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Principles of palliative medicine

Cicely Saunders, who is considered to be the founder of modern palliative medicine, established the following principles:

  • The treatment of the patient should take place in the environment of his choice (as an outpatient, inpatient, at home, Nursing home or similar)
  • The physical, psychological, social and spiritual needs of patients, family members and treatment team should be considered (holistic approach)
  • The principle of “high person, low technology” shall apply, this means that humans should take priority, what is feasible medically with lots of technical effort should be in the background. The aim of the therapy is to focus on the patient’s quality of life
  • Individual treatment of every patient shall be carried out by a multidisciplinary team
  • Openness and truthfulness are the basis of the relationship of trust between all parties concerned
  • The control of symptoms (pain, thirst, distress and other Symptoms) shall be carried out by specialists
  • Professional care by specially trained nursing staff
  • Voluntary staff are integrated into the treatment
  • The treatment team is centrally coordinated
  • Continuous support of the patient and his family until the patient’s death and during the period of mourning
  • Affirmation of life, acceptance of dying and death as a part of life. Death will neither be accelerated nor delayed. Active euthanasia is strictly rejected
  • Research, documentation and analysis of the treatment results
  • Education and training of doctors, nursing staff, social workers, pastoral care and voluntary staff

Support

Comprehensive care of the patients and their families necessitates a team of doctors, care staff, social workers, psychologists, physiotherapists and pastoral care workers. In addition to the full-time staff the involvement of voluntary employees is important particularly in the hospice movement. Palliative medicine works for most patients without a great deal of technical measures, the personal and time expense is therefore greater.
It is important to apply the different experiences and focal points of the different professional groups, and to find an individual treatment goal for each patient from this information together with the patients and family members. Palliative medicinal care is currently financed from different sources. The palliative wards will either be financed like other hospital departments with flat rate payments (DRG) - supplemented with an additional payment since 2007 - or by special payments in accordance with daily rates, which will be freely negotiated by the hospital with the purchasers. Currently only some of the palliative wards break even.

The inpatient hospices are financed by health insurance, nursing care insurance and by a contribution from the hospice who are generally funded by donations.
Hospice care for outpatients is supported by health insurance funds, which have financed coordination positions for hospice services since 2004. The medical and nursing care has so far not been provided as part of the standard care however, so there are only a few individual model projects. Cost agreements for integrated care have been made in many areas with very different financing and care models.

The Association of Statutory Health Insurance Physicians of Nordrhein (Kassenärztliche Vereinigung Nordrhein) has now concluded financial agreements in the context of the general practitioner contracts in several areas so that private doctors can provide continuous care for palliative patients. Recently contracts have been offered to the outpatient home care service providers by the health insurance funds offered, which could result in lump sums being paid for the basic care and treatment of palliative patients if the home care service provider has the appropriate qualifications.