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Palliative medicine: deciding how a life will end

(Vienna, 25th April 2014) A diagnosis of an incurable disease also raises the question of dying. Just how people choose to die is increasingly becoming a topic of public interest. An outpatient facility for supportive cancer therapy has been set up in the Clinical Department of Palliative Medicine at the MedUni Vienna and Vienna General Hospital. The aim is to help affected people arrange their affairs and organise their final days.

 

Herbert Watzke, Head of the Clinical Department of Palliative Medicine at the University Department of Internal Medicine I, a member of the Comprehensive Cancer Centre (CCC) of the MedUni Vienna and Vienna General Hospital and President of the Austrian Palliative Care Society, said in the run-up to the first Austrian Palliative Care Day (www.palliativtag.at) on Saturday: “The majority of people who have incurable cancer are most afraid of being dependent on others and being unable to manage their own affairs."

 

So in practice, it is important to have “end of life discussions” with those affected in good time, i.e. to help them define their goals for the time they have left and help them plan their deaths in the most appropriate way possible from both a personal and medical perspective. Experts at the Clinical Department of Palliative Care Medicine explain to patients what options they will have to control pain, how they can determine for themselves what life-prolonging measures can be taken through a living will, and what social legislation services can be made use of.

 

Outpatient department for palliative care medicine
The palliative care ward and team of consultants has been supplemented by an outpatient unit for supportive cancer therapy. Says Watzke: “We are therefore able to look after CCC patients who are not yet or no longer inpatients as outpatients. This is important, since this is the only way that end of life discussions can be held successfully and in time.”

 

An American study (“Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer, Jennifer S. Temel et al.”, 2010) has illustrated just how important such discussions are. The authors have discovered that patients who received palliative care had a significantly better mental and physical quality of life, required fewer burdensome treatments and intensive care admissions and also ultimately lived longer.

 

At the MedUni Vienna and Vienna General Hospital’s Comprehensive Cancer Centre, patients are referred to the outpatient clinic via the multi-disciplinary oncology meeting. The oncology team managers responsible invite the patients to visit the outpatient clinic. In this context, the team led by Herbert Watzke has also developed guidelines which are used to determine which patients are invited to the outpatient facility.

 

Study platform for palliative care medicine
Of course, the Clinical Department of Palliative Care Medicine also focuses on scientific matters. A number of studies have been carried out, for example, in collaboration with the Austrian Palliative Care Study Group (AUPACS), a network of Austria’s 31 palliative care wards. The MedUni Vienna acts as the leading study centre for these. One of the aims is to define standards that apply throughout Austria and thereby safeguard the quality of care at the very highest level. Says Watzke: “Many aspects of palliative care medicine are of considerable ethical relevance. Through our research, we are attempting to define well-founded decision-making parameters so that we can act in a morally correct way that is in the interests of the patient and their families.”