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The Ebersberg District Clinic's palliative care team helps to live with the disease

From left: Dr. Barbara Eßer and Dr. Anna Bresele in one of the comfortably furnished patient rooms. Photo: kk / sf

Ebersberg, November 2016 - Palliative medicine has been an integral part of medical studies since 2012, around a year ago the German Bundestag passed the Palliative Care and Hospice Act - a sign of how important the issue of making terminally ill people easier for the rest of their lives has become. What can palliative medicine do today? We spoke to the doctors in the palliative ward in the Ebersberg district clinic, which has been under the direction of chief physician Prof. Thomas Bernatik since November, and the specialist in palliative medicine and anesthesia, Dr. Anna Bresele and the specialist in palliative and internal medicine Dr. Barbara Eßer.

Many patients think they are coming to the palliative care unit to die there. Is that so?
Dr. Eßer: No! Our primary goal is to improve the quality of life of our patients and to help them to live with their illness in the best possible way. This also applies to those people who spend their last days on the ward.
On average, the patients stay with us for ten days and often return home or to the nursing home, depending on the situation. There they are looked after by the general practitioners with whom we work closely. If necessary, we can also call in the doctors and nurses of the Specialized Outpatient Palliative Care (SAPV) established three years ago in the district of Ebersberg, with whom we also maintain very good contacts. Some patients still have a good time this way, sometimes for months. If you need more medical help, we can also arrange further care in one of the Munich hospices.

As a palliative care practitioner, what options do you have to improve patients' quality of life?
Dr. Bresele: Well, depending on the illness, the patients suffer from various symptoms, from pain and nausea to dyspnoea and difficulty swallowing. For all symptoms, conventional medical drug therapy is in the foreground. We also use alternative treatment methods, such as aromatherapy with lemon oil for nausea or lavender for sleep disorders. Psychological support is very important. Miss Dr. Eßer and I completed special training for this. A psycho-oncologist is also active in the team.
Dr. Eßer: The people who come to us ask themselves many questions, starting with "Why?" begin - "why me" for example, and they are scared. Not only before death, but even more before what suffering awaits her until then or simply from the unknown. We always have an offer to talk to. Some patients do not want to talk much, others are happy to accept the offer. We can take away some fears, such as the fear of pain - today we have very good and differentiated options for drug pain therapy.
We cannot answer the "why" questions, but we can ask: "What for? What is the situation challenging me to do? How can I make the most of it?"

What other help do the patients receive?
Dr. Bresele: For example physiotherapy. Our team includes physiotherapists and occupational therapists who are trained in palliative care and who work intensively with patients. Every physical progress is also motivating, for example when a bedridden patient can get up again - even if only briefly. With respiratory therapy, patients learn to deal better with shortness of breath and how they can counteract them so that existential anxiety is reduced.
All impressions and experiences that we, our therapists, the palliative care nurses and nurses collect with the patients are discussed together on a daily basis, after which we plan the further therapeutic measures. In this way, each patient receives the best individual care for them. Social workers from the clinic and members of the Ebersberg Hospice Association also come once a week.

Has anything changed in recent years with regard to the age and illnesses of patients?
Dr. Bresele: We have been admitting patients with advanced dementia for certain indications for five or six years. The incidence of the disease is increasing as people get older. The consequences are a gradual decrease in body functions; in the advanced stage, swallowing disorders often occur. Studies have shown that artificial feeding via a gastric tube (PEG) does more harm than good and does not extend the lifespan. Often this also means that human attention is no longer needed to support food intake, so that social contact tends to decrease.

So intensive care is the most important thing in palliative medicine?
Dr. Eßer: Yes, not only for the patient, but also for the relatives. Sometimes they find it even more difficult than the patient himself. However, if they feel that they are in good hands, the patient is better off too. Together with the relatives and everyone involved, we try to build a space of trust in which the patients feel safe and secure. Often they even need less painkillers or sedatives.

When does a patient come to the palliative care unit?
The patients are admitted by the resident doctors after they have registered by telephone or they are transferred to us from the clinics in the area or from the other departments here in the house.

The interview was conducted by Sybille Föll

“To the palliative care unit