Non oncologic palliative care and end life aproach for primary care physicians in Chile

Description

Introduction: In Chile, access to palliative care (PC) are insured for patients with oncological pathologies by the explicit health garanties, however, in order to ensure dignity and quality of life, it should be extended also to patients with advanced chronic diseases.The objective of this article is to expose to primary health care physicians (PHC), an approachment to the clinical assessment and management of patients with non-oncological diseases who require PC and how to face the end of life in them.
Development of the theme: There are multiple chronic diseases that require access to PC, so it is vital to identify patients whith these needs, using instruments that target symptoms, degree of functional disability, quality of life, and prognosis. Among the most used instruments for this purpose we find the Palliative Needs Scale (NECPAL), the Scale Eastern Cooperative Oncology Group (ECOG), the Karnofsky Index, the Palliative Performance Scale (PPS) and the ZARIT Caregiver Overload Scale. Likewise, the elaboration of an individualized therapeutic plan with the necessary resources, the individual preferences and the anticipated wills of each patient, is crucial to alleviate the pain and suffering that are present throughout the disease, these being more pronounced in the end stage of life; therefore, it is important to know this process and handle it properly.
Conclusion: It is necessary and very important to expand access to PC for patients with non-oncological chronic diseases, this being a great challenge for Chile. For this reason, the authors recommend the creation of a PC program in PHC, which includes guarantees of access to medicines in the basket and training for first-level health teams to provide this care.