The word “palliative” is often scary, as it is associated with serious illnesses at the last stage. In fact, this is not the case, and palliative care may be required even with ordinary hypertension if the patient has macrovascular complications (myocardial infarction, heart failure, cerebral stroke). To receive palliative care, a person needs a special status – “palliative patient”. How to get it told general practitioner, head of the coordination center for palliative care of the region Anna Shestakova.
“Palliative status is a condition of a person who has been diagnosed with a chronic incurable disease and at the same time the possibilities of etiopathogenetic treatment have been exhausted (therapy based on knowledge of the nature and pathogenesis of the disease). In addition, the status of such a patient also means the totality of his rights to receive special support, including medical, psychological, social assistance, the issuance of medical equipment for use at home and preferential provision of medicines, ”explains Anna Shestakova.
When is palliative status assigned?
As the specialist notes, palliative status is assigned to a person in the presence of a number of diseases:
- various forms of malignant tumors;
- various forms of dementia, including Alzheimer’s disease;
- severe irreversible consequences of cerebrovascular accidents;
- terminal stages of diseases of the circulatory and respiratory organs;
- renal and hepatic insufficiency;
- degenerative diseases of the nervous system;
- BAS (amyotrophic lateral syndrome) and other diseases of the motor neuron;
- multiple sclerosis.
“For all these diseases, there are clarifications that the attending physician of a person knows about. It is the observing specialist who first thinks that the patient needs palliative care,” says Anna Shestakova.
For example, the specialist notes, in a person with liver disease, such extended indications would be:
- the severity of liver cirrhosis on the Child-Pugh scale is at least 10 points;
- ascites (accumulation of fluid in the abdominal cavity), resistant to the action of diuretics (diuretics);
- hepatic encephalopathy;
- repeated bleeding from varicose veins.
“If we are talking about patients with diseases of the cardiovascular system, then for them the indications for palliative care will be: the end stages of chronic heart failure (III and IV functional class according to NYHA), repeated hospitalization due to heart failure / other forms of coronary artery disease (ischemic heart disease) that has occurred at least 3 times in the last year, shortness of breath or chest pain at rest or with little exertion, a pronounced decrease in ejection fraction (<25%) или выраженная легочная гипертензия (давление в легочной артерии > 70 mmHg Art. according to echocardiography).
How to understand that you need a status?
Anna Shestakova notes that the following signs may suggest the need for palliative care:
- The patient does not get better, despite the ongoing treatment, while he has a rapid loss of strength, a decrease in mental activity.
- A person begins to lose weight quickly, loses appetite for no apparent reason – a loss of body weight of more than 10% in six months is considered critical.
- Decreased activity in a person, for example, if he has lost the ability to perform two or more daily activities.
“If such signs are observed by people close to the patient, you should contact your doctor and point out the existing problems. Next, the doctor evaluates the medical indications for groups of diseases or conditions and decides on the need for palliative care, ”explains the specialist.
How is the status assigned?
For this, a special medical commission is being assembled – this one works at every medical facility in clinics and hospitals. The decision to assign “palliative status” is taken collectively. As part of such a commission, the patient’s attending physician or a doctor according to the profile of the disease, for example, a neurologist or pulmonologist, a geriatrician for people over 75 years of age, as well as the head of a medical institution or deputy head physician. The committee should also include a specialist in palliative care. If there is no such person in the medical institution, he may be invited from another clinic.
“Usually, such a process takes about one day if the necessary examination results are available,” says Anna Shestakova.
After a person is recognized as a palliative patient, the general practitioner or palliative care specialist enters the available information into the register of such patients, after which social services receive information about him. The registry also determines the need for special potent analgesics, special equipment for home life support, and special nutrition.
Why is palliative status necessary?
The possibility of obtaining palliative status should not be ignored. After all, it provides a number of advantages. Among them, Anna Shestakova lists, the following items:
- accelerating the process of obtaining disability;
- a person receives preferential medicines and is provided with special equipment according to a special program;
- a person can be hospitalized if necessary in any department of palliative care;
- a team of mobile patronage service can come to a person’s house, carry out the necessary manipulations, write out prescriptions for strong analgesics.
“Most often, the patient and his relatives refuse such a status because of the fear of being left without treatment and specialist supervision. And here it is worth understanding that the person will continue to receive the previously prescribed therapy, plus he will receive the opportunity for additional assistance, including medical, social and psychological, ”says Anna Shestakova.
It is important to remember that both the patient and his legal representative can refuse palliative care, while the status of a palliative patient is not. It is assigned to a person without fail, if there is evidence for that. And then the person himself and his relatives decide whether to use it or not, sums up Anna Shestakova.