Anyone suffering from a far-advanced illness, with no prospect of a cure and who is also struggling with severe symptoms, generally receives palliative care in Germany. Recently, this option is often already available for initial diagnoses of malignant tumors or chronic diseases. Care can be provided on an outpatient basis by trained general practitioners and specialists as well as trained nursing staff, or on an inpatient basis. In the first case, this is so-called "specialized outpatient palliative care" (SAPV) or "specialized inpatient palliative care" (SSPV).
Those who superficially deal with palliative care might at first glance get the impression that care by palliative physicians and nurses is purely end-of-life care. However, this is not the case, as Dr. med. Yann-Nicolas Batzler, a specialist in urology and palliative medicine at the Interdisciplinary Center for Palliative Medicine (IZP) at the University Hospital Dusseldorf (UKD) explains: "We are trying to change the way people think and look at palliative medicine. Palliative medicine has long since ceased to be the care of the dying, as many people might think. For us palliative physicians, it is about accompanying patients in the early stages of an illness, pointing out possible care options and determining the various options for symptom control. Studies show that the earlier palliative medicine is on board, the fewer symptoms occur and the better the quality of life with system therapies. I think it's very important to know that. Palliative care is there for symptom management, to be a strong support and knowledgeable and helpful contact in the treatment and to maintain or increase the quality of life of those affected as best as possible."
What does palliative care do for those affected??
As a rule, palliative care wards are independent wards that are affiliated with hospital operations. The IZP at the Dusseldorf University Hospital, for example, currently has eight beds. The goal of interdisciplinary treatment and care is to discharge patients as quickly as possible if symptoms are sufficiently relieved. Prior registration in a palliative care unit can be made by the patients themselves, their relatives, a nursing service, the attending physicians in private practice, nursing homes or employees of the respective clinics. Admission requires a physician's referral. The stay for the purpose of specialized inpatient palliative care is usually limited in time.
The costs incurred are borne by the health insurance companies. This applies to both the statutory and private health insurance schemes. For the care of patients in specialized inpatient palliative care units and hospices, private health insurance provides benefits according to the usual reimbursement regulations. This takes into account the special needs of patients in their final phase of life. Special regulations apply to the care of seriously ill children, who are often cared for more than once in an inpatient hospice or a palliative care unit. Here, too, private health insurance provides the corresponding services – even on multiple occasions.
Great responsibility for a great team
On a palliative care ward, patients are cared for and looked after by multiprofessional teams after their admission. The targeted treatment of advanced, incurable diseases by means of system therapy often results in patients being able to live for quite a long time without further assistance from medical professionals in their respective maintenance therapies, explains Dr. Batzler. "It is quite the case that we no longer have to care for patients, because the quality of life after our care is very stable. We also have an outpatient team that then provides care at the patient's home, and it's the nicest thing when we find that our colleagues can do their job because the symptoms are under control, the quality of life is right, and the patients can live self-sufficiently without any help from us."
A wide range of knowledge is required for the diverse tasks of palliative care. This can be exemplified by the broad-based team of the palliative care center at the UKD: The team includes specialists who are also palliative physicians, assistant physicians, the nursing team, consisting of specialist nurses and palliative specialists, case managers, physiotherapists, masseurs, psychologists, social pedagogues, social workers, grief counselors, pharmacists, a priest and even a therapy dog.
SSPV, SAPV and consult service work hand in hand in palliative care
Colleagues from a wide range of disciplines work hand in hand to provide all-round care for patients both on and off the ward. "We have a SAPV team that can go to patients' homes, and we also have the consult service, which helps care for other specialist departments in the university hospital. We also offer communication seminars for departments, something a colleague has done very successfully on the Covid ward, for example," adds Dr. Batzler.
However, the medical history is always part of the patient's care, especially if the patient has a long history of illness. For the treating palliative physicians, the question always arises: Who were and are the treating specialists and general practitioners?? Copies of doctors' letters and examination records are available? Who are the contact persons in an emergency? Do precautionary documents exist, such as z.B. a valid living will and a health care proxy? Questions for which the palliative physicians are happy to call on the help of the patients and their relatives.
No one need be afraid of palliative care
"The relatives in particular are not left out. In concrete terms, this means that we are happy to include them in the admission interview and to hold so-called family discussions. Relatives and patients benefit totally from this and we already discuss during the admission interview that we will meet again soon after a few days of getting to know each other in order to plan the care and to discuss medical and nursing topics. We want to know whether home care is guaranteed, whether aids need to be prescribed and applied for, whether the degree of care has been determined or adjusted, or whether the patient is in need of care. must be graduated higher in order to make additional care possible. For us, cooperation with relatives does not stop at the doorstep; on the contrary, it is just beginning there," says Dr. Yann-Nicolas Batzler concludes.
For those with general questions about palliative medicine, the palliative medicine specialist recommends visiting the website of the German Society for Palliative Medicine. There, those seeking advice and those interested can get a lot of information and download options, also in the area of preventive care and symptom control. In addition, there is always the possibility to inform yourself on the websites of the respective palliative care units and to seek direct contact. General practitioners and specialists also provide information about the many options for palliative care. If you have any questions about care and support, you can always contact the care support points or care advice centers.