According to the explanation of the World Health Organization, palliative care especially considers people’s “physical, mental, social and spiritual” needs, and regards near-death as a normal process, neither accelerating nor delaying death, but only at the end of a person’s life. Pain relief services, providing a support system to help families deal with bereavements and provide comfort.
As early as 2004, initiated by the World Health Organization (WHO), the World Hospice and Palliative Care Alliance (WHPCA) proposed that the second Saturday in October each year be the World Hospice and Palliative Care Day.
”As a medical institution featuring tumor treatment, we should pay more attention to how people can have more quality and dignity in the final stage of life.” Ding Jian, director of Beijing Huanxing Cancer Hospital, told reporters that palliative care is not only about For cancer patients and their families, its concept should run through the treatment process of all diseases.
But in fact, my country’s existing medical conditions can only meet the needs of 0.3% of patients for palliative care.
”This is inseparable from the lack of understanding of palliative care by front-line medical workers.” Ge Nan, an attending physician in the Department of Geriatrics of Peking Union Medical College Hospital, believes that domestic education on palliative care must keep up.
According to the reporter’s understanding, only a few medical institutions in major cities in China have outpatient clinics or wards for palliative care, but most of them are “hidden” in medical oncology, palliative care, and geriatric medicine.
Pain control should not be ignored
”When it comes to cancer, the first problem is pain.” Yu Lei, director of the General Department of Cancer Hospital, Chinese Academy of Medical Sciences, said that cancer pain can cause severe stress reactions in the body and seriously affect the quality of life of patients.
But unfortunately, in reality, about 75% of cancer patients die in pain. In fact, a related study from the World Health Organization and the hospice agency shows that 85% of cancer pain can be relieved by the use of oral opioids.
”Some medical workers believe that pain is a process that cancer patients must experience, and they are worried about respiratory depression and opioid addiction caused by the use of painkillers,” said Cong Minghua, an attending physician in the General Department of Cancer Hospital, Chinese Academy of Medical Sciences.
According to Wu Xiaoming, deputy director of the General Department of Cancer Hospital, Chinese Academy of Medical Sciences, scientific and rational drug use will not lead to drug addiction and respiratory depression.
In addition to pain, the psychological problems of cancer patients are also a threshold for medical workers.
”All cancer patients bear enormous psychological and physical pain, fear death, pain, loss of function, and are also full of worries about their families and the future. Oncologists should listen, comfort, and understand their patients’ psychological feelings more, while Don’t treat them as ‘gasping tumors’,” said Tang Lili, director of the Rehabilitation Department of Peking University Cancer Hospital.
But in reality, the work of psychotherapy for cancer patients in my country is still lacking, especially the lack of professional talents. Palliative care can better bridge the “gap” between doctors and patients.
”Actually, for cancer patients, in addition to the most advanced drugs and surgical treatments, professional psychotherapy can also arouse their hope for life.” Tang Lili told reporters a story: an old man with advanced cancer couldn’t bear his daughter’s death He worked hard and chose to commit suicide by taking sleeping pills. Fortunately, he was discovered in time by the nurse and underwent gastric lavage and other treatments.
When Tang Lili rushed over, the old man’s mood had calmed down a little. “He told me that he felt like a burden and caused a lot of trouble to his daughter, so he wanted to leave.”
”Your daughter has two fathers in her life. One is a ‘real father’ and you are the father-in-law. When you leave, she will lose the opportunity to call her father.” Tang Lili tried to communicate with the old man in this way, and The daughter was also present and expressed that she was not too tired and wanted to spend more time with her father.
In this way, the old man no longer had mood swings, and left safely two months later.
Tang Lili said that for terminal cancer patients, we should try to find the courage to live for them from the three dimensions of value, meaning and love.
”Tumor nutrition is a science and a treatment method, and it is not dependent on any other treatment methods.” Shi Hanping, director of general surgery at the Aviation General Hospital of China Medical University, said that more than 50% of cancer patients have malnutrition when they are first diagnosed. However, malnourished cancer patients have a relatively short survival period, cannot tolerate radiotherapy, chemotherapy and surgery, and are prone to complications or side effects.
However, in reality, the concept of tumor nutrition has not been widely accepted by people including medical staff, and there are even misunderstandings that nutrition can promote tumor growth.
No amount of intervention for cancer patients may be able to prevent the final parting. And how to say goodbye with peace of mind is also the focus of palliative medicine.
”From the time the patient is diagnosed with cancer to the time they leave, the suffering and pain of the family may be no less than the patient.” Liu Yingjie, director of the Nursing Department of Beijing Huanxing Cancer Hospital, said that palliative care not only pays attention to the patient, but also takes care of the patient’s family member. “Many times, the patient’s family cannot accept the final outcome.”
In fact, birth, aging, illness and death are the natural process of life, but people often attach importance to “life”, but are taboo to talk about “death”. “Only by facing death and not avoiding death can the public get out of the misunderstanding of ‘taking death as a failure of doctors and medicine’.” Liu Duanqi said.
”In the past, we saw patients leave helplessly, and we were very hesitant, and we also felt job burnout. Under the guidance of the concept of palliative care, we can use various methods to let patients leave peacefully, and let the patients leave peacefully. Family members can feel at ease.” Ning Xiaohong, deputy chief physician of the Department of Geriatrics at Peking Union Medical College Hospital, said that more and more evidence shows that patients who are treated with palliative care and those who are treated at all costs not only live well, but also live longer .
Palliative care gap remains large
In the Spring Festival of 2020, Yu Shiying, a professor at the Tumor Center of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, received a New Year’s card. The greeting card comes from a doctoral graduate who has gone abroad to study. The first sentence on it reads: I took a music class last week, and the host asked us to choose a word to describe our profession. I chose “caring”.
Seeing the student’s choice, Yu Shiying was “hot in my heart”. Having been following and promoting the concept of palliative care for many years, she is well aware of the weight and warmth of the word “care”. “What doctors care about the most is treatment, while palliative care cares about care.” Yu Shiying said.
”We have been promoting eugenics and eugenics in the past, which is actually not comprehensive,” said Liu Duanqi, chief physician of the Seventh Medical Center of the PLA General Hospital. “Adding eugenics, eugenics, and eugenics is a complete policy.”
2015 In 2018, the Economist Intelligence Unit released the Quality of Death Index report for 80 countries around the world. The rankings are assessed on five dimensions: palliative care and the healthcare environment, human resources, affordability of healthcare, quality of care, and level of public engagement. Regrettably, China only ranks 71st, well below average in all dimensions, with the lowest score being the quality of care.
Some experts believe that if the ranking is done again, China’s ranking will rise. In recent years, palliative care has accelerated in China—the “Healthy China 2030″ Plan Outline launched in 2016 included palliative care; The Health Promotion Act, also mentions palliative care.
”The needs of patients are the considerations that lead to the development of palliative medicine.” Chen Yongyi said. As the vice president of Hunan Cancer Hospital and the chairman of the Chinese Nursing Association Palliative Care Professional Committee, Chen Yongyi has rich clinical experience and is also active in the front line of promoting palliative care. She introduced that about 80% of cancer patients will have severe pain in the advanced stage, and about 60% of the patients have dyspnea and different conditions, which seriously affect the quality of life of patients and their families.
”We have been promoting eugenics and eugenics in the past, which is actually not comprehensive,” said Liu Duanqi, chief physician of the Seventh Medical Center of the PLA General Hospital.
Hospice, also known as palliative care, is a systematic approach to treatment provided to seriously ill patients and their families to improve their quality of life and ability to face the crisis of death.
In 2013, the Hunan Cancer Hospital, where Chen Yongyi is located, set up an Anning Ward. She told reporters that the Anning ward was originally used with the neurosurgery ward, with only 8 beds; after it became independent in 2018, it was expanded to 20 beds. Currently, there are 5 doctors, 11 nurses and 2 nurse assistants in the hospice ward.
”This kind of equipment is actually not enough, but we can only take it slowly.” Chen Yongyi said frankly that the current number of beds in the Anning ward is far from being in short supply, and many patients may not be able to live in the queue for half a year or even a year.
Ideally, palliative care should be advanced from the medical institution, the community, and the home. Medical institutions undertake the task of sampling and leading research and development, and specific treatment and implementation are carried out at community medical sites, and patients with home needs can enjoy palliative care services at home.
But Chen Yongyi said that the actual situation is that “the quality of services in the community is still far behind, and patients will be dissatisfied when they go there.” At the same time, China still has a huge gap in home medical care, and even if it is implemented, it can only rely on volunteers.
What is even more in short supply is specialist personnel. Yu Shiying introduced that since palliative care focuses more on nursing, nurses play the most important role in the treatment process. However, at present in China, there are obvious shortages in both the number of nurses and the professional training of palliative care.
“Troika” is indispensable
Wang Ying, director general of the Living Will Promotion Association, believes that in order for palliative care to truly take root in China, the development of life education and living will must be promoted simultaneously, and “the ‘troika’ is indispensable.”
The so-called life education is to let everyone form a more accessible cognition of death and have a more calm acceptance of the process of death. This is also the premise that the entire palliative medical system can be implemented. A Living Will, on the other hand, is a document of instructions that people sign when they are healthy and conscious about what kind of medical care to or not to receive at the end of an injury or death.
”The common people have to slowly accept that they are aging and dying is a very natural phenomenon, rather than being alive is good.” Liu Duanqi said, “Many people end up being intubated and rescued at the end of the day. These are actually unnecessary. They just suffer and spend money. , pain, and ultimately does not prolong life.”
Liu Duanqi recalled that he was invited to give a lecture in a nursing home, and he wanted to talk about the will of his life, but was opposed by the management. “Don’t you wait to be scolded by these old people when you talk about death in a nursing home?” Finally, the topic of the lecture was changed to “cancer prevention and early detection.”
In 2006, Luo Diandian, the daughter of the founding general Luo Ruiqing, and others founded the “Choice and Dignity” website, which advocates living wishes and dying with dignity. In 2013, the Beijing Living Will Promotion Association was established. The Choice and Dignity website draws up a sample Living Will, “My Five Wishes” – what medical services do I want or don’t want, what do I want or don’t want on life support, how do I want others to treat me, What I want my family and friends to know and who I want to help me.
Wang Ying said frankly that the will can only play the role of concept advocacy, and has no legal effect. “Although more than 40,000 people have signed living wills, until now, we have not been able to actually recommend to them which hospital can execute your will.” The
lack of legal effect means that Now living wills do not have real executors, and medical institutions cannot treat patients according to their requirements.
Liu Duanqi envisages that if the “Palliative Care Law” can be introduced in the future, every critically ill patient can sign a living will when hospitalized. As part of the medical record, it will be executed by medical staff in the future. “But it is difficult to implement at the national level. The goal is to form local regulations, such as the provincial level, and then promote it nationwide.”
After life education and the promotion of living will, palliative care is the ultimate goal. In order to fill the gaps in professional talents, home medical system, etc., those who are active on the front line are making different efforts in their own professional fields.
In 2015, the Chinese Nursing Association, where Chen Yongyi is a member, established the “Palliative Care Study Group” and started a palliative care training class. Currently, 32 bases have been opened in China and more than 400 specialist nurses have been trained.
Because the discipline is too new, many items involved in palliative care have not yet been included in medical insurance. “At present, the hospitalization fee, doctor’s fee, and pain-relief facility expenses of palliative care patients can be reimbursed, but we can’t reimburse the expenses for massage, massage and psychological counseling. These are all important parts of palliative care.” Chen Yong Yi said that he has been communicating with the hospital leaders responsible for medical insurance, hoping to make a special project for palliative care.
For the Troika to move forward, public policy support is an indispensable driving force. Wang Ying hopes that local governments can include palliative care in their work plans and put them in their sights.