Silver Age Health | Detailed Discussion on Hospice Care

People are full of joy for the arrival of new life, but often avoid the end of life, which is due to the fear and helplessness in their hearts and the difficulty in settling the emotions after the death of their loved ones. When life inevitably declines, society provides the possibility of alleviating pain and fear for the dying, which is the warmth of hospice care. It provides the warmest protection for members of civilized society, allowing life to be peaceful and dignified in the last journey.

▏What is hospice care?

The so-called end-of-life care refers to a comprehensive service provided by a multidisciplinary team of medical experts, psychologists, social workers, etc. for patients facing fatal diseases. This service takes pain relief as the primary task, and through professional treatment and care, it tries its best to reduce the psychological and mental burden of patients and their families, and strives to improve their quality of life.

End-of-life care is not only a medical discipline, but also a marginal discipline that intersects with other fields. In Europe and the United States, it is called "hospice care", and in Singapore, Malaysia and other places, it is translated as "loving guardianship", "the best end-of-life service" or "palliative care". This care model focuses on multidisciplinary collaboration, emphasizes early identification and accurate assessment of the patient's condition, and then provides comprehensive and active treatment.

In 2017, the National Health and Family Planning Commission of my country issued the "Palliative Care Practice Guidelines (Trial)", which uniformly defined end-of-life care, palliative care, and palliative treatment as palliative care. It focuses on patients at the end of their illness and their families, and provides care from multiple levels, including physical, psychological, social, and spiritual/spiritual. Its purpose is to provide patients (including adults and children) with a full range of "ultimate end point" services and to provide them with comprehensive care in a way that meets their expectations.

Such services not only help patients achieve a comfortable, peaceful and dignified death, but also aim to achieve the goal of the deceased dying peacefully, the living being comforted, and the witnesses having peace of mind. Therefore, terminal care is not only a medical act, but also a manifestation of respect and care for life.

▏The development of hospice care

On July 15, 1988, Tianjin Medical College established the first hospice research center in China. This feat laid the foundation for hospice research and practice in my country.

Entering the new century, a foundation funded the "National Hospice Medical Service Plan" in 2001, and as a result, a number of foundations were established across the country. By 2011, 32 hospices had been successfully established across the country, with more than 200 professional practitioners.

So far, the development of hospice care in my country has gone through three stages: introduction of theory and start of research, promotion of publicity and professional training, and comprehensive progress in academic research and clinical practice. These stages have jointly built a solid foundation for hospice care in my country.

▏Is hospice care the same as “euthanasia”?

The answer is obviously no. The core concept of hospice care is to respect life and provide patients with a comprehensive support system by controlling pain and psychological and mental problems. It does not mean giving up treatment or accelerating the end of life, nor is it "euthanasia". On the contrary, it helps patients maintain the best quality of life in a professional way, while helping their families face the separation calmly. This nursing method focuses on the spiritual needs of patients and gives them spiritual comfort and help.

What services does hospice provide?

Hospice care is a comprehensive care model that takes terminal patients and their families as the core of the service, adhering to the "six-all" care concept. It focuses on the integrity of the patient, including comprehensive care at the physical, psychological, social and spiritual levels, and also pays attention to the needs of the patient's family members. From the patient's hospitalization to the peaceful home, the entire disease process and until death, continuous care and attention are provided to the patient. This is a model of collaborative cooperation by a multidisciplinary team, which brings all-round care to the patient. In addition to basic ward environment management, bed unit management and daily life care of patients, it also focuses on targeted management of the disease. Including symptom control, such as pain relief, dyspnea assistance, etc., using scientific, personalized and comprehensive management methods to tailor symptom control measures for each patient to ensure that they receive comfortable and caring care. Such care is not limited to the hospital, but also extends to the community and family, realizing peaceful home care for the entire community.

▏Can family members participate in the patient’s treatment and care plan throughout the process?

Some patients have obvious deficiencies in their understanding of their own diseases and decision-making abilities, especially in the terminal stage of the disease, when some patients will have impaired consciousness. In response to this situation, the hospice team advocates the participation of patients, family members and medical staff to discuss and formulate care plans, choose treatment methods and clarify end-of-life wishes. We not only respect the wishes of patients, but also the opinions of their families. At the same time, we also provide social and psychological assistance to family members to help them reduce the pressure caused by grief and pain.

Regarding hospice workers, someone once commented incomprehensibly: "Your work seems to have no sense of accomplishment, and all patients who come here seem to face the same outcome." However, in fact, with the advancement of medical technology, although there are more ways to prolong life, we also need to pay attention to the negative effects of treatment. Hospice care focuses more on improving the quality of life. As Cicely Sanders, a pioneer in hospice care, said: "We care about the quality of life as much as we care about the length of life."

Different from the traditional medical model, hospice care mainly serves patients at the end of their lives and is committed to improving their quality of life and dignity. At the same time, it also provides psychological comfort to family members, helping them learn how to face death correctly and alleviate the pain of separation.

Everyone is important because everyone is unique. At the last moment of life, you are still important. We hope to bring warmth to every dying patient and their family through "hospice care" so that they can leave the most brilliant memories at the end of their lives.

▏Institutional forms of hospice care

my country has established various forms of hospice institutions, including:

1. Hospice wards set up within hospitals, such as specialized wards in general hospitals, are dedicated to providing patients with advanced medical care.

2. Independent hospices, such as Tianjin Yan'an Hospital and Songtang Care Hospital, are independently operated and focus on providing comprehensive care services to patients.

3. Hospice care services in nursing homes mainly cover technical and humanistic care. Technical care focuses on alleviating pain, such as ensuring the comfort of the elderly through drug and non-drug therapies and basic care. Humanistic care focuses more on psychological counseling and spiritual support to help the elderly overcome their fear of death and maintain their dignity.

4. Family hospice care service is based on the community and carried out on a family basis. For example, 76 community hospitals including Shanghai Jing'an District Community Hospital have this service. This service model makes hospice care closer to the family and more humane.

These institutions and service forms together form a complete hospice care system in our country, which aims to improve the quality of life of the elderly and help them spend the last stage of their lives peacefully.

▏ Policies related to end-of-life care

Regarding the development of hospice services, the relevant content of hospice services was first mentioned in the "Notice on Accelerating the Development of Elderly Care Services" (Guobanfa [2006] No. 6) jointly issued by the General Office of the State Council and other departments. Then, in 2006, the state and the aging work department launched the "National Love Care Project Pilot Work Procedures", which detailed the purpose and implementation methods of hospice services.

As time went by, in 2015, mainland my country reached a milestone. The General Office of the Qingdao Municipal People's Government issued the "Opinions on Vigorously Developing the End-of-Life Care Industry", which is a separate local document for end-of-life care services, marking the specific implementation of end-of-life care services at the local level.

In 2017, the National Health and Family Planning Commission further issued the "Basic Standards for Hospice Care Centers (Trial Implementation)", which set clear requirements for beds, departments, and staffing, providing all-round care and humanistic care for terminally ill patients. However, despite the promotion of these policies and documents, due to the influence of traditional concepts, policy mechanisms and other factors, the improvement and popularization of the hospice care system still has a long way to go. We hope that in the future, hospice care services can be more popularized and provide necessary support and care for more people.

▏Old people who are dying are often the ones who need hospice services

As the global population ages, the incidence of malignant tumors among the elderly is rising year by year, especially for those in their 70s, 80s, and even 90s. According to statistics, the proportion of cancer patients over 65 years old worldwide is as high as 60%, making them the main force of cancer patients.

In my country, as the aging of society continues to deepen, a worrying phenomenon has gradually surfaced. About one-third of the elderly have received "overtreatment" within six months of dying. This treatment is not based on the needs of the disease, but out of excessive obsession with life. According to data from the National Bureau of Statistics, as of 2023, the number of elderly people over 60 in my country has reached 296 million, accounting for 21.1% of the total population. According to the latest data released by the National Cancer Center, there will be about 4.8247 million new cases of malignant tumors in my country in 2022, and the incidence rate is shockingly high.

In this context, it is not uncommon for elderly people with cancer to be overtreated. Overmedicalization, as the name suggests, is unnecessary treatment for incurable terminal illnesses. This not only increases medical expenses, but is also likely to harm the health of patients. For many elderly people who are seriously ill or have been diagnosed with terminal illnesses, they often hold on to a glimmer of hope for survival and spare no effort to seek treatment, even if it means enduring great pain. However, the meaning of this survival has become blurred to some extent.

A research report by Australian scholars published in the British medical journal International Journal of Quality in Healthcare pointed out that these overtreatments consumed huge medical resources, but did not significantly improve the physical condition of patients, but instead brought them physical and psychological pain. The report also revealed a thought-provoking phenomenon: these overtreatments are often not the patients' own wishes, but are imposed on them by hospitals or their families. In the last stage of life, patients often lose their ability to take care of themselves and express themselves, and are unable to make their own decisions, and can only passively accept the arrangements of doctors and their families.

The study involved 38 cases in 10 countries, and treatments included surgery, chemotherapy, imaging diagnosis, blood transfusions and intensive care. One of the researchers, Professor Ken Hillman of the University of New South Wales in Australia, has always been opposed to over-treatment of the elderly at the end of their lives. Although he himself took a variety of medical measures before his mother died, he admitted that such behavior is often irrational. Hillman emphasized that it is particularly important for the elderly at the end of their lives to reach a consensus with their family and doctors on life and death issues.

Faced with this series of problems, we can't help but think: while pursuing medical progress, have we neglected humanistic care? For the elderly who are dying, what they really need may not only be medical treatment, but also spiritual companionship and respect. On this issue, society, hospitals and families need to conduct in-depth reflection and discussion to find a more reasonable and humane solution. Only in this way can we better face the end of life and allow every elderly person to complete the last journey of life in an environment of dignity and care.

▏Hospice care is to allow the elderly to reach the end of their lives with dignity

As the times change, people's pursuit of quality of life continues to improve, and the quality of life has gradually received widespread attention. While pursuing health and happiness, people also desire to end their lives without pain. The embodiment of this desire is one of the important goals of hospice care.

Life and death are the biggest issues in life. We cherish life, but we should also face death. Death, like life, should be valued and respected. Since my country launched the book "Who Decides My Death?" in 2011, the concept of dignified death has been popularized to the public. This book has become the starting point for Chinese people to get in touch with advance directives. Prior to this, this concept has been promoted for many years in the United Kingdom, the United States and other countries. Since then, many celebrities have publicly expressed their hope to die with dignity when their lives are in danger and refuse excessive medical intervention, which has further promoted the popularization of advance directives.

Professor Rao Geping of Peking University Law School believes that when people enter old age, especially when they are old, seriously ill, or dying, their bodies and minds become extremely fragile. At such a moment, if they can complete the last stage of their lives in a comforting, calm, and peaceful way, it will be the greatest humanistic care and welfare that society can give them.

Hospice care regards death as a natural process, neither accelerating nor delaying it. Its purpose is not to forcibly prolong life, but to improve the quality of life by alleviating pain and other discomfort symptoms, so that patients can reach the end of their lives in dignity and peace. For the elderly, they are more eager for the recognition of their family, the company of their friends, and the sincere care of the society in the last stage of their lives.

Therefore, institutions with professional qualifications should provide authentic and reliable hospice care services, and use professional palliative care and psychological protection measures to do their utmost to alleviate patients' physical pain and psychological pressure. This can not only satisfy their desire for dignity of life, but also eliminate their fear of the passing of life. At the same time, such services can also effectively adjust the psychological state of family members, so that patients can face the end of life in a more peaceful and calm state of mind. This kind of care will undoubtedly make life more dignified in its final journey.

(Picture from the Internet)
Author | Han Mei is a practicing pharmacist who has worked in a well-known national tertiary hospital for more than 30 years and has rich medical care experience. She has represented the hospital on many occasions to go out for exchanges and study. She is an expert in food hygiene and nutrition, has a national nutritionist qualification, and is a science enthusiast.