Palliative care (PC) has taken off since the late 1960s, especially in Anglo-Saxon countries, after Dame Cicley Saunders was able to open the first hospice in London. In Switzerland, too, great progress has been made in the care of seriously ill patients over the past 20 years.
An important milestone for further development was the implementation of the National Strategy for Palliative Care 2010-2012 by the FOPH, as well as its extension to 2015, since the implementation of the defined goals was judged to be not yet satisfactory.
According to the “National Guidelines for Palliative Care”, palliative care “comprises the care and treatment of people with incurable, life-threatening and/or chronically progressive illnesses. It is included proactively, but its focus is during the time when curation of the disease is no longer considered possible and is no longer a primary goal. Patients are guaranteed an optimal quality of life adapted to their situation until death, and close caregivers are adequately supported. Palliative care prevents suffering and complications. It includes medical treatments, nursing interventions, and psychological, social and spiritual support.”
In practice, however, the very interpretation of the definitions often presents us with difficulties. For some physicians and patients, palliative care is euthanasia medicine or perhaps even assisted suicide medicine. For some payers, palliative care is not a qualified medical challenge, but a nursing challenge at best. While on the one hand there is a call for specialists trained in palliative care, other voices say that these competencies have been part of the basis of medical thinking and action for many years and are “rather old wine in new bottles”.
It is an undisputed fact that, due to sociodemographic developments in the Western world, the need for qualified medical and nursing care for seriously ill and or very old patients will increase.
The two articles in the current issue of InFo ONKOLOGIE & HÄMATOLOGIE are intended to provide examples of how diverse the requirements for good palliation can be, without therefore immediately advocating comprehensive provision with specialist physicians. Using pain management as an example, it should be made clear that good knowledge and skills in the implementation of sufficient analgesia can be achieved with reasonable effort, without therefore denying that pain management can sometimes also be a difficult medical challenge that requires specialized knowledge.
We believe that the fundamentals of palliative care should be part of the basic competencies of every practicing physician. On the other hand, a sufficiently large number of specialists with the necessary know-how must be available to adequately accompany even demanding phases of suffering and dying of patients with their knowledge and competence and to ensure the corresponding increase in knowledge through qualitatively good research.
With this in mind, we wish you an exciting read of the articles!
Christel Nigg, MD
Nic Zerkiebel, MD
InFo Oncology & Hematology 2014; 2(3): 4.
