Palliative Care Practices in Turkey - Part 2

Palliative Care Practices in Turkey - Part 2

("Palliative Care Practices in Turkey" - Part 2)

Palliative Care in Turkey

The first institutions resembling palliative care in our country can be traced back to the Anatolian Seljuk period, and they continued during the Ottoman Empire, including Darüşşifas (hospitals), home care services, imarets (charitable kitchens), and caravanserais. Perhaps the earliest forms of palliative care in Turkey can be found in these organizations. The first institution working with a hospice model aimed at providing services to the elderly and the poor was established in 1896 during the reign of Sultan Abdulhamit II. When we talk about palliative care, the immediate need that comes to mind is pain management. In Turkey, the initial efforts related to palliative care started in 1998 with the initiatives of the Ağrı Association. In 1999, the Support Treatments Working Group was established within the Turkish Oncology Group Association, significantly raising awareness about palliative care.

In 2010, the Ministry of Health initiated efforts to develop palliative care organization in Turkey. In 2010, there were only 10 palliative care centers in the country. The most significant development over time was the PALLIA-TURK project carried out by the Ministry of Health's Directorate of Cancer Control between 2009 and 2015. It began as a pilot project in three hospitals in 2011 and aimed to establish 197 palliative care centers, including 57 in hospitals and 140 at the primary care level. Additionally, the project aimed to increase the availability of opioids and implement a community-based palliative care model. This project accelerated the establishment of palliative care services.

Intensive efforts were made to implement this project, and it was gradually introduced as a regulation in clinical practice. The PALLIA-TURK project was primarily based on nursing care and was supported by family medicine, cancer control centers, and non-governmental organizations. It was presented as the most suitable system for Turkey's socio-cultural structure and was the world's first community-based palliative care project. Within this project, an organizational model for palliative care centers was established. According to this model, primary care includes family physicians, home health services, and hospital-based palliative care units. Oncologists are not available at this level. At the secondary level, there is a more advanced care center, managed by a multidisciplinary team, and it is recommended that palliative care centers at this level have 10 beds. At the third level, comprehensive palliative care centers are recommended, with a capacity of 10-20 beds, which can be established within Education and Research hospitals. In addition to these, volunteers, municipalities, and non-governmental organizations were identified to provide support at all levels. Support houses were described as healthcare facilities where, instead of detailed care, the control of patients' symptoms in their final days and all kinds of support to patients and their families were provided.

The first institution in Turkey that adhered to the hospice model was the Cancer Care House established by the Turkish Oncology Foundation. This facility operated in Istanbul from 1993 to 1997. Another similar hospice structure was created by the Hacettepe Oncology Institute Foundation in 2006 by converting a historic house in Ankara with 12 rooms into a hospice. At that time, due to the lack of sufficient legal regulations, this house was envisioned to serve cancer patients under the name "Hacettepe House of Hope."

On April 25, 2013, a Palliative Care Workshop was held in Izmir, Turkey. This workshop established criteria for entering palliative care, transitioning from palliative care units to home care, and decided that palliative care training should be multidisciplinary, leading to the creation of a General Palliative Care Course.

In 2015, the Directive on the Implementation Principles and Procedures of New Palliative Care Services came into effect. This directive covers the definition of centers, their physical requirements, staff duties, authorities, responsibilities, service scope, training and supervision, and cooperation with other institutions and organizations.

According to data from the Ministry of Health's Turkish Public Hospitals Organization website in 2016, there were 168 palliative care units with a total of 1,898 beds in 68 provinces. In 2017, these numbers increased to 287 palliative care centers with a total of 3,650 beds. In 2020, according to data on the website of the General Directorate of Public Hospitals, there were 5,481 beds in 81 provinces, operated by 410 healthcare facilities. The same website also indicates that Home Healthcare, which is a branch of palliative care provided outside of bedded facilities, was offered in all 81 provinces by 757 healthcare facilities.

In Turkey, palliative care services started with pain units and later expanded to palliative care units. However, palliative care should not only be limited to patients but should also include their families, covering aspects such as accepting the disease, acquiring information, and coping with grief after death. Despite the progress in palliative care services in Turkey, it remains primarily focused on pain and symptom management. In addition to clinical services, providing services such as spiritual support, economic assistance, and psychosocial support will ensure the complete fulfillment of palliative care services. The full and effective implementation of these services will also contribute to the country's economy.

Conclusion

Today, the number of diseases that require chronic care, such as cancer and non-curable diseases like Alzheimer's, cerebrovascular diseases, and chronic obstructive pulmonary disease, is increasing. This rising trend in such diseases underscores the growing need for palliative care in the final stages of these illnesses. Until the past decade, palliative care services in Turkey were neglected due to reasons such as family structure, psychosocial culture, human resource issues, lack of education, absence of palliative care specialization, and insufficient awareness. The PALLIA-TURK project initiated by the Ministry of Health in 2010, followed by subsequent efforts and the issuance of regulations on this topic in 2015, have given momentum to palliative care in Turkey.

This concludes the article on "Palliative Care Practices in Turkey." Stay healthy.

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