WHAT ARE THE ESSENTIALS OF HOSPICE?

Hungarian Hospice Palliative Association

community of Hungarian hospices

Hospice means a humane, complex treatment of primarily cancer patients in the end-stage of their serious illness with the help of a multidisciplinary team. The purpose of care is to improve the quality of life of patients: relieve somatic and psychic suffering, support physical and mental activity and assist relatives to cope with the burdens of the illness and with bereavement.

Physicians, nurses, physiotherapists, mental health professionals, social workers, clergymen, dieticians and skilled volunteers take part in the care. Members of the team thus can provide holistic (physical, psychological, social and spiritual) support.

Hospice care can occur in inpatient settings (in organisationally independent hospice homes, in hospital palliative care departments, or perhaps with the help of skilled mobile teams in general hospital departments), as ambulatory care (in outpatient clinics), or in the patient’s own home (in the form of professional home care).

A terminally ill patient is one who is suffering from serious incurable illness, whose condition is continuously declining despite medical treatment, and whose life expectancy is less than 12 months.

Palliative therapy (terminal palliative medicine) is a totality of the supporting treatments intended to relieve pain and other symptoms of terminally ill patients, which involves hospice philosophy and high quality medical expertise within the institutional healthcare system. Palliative care involves applying all appropriate actions, such as surgery, radiation therapy, chemotherapy, hormonal intervention, etc. The final aim of these interventions is the greatest possible rehabilitation of the patient, and to achieve the best possible quality of life.

In 2002 the WHO defined palliative care as  1 :

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-shortening illness, through the prevention and relief of suffering by means of identification and impeccable assessment and treatment of pain and physical, psychosocial and spiritual problems. Palliative care:

  • provides relief from pain and other torturous symptoms;
  • regards life and dying as a normal process;
  • does nothing to hasten or postpone death;
  • integrates the psychological and spiritual aspects into patient care;
  • offers a support system for patients to live as actively as possible until death;
  • offers a support system for the family during the illness and bereavement period;
  • uses team work which is directed to the needs of patients and their families, including bereavement counselling if indicated;
  • highlights the quality of life and has also a positive attitude towards the course of illness;
  • is applicable in the early stage of illness along with life-prolonging therapies – such as chemotherapy or radiotherapy – and also includes those investigations that are necessary to understand and better treat the distressing clinical complications.

The WHO definition formed in 2002 puts more emphasis on prevention of suffering and the importance of team work, and it places palliative care on a broader foundation and also extends the length of care.  2 

1 Sepulveda, C. et al. (2002): Palliative care: WHO global perspective. Journal of Pain and Symptom Management, 24.(2.)

2 For details see: Katalin Hegedűs: Death and dignity. Budapest: Osiris, 2000. and Katalin Hegedűs: The theory of hospice care, Budapest: Institute for vocational and continuing education in healthcare, 2006.