Palliative care, essential for public health | @diariofarma

DAILYPHARMA | 06.14.2022 – 12:40

The president of the Spanish Society for Palliative Care, Juan Pablo Leiva, advanced last Saturday that the need to recognize “palliative care as essential for public health” will mark the entity’s strategy for the coming years. He has done so during the closing ceremony of the XIII International Congress of SECPAL, which has been held these days in Palma de Mallorca and which has brought together more than 800 attendees and numerous figures of reference in this field of care.

This will be precisely the motto of the next edition of this important event, which will be held in Malaga in 2024, but this approach will also guide the actions that SECPAL will develop until then, according to Leiva, who has cited a report published on the 31st of January by the Lancet Commission on the value of death. In it, the Commission makes it clear that “death, dying and mourning today are unbalanced”, and proposes a new vision of death and dying, with greater participation of the community, together with health services. health and social care, and greater bereavement support.”

From this perspective, the president of SECPAL has considered that the approach centered on public health must be present in all actions that constitute the hallmarks of comprehensive and quality palliative care, and has cited as examples “bereavement care , comorbidity and social comorbidity, the adequacy of the therapeutic effort, pain and opioid management or the response to wishes to hasten death”, among others.

“We, the professionals, have to understand it this way, but not only that, but we must also know how to explain it to society, so that from now on we work to make the message Palliative care, essential for public health, a guideline to give diffusion and approach to our work”, he underlined.

Proof of the relevance that this perspective will have for SECPAL is that the celebration of the 13th World Research Congress of the European Association for Palliative Care (EAPC) will also be based on it, which will take place in 2024 in Barcelona, ​​after accepting the joint candidacy Presented by SECPAL and the Societat Catalano Balear de Cures Pal·liatives (SCBCP), which suggested Public Health in Palliative Care as the motto.

spiritual care

On the other hand, the XIII International Congress of Palliative Care held in Palma de Mallorca has dedicated this Saturday its last plenary conference to the SECPAL model of spiritual accompaniment, which began to take shape in 2004 within the Spirituality Working Group. In 2008, the GES coined, in a pioneering way in Spain, a definition of spirituality as “the deep and intimate aspiration of the human being to a vision of life and reality that integrates, connects, transcends and gives meaning to existence” .

This was recalled by Enric Benito, an oncologist and honorary member of SECPAL, in a session he shared with Mónica Dones, a nurse, an expert in palliative care and bioethics and a member of Ethics and Spirituality at SECPAL, and in which both discussed the milestones of this accompaniment model “that connects us and transforms us”.

During his speech, Dr. Benito, an authority in this field, assured that, as human beings, “our essential nature is spiritual, it is what makes us what we are, that conscience that drives and inspires us”, and with it we connect when certain “gaps” open, such as the one that represents the process of dying. “Science cannot answer any of the existential questions, like why do we die or why do we feel fear and suffering. It is necessary to change the paradigm, because, just as before it was thought that the earth was flat, people continue to believe that we are matter and that when we die we fall off the edge of life”, he reflected.

From this point of view, and taking into account that in SECPAL’s model of spiritual accompaniment the tool is the professional, “the cultivation of our own spirituality is what makes us be present, connect with the patient, be empathetic and compassionate and , at the same time, equanimous and wise” about the processes that are responded to from palliative care.

On this path, “training in accompaniment attitudes” is necessary, which the GES promoted between 2009 and 2011 through “experiential and experiential” training workshops, as Mónica Dones has recalled, who has highlighted that the model promoted by SECPAL “It has permeated our work, and now we palliative care workers have engraved in our hearts that it is essential to attend to the spiritual dimension” of the sick person and their loved ones.

Beauty at the end of life

In another of the plenary sessions scheduled during the scientific meeting under the title An anthropologist in the Palliative Care unit: experiences from the other side, Olga Soto Peña, professor at Pablo de Olavide University, emphasized that “there is a lot of beauty at the end of life if you know how to look”.

From her experience in accompaniment, she has valued those “elements that give beauty and fullness at the end of life; experiences that are sometimes seen very little, but that are very luminous” and represent a “reference for good practices in palliative care”. An “intangible heritage”, she has said, which can be the essence so that the patient and her family “can reach the end in the best possible way with affection, hope, humor, help to work through mourning…”.

From the acceptance of vulnerability, considers the expert, “the ability to resist, to know that help is needed and to ask for it, is achieved, and when the patient feels welcomed, he is able to receive everything that can be given from palliative care ”.

Opioid use

For his part, Dr. Eduardo Bruera, director of the Department of Palliative Care at the MD Anderson Cancer Center in Houston (USA), dedicated his plenary session to the use of opioids, a type of drug that “is necessary to treat pain, but they are at risk of causing dependency in patients.”

“In recent years, we have learned that they are complex drugs and that their use carries a higher risk of toxicity or dependence in some groups of patients,” explained the specialist. Therefore, one of the main challenges that arises in the midst of the current global opioid overdose crisis is to establish mechanisms that allow “identifying these risk factors” and determining how to use these drugs “in a way that benefits patients and their families.” relatives”.

tired professionals

The XIII International Congress of the Spanish Society of Palliative Care has also included interesting meetings with experts, in which the development of tools for professional self-care has gained special importance. In this context, Helena García-Llana, a research psychologist at the La Paz-IdiPAZ University Hospital, and Alberto Meléndez Gracia, a doctor at the OSI Araba Palliative Care Unit, have addressed the necessary mechanisms to know “how we detect fatigue and how we commit ourselves to it.” with the same”.

“We have to take care of ourselves in order to take care of ourselves; It is no longer just a matter of protecting ourselves, but also of protecting patients and families”, they assured. Because “when working with suffering human beings, and especially when the work consists of caring for and accompanying other people in moments close to death, it is not uncommon to hear from professionals that they are exhausted and cannot bear any more suffering”.

Thus, with the aim of sharing the risks and opportunities that professionals assume in this process, they have shown tools “that help us identify when we are tired and what we can do with it”, and they have done so from a practical and experiential perspective, sharing doubts and proposals with the attendees.

Among them, the preparation of a letter by all those present addressed to themselves, where they had to tell “how they are going to commit to taking care of themselves and managing fatigue.” They themselves will receive it in time so that they do not forget that personal and fundamental commitment to self-care.

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Palliative care, essential for public health | @diariofarma