What is Palliative Care?

Palliative care is called "palliative care" in Europe and the United States, and it is translated into soothing medicine in Japan and Taiwan. It is currently translated into palliative care in mainland China.

Palliative treatment originated from the hospice movement, which first originated in the fourth century AD. Starting from hospice in the 60s of the last century, after decades of development, palliative care has become an important link and aspect of cancer prevention and control systems worldwide.

Chinese name: Palliative care
Foreign name: palliative treatment (care)
Origin: hospice movement

Make up: Origin and history of palliative care
Related agencies: World Health Organization, NCCN, EAPC
Method: Palliative treatment

Palliative care

Origin and development of palliative care

Palliative treatment first appeared in the 12th century. HOSPICE originally referred to the post station on the pilgrimage route. 1879: A nun, Mary Aikenhai, a Berlin nun, uses the Abbey House hosted by her monastery as a place for patients with advanced cancer. 1905: A St. Joseph's Anning Home run by a nun in London also specializes in accommodating patients with advanced cancer. Later, the Anning Hospital gradually changed from a post station to a special care institution for advanced patients. 1950: Ms. Sanders of Sicily is a nurse and advocates the establishment of a more humane Anning Institute. 1967: Ms. Sicily Sanders followed the patient's wishes to study psychology and medicine. In 1967, she set up the world's first modern St. Klissdorf Anning Home with medical technology and psychological care. Ms. Sanders personally led the medical team to conduct a series of cancer analgesics and spiritual care.

The model of modern palliative medicine has been established since the establishment of St. Klissdorf Anning Institute in 1967. Since then, this model has gradually been accepted and promoted by developed regions of the world. 1976: The first Analytical Institute in the Americas was established in Connecticut, USA. Since then, the hospicesian Analytical Institute in the St. Klissdorf model has been established in Europe and the United States. In the early 1990s, Japan, Singapore in Asia, Hong Kong, and Taiwan in China also began to develop palliative care services. China's palliative care began in the early 1990s, and developments across regions have been inconsistent.

In 2010, the Massachusetts General Hospital of the United States published a study on anti-tumor therapy for patients with non-small cell lung cancer and early palliative care to improve the quality of life and overall survival of patients. Studies on early palliative care have been published. Get promoted within.

The concept and practical significance of palliative care

The World Health Organization has identified four priorities in prevention, early diagnosis, radical treatment and palliative care in the comprehensive plan for oncology work. This shows that palliative care is an essential aspect of cancer control. The World Health Organization's definition of palliative care is "palliative care medicine is the complete active treatment and care of patients who do not respond to curative treatment. Control pain and patient-related symptoms, and pay attention to psychological, social and mental problems. Its purpose is to win the best quality of life for patients and their families. WHO pays special attention to palliative care in terms of symptom control, patient support, and quality of life. It should be noted that palliative care should be combined with radiotherapy and chemotherapy in the "early course". Application is an effective supplement for chemoradiation, allowing clinicians to "better understand and manage painful clinical complications" from the beginning of cancer treatment.

For example, in addition to WHO, major authoritative medical institutions such as ASCO, ESMO, NCCN, and EAPC have emphasized the need to strengthen the management of the physiological symptoms, psychological and spiritual needs of cancer patients throughout the disease.

Palliative care has far-reaching practical significance for current medical development. 1. Turn from "disease-oriented" to "patient-oriented". In addition to the professional skills of medical staff to alleviate the physical symptoms of patients, the care needs of patients with "end-stage disease" are as important as the treatment of symptoms. More attention needs to be paid to "people", not just "illness". (2) Saving medical resources. Palliative medicine in the United States, some developed countries in Europe and Asia has confirmed that it meets the minimum health economics assessment, which is conducive to the rational allocation and utilization of limited medical public resources. (3) Relieve doctor-patient relationship. Palliative care attaches great importance to communication with patients and their families, advocates that medical care and patients are partners and equal relations, and the training of communication skills of medical staff plays a very important role in palliative medical education and training. In the process of palliative care, medical staff pays attention to the communication skills with patients, which relieves the tension between doctors and patients to a certain extent, and has important clinical significance.

The different stages of palliative care and its implications

Stage 1: Combination of anti-cancer treatment and palliative treatment, the target is cancer patients who may be cured; palliative treatment is mainly to alleviate symptoms and adverse reactions caused by cancer and anti-cancer treatment, symptomatic supportive treatment, and guarantee quality of life during treatment.

Phase 2: When anti-cancer treatment may no longer benefit, palliative care is the main target for patients with advanced cancer that cannot be cured; palliative care is mainly to relieve symptoms, reduce pain, and improve quality of life.

Stage 3: Provide hospice care and hospice services for end-stage cancer patients with an expected survival time of only a few days to a few weeks.

In order to ensure that palliative care runs through the whole process of cancer treatment, patients should be allowed to establish the concept of palliative care as early as possible to ensure that anti-cancer treatment is used reasonably at the benefit stage. For example, in palliative care, more attention is paid to symptom control, such as pain, anorexia, constipation, fatigue, dyspnea, vomiting, cough, dry mouth, diarrhea, and difficulty swallowing. At the same time attach importance to mental and psychological problems and psychological care.

Palliative care Palliative care runs through the entire course of cancer treatment

In 1998, ASCO proposed that the responsibility of oncologists and palliative teams is not only to treat cancer, but to integrate palliative care and standard anti-tumor treatment throughout the entire disease treatment process.

A landmark study on palliative care emerged in 2010. "Early palliative care for patients with metastatic non-small cell lung cancer" published by the Massachusetts General Hospital in the New England Journal was included in this study. Randomly assigned to receive early palliative care in combination with standard anticancer therapy or standard anticancer therapy alone. The results suggest that compared with the standard treatment group, patients in the early palliative treatment group significantly prolonged their median survival by 2.7 months, and the proportion of patients receiving intensive hospice treatment decreased. Subsequent research on the early addition of palliative care improved the quality of life and reduced the subjective burden not only for patients but also for caregivers. Therefore, palliative care is increasingly becoming a comprehensive treatment model throughout the whole course of tumor treatment.

Just like the five-all care of the peaceful care model in Taiwan, the whole person: to meet the patient's physical, psychological, social and spiritual needs; the whole family: sadness counselling for family members during illness and after the patient's death, and the whole process: continuous sadness (bereavement) counselling; Whole team: a group of trained teams to take care of the whole family of patients; whole community: refers to the integration of all social resources to provide patients with comprehensive care in the family or community.

Palliative treatment is not only "treating" but also "saving people"

The nine goals of the World Cancer Declaration: Emphasize the importance of the full management and control of cancer, the importance of rehabilitation, palliative and supportive treatment, and the effective control of cancer pain and psychological suffering. Through a lot of research and practice, we can see that palliative care hospice care can be simply understood as supportive care and / or soothing treatment, and more directly, let patients and their families "live good + dignity die". This requires that palliative care not only treat the disease itself, but also pay attention to the patient himself. As Jimmy Holland, the founder of psychosocial oncology, said: Medicine is more than just medicine in a bottle! It is hoped that through more systematic, comprehensive, objective, and scientific palliative care, the medical community will bring a "private customized" anti-cancer and palliative treatment plan to our cancer patients in China.