Palliative care: what it means?

People are getting older on average. Environmental influences also lead more frequently to serious diseases such as cancer. Consequently, the importance of treating these patients palliatively is also increasing. Here, the causes are no longer treated, but the disease is made more bearable in order to give the patient the best possible quality of life. But there is a limit to when palliative treatment is given? How long does the palliative patient usually have to live?? Can palliative patients also be cared for at home? We answer the most important questions about palliative treatment.

Palliative care: What does that mean?

➠ Contents: What to expect

From when palliative: How long to live?

How long a palliative patient has to live depends on the individual case. When palliative care is used therefore varies quite a bit. This can be a period of a few days up to several years.

The decisive factor for the importance of palliative treatment (palliative care in English) is rather another point: there may be no more medical possibilities for a cure. This means that in many cases of a serious disease such as cancer, life expectancy is actually foreseeable – but there is no clear limit to this.

Definition: What does palliative mean??

The term "palliative" is derived from the Latin word "pallium," which literally means "mantle". The definition of "palliative" could therefore be translated as "enveloping". In concrete terms, palliative care means treating a terminally ill patient in such a way that his or her symptoms are alleviated as much as possible. Or to remain in the picture: A cloak is put on him so that he can better bear his situation.

The cause of the disease is no longer treated in palliative therapy, only the symptoms are alleviated. It is not about life-prolonging measures, but about keeping the quality of life as high as possible. This concerns pain therapy in particular. Patients receive pain-relieving medication to ensure the best possible quality of life for the time remaining to them. But other accompanying symptoms such as depression or nausea are also combated with medication.

The word "palliative" is often used in connection with the following terms:

  • Palliative care
  • Palliative Care
  • Palliative care
  • Palliative care
  • palliative care

In principle, this always means the same thing: the palliative care of a terminally ill patient until the end. Usually in specially equipped wards of a hospital or a hospice.

What is done during palliative treatment?

The central goal of palliative therapy is to control and alleviate the symptoms that are a burden to the affected patient. Therefore, these must first be clarified. It is also important to record the wishes of patients and relatives in order to be able to take appropriate measures.

In these measures, palliative physicians distinguish between general patient care and special patient care. If the symptoms are still within tolerable limits, measures are taken by the nursing team, the so-called "palliative care team," to leave patients in their home environment if possible and to provide them with pain therapy on an outpatient basis.

Specialized palliative care is usually provided in hospices or palliative care units of hospitals. The reason is that the measures and also the review of the therapy are more extensive and time-consuming. In addition, a doctor must be available on a regular basis.

Depending on which phase the patient is in, the corresponding measures are also combined with each other. It is very important for palliative care workers to deal openly and in a spirit of trust with both patients and their relatives. The topic of death and dying must be discussed honestly and the patient’s feelings as well as their safety, self-determination and security must be placed in the foreground.

How long can one be treated palliatively?

How long palliative treatment lasts is difficult to predict. There is no clear time limit on how long a patient receives palliative care. However, as it concerns the final phase of a serious illness, it naturally lasts a few weeks rather than months in most cases.

In many cases, palliative treatment is only given in the last days before the patient dies, when the patient becomes increasingly bedridden and withdrawn, and emotional support in particular becomes more important in order to alleviate fear and grief.

However, depending on the clinical picture, palliative can also mean much earlier support. The physician Dr. med. Ingeborg Jonen-Thielemann therefore makes a distinction not according to the length of the palliative process, but according to four phases:

  1. Rehabilitation phase
    In the first phase, the aim is to enable patients to lead as normal a life as possible, with social participation and mobility guaranteed. In some cases, this phase can even last for several years, and care is usually provided on an outpatient basis.
  2. Pre-terminal phase
    In the second phase, the impairments caused by the disease increase and it becomes increasingly difficult to lead an active life. Inpatient stay becomes more likely.
  3. Terminal phase
    The third phase is considered the preliminary stage of dying. In many cases, extensive palliative therapy only begins at this stage, since the patients can hardly or no longer leave their beds.
  4. Final phase
    In the final phase, the focus is on dying with dignity and accompanying the relatives. The terminal phase usually lasts only a very short time: from several hours to a few days.

Palliative care at home

Those who are terminally ill are grateful for every day that they can still enjoy as much as possible. An essential component in this context is that the symptoms of the disease – especially the pain – are kept to a tolerable level.

This can happen basically anywhere, theoretically also at home. In fact, however, palliative treatment in the vast majority of cases takes place in specially equipped palliative wards in hospitals or even in facilities that were created just for this purpose – hospices.

The reason is simple: palliative patients usually require intensive observation and care. The administration of high doses of painkillers in particular requires medical skill and experience. This is possible at home only in very few cases.

Caring for palliative patients

If the palliative patient can be cared for at home, the family caregivers are almost always supported by an outpatient care service. In addition, there are physicians in private practice and other helpers who work on a voluntary basis. All these forces are specially trained to provide outpatient palliative care and form the mobile palliative care team.

Their work is well coordinated. Thus, one cog meshes with the other and good care is guaranteed. However, the demand for outpatient palliative care teams far outstrips the demand. In the end, the decisive factor is the diagnosis and the possibility to carry out palliative care at home. Especially in rural regions, there is often a lack of appropriate infrastructure in this respect.

Palliative care: The elements of palliative care

Whether outpatient or inpatient: In addition to the medical side, a palliative therapy also includes a number of other measures. They are directed not only to the patients concerned, but also to those around them. Both in a hospice and in the corresponding palliative care units of hospitals, there are experts who can provide support in this context.

  • Palliative therapy
    Ergo- and physiotherapists, as well as masseurs help with special mobilizations and thus also support the work of the nursing staff, since keeping the patients strong also simplifies wound care and positioning.
  • Palliative care
    Volunteers and specially trained helpers not only take care of everyday tasks, but also accompany the patient’s relatives and are there for the patient as a discussion partner and interpersonal contact person.
  • Social work
    The social workers in the palliative care support mainly bureaucratic and socio-legal matters such as correspondence with health insurance companies or pension insurance, but are also available as contact persons for the relatives.
  • Pastoral care
    Church pastors, as well as psychotherapists, help with emotional distress and support the care of volunteers in the field of psychosocial support.

Palliative chemotherapy and other treatments

The fact that the patient is receiving palliative care does not mean that he or she is simply receiving a high dosage of pain medication and is otherwise left to his or her fate. Palliative therapy is much more extensive than one might think at first glance.

In most cases, it contains various components, for example:

  • Medication
    Medication is administered to relieve pain, but also to provide nutrition, prevent respiratory distress and prevent depression. This does not necessarily have to be in tablet form; drops, injections, infusions, patches or even lollipops are also used.
  • Radiation
    In tumor patients in particular, radiation is used to reduce the growth of metastases – especially on the bones. This is how mobility is to be maintained to some extent.
  • Chemotherapy
    As with radiation, chemotherapy can no longer cure the tumor patient in the final phase of the disease. However, it can positively influence the course of the disease and thus make it more bearable.
  • Surgery
    In principle, the idea of palliative care contradicts surgery. In individual cases, however, this can make perfect sense if, for example, an intestinal obstruction, which would mean great agony for the patient, is removed surgically.

All forms of palliative therapy are ultimately aimed at alleviating, controlling and cushioning agonizing symptoms. Since the life span is foreseeable, no attention has to be paid to possible late and long-term consequences. For this reason, morphine preparations are also frequently used, which are otherwise used very sparingly in administration.

What is the difference between hospice and palliative care??

A hospice is an independent care facility whose sole aim is to provide terminally ill patients with care that enables them to enjoy the highest possible quality of life and self-determination. These homes are designed to accompany the palliative patients to the end.

Palliative care units in hospitals, on the other hand, are not prepared to provide long-term care. If the end of a patient’s life is foreseeable, there is usually no longer any need for transfer. But when this is not the case, palliative care units are designed to discharge their patients: Home or hospice.

In both cases, palliative treatment is used not only for cancers. Palliative care is also used for other serious terminal illnesses in the last phase of life, for example:

  • Cystic Fibrosis
  • Traumatic brain injury
  • Amyothrophic lateral sclerosis (ALS)
  • Pulmonary Fibrosis

More information on palliative care

Both the German Medical Association and the Federal Ministry of Health offer guidebooks and information brochures on the subject of "palliative care" on their websites. There you will also find appropriate contact points and offers in your area.

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Important notice

This article does not claim to be complete and only provides general information. It cannot and should not replace a medical consultation with a doctor. Before taking any medication, please read the package insert carefully and ask your doctor or pharmacist.

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