Palliative Care Practices in Turkey -1

Introduction:

Palliative care is the care provided to patients with life-threatening or incurable chronic illnesses to improve their quality of life. It is the opposite of curative treatment, which is only possible for treatable conditions. Palliative care aims to manage symptoms, provide psychological and emotional/spiritual support, and support the families and loved ones of cancer patients. It is a multidisciplinary approach involving not only medical professionals but also care nurses, psychologists, physiotherapists, social communication specialists, and religious leaders. Palliative care services started to gain momentum in Turkey around the 2010s through efforts by the Ministry of Health, with the first comprehensive palliative care center established at Ulus State Hospital in Ankara (1). As part of the healthcare transformation project by the Ministry of Health, the PALLIA-TURK project was prepared to standardize and organize palliative care services.

Over time, medical associations, symposiums, congresses, and training meetings have aimed to raise awareness of palliative care and promote legal regulations, with the goal of becoming an effective country in palliative care.

Definition:

The World Health Organization (WHO) initially defined palliative care in 1990 as "active and comprehensive care provided to patients who do not respond to curative treatments." The definition was later expanded to describe palliative care as an approach that aims to enhance the quality of life for patients and their families facing problems arising from life-threatening illnesses, especially through the early detection and effective management of all physical, psychosocial, and spiritual issues, including pain (2). The goals of palliative care include relieving pain and other distressing symptoms, affirming life, and presenting death as a normal process. It integrates the psychological and spiritual aspects of patient care, does not seek to hasten or postpone death, and provides a support system to help patients live as actively as possible until death. It also helps family members cope with the patient's condition. Palliative care begins at the time of diagnosis and continues alongside curative treatment, with its effectiveness increasing as the patient approaches the end of life.

The American Society of Clinical Oncology (ASCO) defines palliative care in cancer as improvements made for cancer patients and their families regarding various issues that cause suffering and affect their quality of life (3).

Where Is Palliative Care Provided?

Palliative care services can be provided in hospital settings, primary healthcare centers, home settings, and end-of-life care facilities. In Turkey, palliative care services are offered through palliative care centers and home healthcare services, in addition to primary healthcare through Family Medicine.

Palliative care services are provided in inpatient healthcare facilities by palliative care centers, while outside inpatient facilities, they are carried out by family physicians and home healthcare units. Although the concept of hospice care is not well-established in Turkey, it is still in its infancy. Hospice care provides support to end-of-life patients and their families, and it involves discontinuing curative interventions. Hospice patients typically have a life expectancy of six months or less. In the past, institutions like Darüşşifas, built during the Anatolian Seljuk period and continued during the Ottoman Empire, along with charitable organizations such as imarets and caravanserais, were designed to meet similar needs. However, modern institutions to replace these organizations have not yet been established. The reason for this lack of development is the strong preference for providing care within families in Turkish society.

Palliative care services vary depending on the country's level of development. Worldwide, palliative care services are categorized into four main groups:

• Group 1: No palliative care activities are available.
• Group 2: Capacity-building activities exist.
• Group 3: Local hospice and/or palliative care services are provided.
• Group 4: Hospice and palliative care services are integrated into the basic healthcare systems.

Group 3 is further divided into 3a and 3b (4). Turkey falls into Group 3b, where there is no hospice service, but local and regional support for palliative care services is available.

We will continue discussing this in the second part of the article. Stay healthy!