REVIEW – March 2008

The principles and goals of palliative medicine


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The World Health Organization defines palliative care as “the active total care of patients whose disease is not responsive to curative treatment”. The goal of palliative care is to ensure the best possible quality of life for the patient and her/his family. That means symptom control and attention to the patient as a whole. The transition from active to palliative care is not something that occurs at a single time point but is a process. The most important things in planning palliative care are symptom assessment and that the health care professionals discuss the goals of care with the patient and his/ her relatives. As the most prevalent symptom in palliative care is pain, effective pain management is highly important. Palliative care does not mean only care of patients with advanced cancer. Also patients with other chronic progressive diseases such as heart or renal failure, and dementia should be offered the possibility to receive palliative care if they need it. Palliative care can be provided in a variety of places: at the person’s home, in hospitals, in nursing homes or in hospices; it can be provided by a specialist or by a family doctor. Although studies have shown that most patients would prefer to die at home, yet most of them die in hospital. In Estonia, palliative care is organised by university hospitals, municipal hospitals, family medicine centers and the cancer society. The Estonian Cancer Society launched a projection home based supportive treatment of cancer patients in 1997. Today there are 15 palliative care teams active in Estonia. One team consists of a nurse or nurses, a doctor and some volunteers. The service of palliative home care is free of charge for the patient in Estonia. In the oncological clinic palliative chemo- and radiotherapy and palliative surgery are applied if the patient needs this kind of treatment. Despite the advances in modern medicine, many illnesses continue to progress and the number of patients whose disease is incurable is growing. Hence there is great need to develop palliative medicine.