient.

With sufficient progress data oncological pathology, the doctor, together with the patient, has the opportunity to choose appropriate methods aimed at preventing unwanted complications and combating the disease directly. When choosing a specific treatment strategy, the doctor should definitely include elements of symptomatic and palliative therapy simultaneously with antitumor therapy. therapeutic effects. In this case, the oncologist must take into account biological state individual, his social status, psycho-emotional mood.

The organization of palliative care for cancer patients includes the following components: advisory support, assistance at home and in a day hospital. Consultative support involves examination by specialists who are able to provide palliative support and are familiar with its techniques.

Supportive medicine, in contrast to the usual conservative antitumor therapy, which requires the cancer patient to be in a specially designated hospital department, provides for the possibility of providing assistance in one’s own home.

In turn, day hospitals are formed to provide assistance to lonely individuals or patients who have limited ability to move independently. Staying in such a hospital for several days over a decade creates the conditions for the “doomed” to receive advisory assistance and qualified support. When the circle of home isolation and loneliness dissolves, psychotherapy takes on enormous meaning. emotional support.

Palliative care for children

The type of medical care under consideration has been introduced in children's health-improving institutions, in which special rooms or entire departments have been formed. In addition, palliative care for children can be provided at home or in specialized hospices that include many services and specialists with supportive care.

In a number of countries, entire hospices have been created for children, which differ from similar institutions for adults. Such hospices are an extremely important link connecting care in medical institutions with support provided in a familiar home environment.

Palliative pediatrics is considered a type of supportive medical care that provides the necessary medical interventions, consultations and examinations, and is aimed at minimizing the suffering of incurable babies.

The principle of the approach to palliative pediatrics as a whole does not differ from the focus of general pediatrics. Supportive medicine is based on consideration of the emotional, physical and intellectual state of the baby, as well as the level of its formation, based on the baby’s maturity.

Based on this, the problems of palliative care for the child population lie in applying efforts to terminally ill children who may die before they reach adulthood. age period. Most pediatricians and specialists encounter this category of incurable children. Therefore, knowledge of the theoretical foundations of supportive medicine and the ability to practically apply them is often more necessary for specialized specialists than for pediatricians general profile. In addition, their acquisition of psychotherapy skills, elimination of all kinds of painful symptoms, and pain relief will be useful in other areas of pediatric practice.

Below are the differences between palliative medicine, aimed at providing support to children, and helping adults at the terminal stage of cancer pathology.

Fortunately, the number of children dying is small. Due to the relative small number fatal outcome Among the child population, the system of palliative support for children is poorly developed. In addition, too little has been done scientific research substantiation of palliative methods aimed at maintaining the quality of life of incurable children.

The range of incurable childhood illnesses that invariably lead to death is large, which forces the involvement of specialists from different fields. In adults, regardless of the etiological factor of the disease, experience and scientific confirmation of palliative support in oncology are often successfully used at its terminal stage. In pediatric practice, this is often impossible, since among incurable pathologies there are many poorly studied. Therefore, it is impossible to extend the experience acquired in a separate narrow area to them.

The course of most illnesses in children is often impossible to predict, and therefore the prognosis remains vague. It often becomes impossible to accurately predict the rate of progression of a fatal pathology. The uncertainty of the future keeps parents and the baby in constant tension. In addition, it is quite difficult to provide palliative care to children using only one service. Often, several services provide support to patients suffering from incurable chronic pathology, and activities are intertwined in some areas with each other. Only at the terminal stage of the disease does palliative care take on leading importance.

It follows that the methods of supportive medicine are designed to relieve painful symptoms, alleviate the condition of the baby, improve the emotional state of not only the little patient, but also the immediate environment, which includes brothers or sisters experiencing stress and psychological trauma.

Below are the basic principles of the work of experts in palliative pediatrics: pain relief and elimination of other manifestations of the disease, emotional support, close interaction with the doctor, the ability to conduct a dialogue with the baby, relatives and the doctor regarding the adjustment of palliative support, in accordance with their wishes. The effectiveness of support activities is determined by the following criteria: 24/7 availability, quality, free of charge, humanity and continuity.

Thus, palliative support is a fundamentally new level of awareness of the disease. As a rule, the news of the presence of an incurable pathology knocks the individual out of his usual existence and has a strong emotional impact directly on the sick person and on his immediate environment. Only an adequate attitude towards the disease and the process of its progression can significantly minimize the stress experienced by relatives. Only family unity can truly help children and loved ones get through difficult times. Specialists must coordinate their own actions with the wishes of the child and his family in order for the help to be truly effective.

The procedure for providing palliative care

All human subjects are aware of the fatal end that someday awaits them. But they begin to realize the inevitability of death only when they are on the threshold of it, for example, in the situation of diagnosing an incurable pathology. For most individuals, the expectation of the inevitable approaching end is akin to the feeling of physical pain. At the same time as the dying themselves, their relatives also feel unbearable mental anguish.

Palliative care, although aimed at alleviating suffering, should not consist only of analgesic and symptomatic therapy. Specialists should not only have the ability to relieve painful conditions and carry out the necessary procedures, but also have a positive impact on patients with their humane attitude, respectful and friendly treatment, and well-chosen words. In other words, an individual doomed to death should not feel like “a suitcase with a missing handle.” Until the last moment, an incurable patient must be aware of the value of his own person as an individual, as well as have the opportunities and resources for self-realization.

The principles of providing the described type of medical care are implemented by medical institutions or other organizations that carry out medical activities. This category assistance is based on moral and ethical standards, respectful attitude and a humane approach to incurable patients and their relatives.

The key task of palliative care is considered to be timely and effective relief from pain and elimination of other severe symptoms in order to improve the quality of life of terminally ill subjects before their end of life.

So, palliative care, what is it? Palliative care is aimed at patients suffering from incurable progressive illnesses, including: 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 supply disorders and injuries, degenerative diseases of the nervous system, various forms, including and.

Outpatient palliative care is provided in specialized rooms or by visiting visiting staff who provide assistance to terminally ill patients.

Information about medical institutions providing maintenance therapy should be communicated to patients by their treating doctors, as well as by posting data on the Internet.

Medical institutions that perform support functions for terminally ill individuals carry out their own activities, interacting with religious, charitable and volunteer organizations.

Speaker of the Medical and Psychological Center "PsychoMed"