The Palliative medicine deals with the medical treatment of diseases that are no longer curable and limit the life span. It is not about extending life, but about improving the patient's quality of life. All treatments are carried out with the consent of the person concerned.
What is palliative medicine?
The development of palliative medicine was the necessary answer to the increasing tabooing of dying in modern times as a result of individualization, the secularization of society and the weakening of the family. In 1967 the English doctor Cicely Saunders founded St. Christopher's Hospice in London.
Long before that, she repeatedly pointed out the grievances in the care of seriously ill and dying people in hospitals. There only measures were taken to prolong life, but these in no way improved the quality of life of the patients. In her concept, she pursued the aim of enabling terminally ill patients who no longer have any prospect of a cure to live in dignity and as far as possible free from symptoms until the end of their lives.
In Germany, the development of palliative medicine began in the 1980s with the establishment of the first hospices. It was not until the 1990s, however, that palliative medicine began to develop rapidly. The goal of palliative treatment is to ensure the quality of life through comprehensive medical, nursing or psychosocial care for those affected and their relatives.
Treatments & therapies
In palliative medicine, 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 treated. Malignant tumors represent the largest proportion in hospices and palliative care departments.
Palliative medicine requires different specialists to work together in a team. On the one hand, the medical and on the other hand the nursing and psychosocial care of the patients must be ensured. Medical care includes symptom control and the relief of symptoms through treatment methods that do not put additional strain on the person affected. The main symptoms that are treated in palliative medicine include pain, weakness, tiredness or difficulty breathing.
Pain is usually relieved by drug treatment. Level 1 medications such as metamizole are used for mild pain. A high pain intensity often also requires the use of weak or even strong opiates of levels 2 and 3. In the case of shortness of breath and nausea, there are similar graduated therapies in the drug application. In special crisis situations, measures such as invasive ventilation or palliative operations are also possible within the scope of the possibilities and with regard to the chances of success for a temporary improvement in symptoms. It should always be considered whether the treatment is necessary or even additionally stressful for the patient.
The aim of therapy is always aimed at alleviating the symptoms. Physiotherapy or physical measures can often alleviate the symptoms. The other pillar of palliative medicine is based on the 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 contributes to a high quality of life even in the final stages of life. It is also important to include close relatives in the overall treatment concept. In the last phase of life, this is a reassuring feeling for both the patient and their relatives.
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➔ Medicines against memory disorders and forgetfulnessDiagnosis & examination methods
In palliative medicine, the principle applies to use as little technology as possible. Stressful diagnostic procedures should be avoided. The patient's main ailment is well known. In the medical field of palliative medicine, it is mainly about controlling symptoms. It is often unreasonable for the patient to conduct research into the cause of newly occurring symptoms.
Most often it 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. Less stressful tests such as laboratory tests for blood, secretion, stool or urine should be carried out. Changes in the blood count or in the other biological samples can provide indications of additional changes that can be controlled in the context of palliative medicine without stressful therapies.
Infections can often be suppressed again through drug treatment. In the case of imbalances in the mineral balance, a different diet composition or the addition of additional minerals may help. In exceptional cases, in the event of a health crisis, an imaging procedure can be helpful to detect sudden changes such as intestinal obstruction, urinary obstruction or others and to initiate immediate emergency treatment. The main focus, however, is on medical and psycho-social support for the serious underlying disease.
As already mentioned, the goal of palliative medicine 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. It is important to note some important principles of palliative medicine. One of the principles is to tell the patient the truth about his condition and to give him orientation for his decisions. On this basis, the patient should decide autonomously about treatment measures. Therapy must not lead to an aggravation of the suffering, even if it should be life-prolonging. Social contact is particularly important in palliative medicine.
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