Make palliative care a well-known discipline in China.
Writing | Wan Shunshun
Source | “Medical Community” Public Account
At the moment of entering the emergency room, the patient’s own wishes are no longer important, and most of the choices are made by the family.
Gu Jin, director of Peking University Shougang Hospital (hereinafter referred to as “Shougang Hospital”), told the “medical community” that at this time, the family members may be in a state of being watched, and the family members may be in a state of being watched. Said: “We are actively rescuing”, he can be very decisive; but if the family members say: “We give up treatment”, they will be very hesitant and especially unsure.
Active rescue or give up treatment? There is another way in the middle.
“I also want to push again in palliative care, so that people will no longer accept ineffective treatment and rescue at the last moment of their lives, and let patients leave with dignity. “As a representative of the National People’s Congress, Gu Jin mentioned palliative care again in a media interview at the two sessions this year.
In March 2017, with his support, Peking University Shougang Hospital became the first tertiary general hospital in mainland China to set up a palliative care center. This year is the 5th year since the center was established. Shougang Hospital has become hard to find palliative care beds, and has truly made “Palliative Care” the brand and pride of the hospital.
Why Peking University Shougang Hospital?
On February 5, 2015, Professor Gu Jin, who was then the Vice President of Peking University Cancer Hospital, was appointed as the President of Shougang Hospital. As a famous gastrointestinal oncologist, he has seen too many patients with terminal cancer in his clinical work. The primary disease of these patients has developed to an irreversible level, and they are burdened with enormous pain and pressure both physically and psychologically, with symptoms such as pain, dyspnea, cough, abdominal distension, insomnia, and anxiety. Words are ineffective medical treatment.
According to the American Medical Association’s definition of “ineffective medicine,” subsequent treatment is considered ineffective when a patient is treated when the medical service may simply prolong the process of dying.
In the case of limited medical resources, hospital beds are more willing to provide patients with therapeutic value and can recover. Gu Jin said that it is difficult to take care of terminal cancer patients, and the hospital does not have enough space for them, which is a big problem.
After taking office as the president of Shougang Hospital, Gu Jin found that a ward in the hospital was still empty. Create a palliative care ward.
Professor Gu Jin, Dean of Shougang Hospital/Photo courtesy of the interviewee
Among the affiliated hospitals of Peking University, Shougang Hospital is far less famous than other hospitals. As the dean, when preparing to build the palliative care ward, Gu Jin was very far-sighted. “I want to create a discipline in Shougang Hospital that is well-known in China. If not, we will create a discipline that others do not have.” At that time, the third-level General hospitals do not have palliative care centers, and some hospitals provide palliative services in oncology, traditional Chinese medicine, and geriatrics.
On January 25, 2017, the former National Health and Family Planning Commission formulated the “Basic Standards for Palliative Care Centers (Trial)” and “Palliative Care Center Management Regulations (Trial)”, which are The first palliative care-related document issued from the government level. Then, Shougang Hospital became the first tertiary general hospital to eat crabs.
To this day, the palliative care center has become the pride of Shougang Hospital. However, in the early stage of the development of the palliative care center, many employees of the hospital did not understand the decision of Dean Gu Jin, because the palliative care did not make money and needed the hospital to subsidize the operation.
“I wouldn’t open a palliative care center if I was just thinking about making money. First and foremost, palliative care is about giving terminal cancer patients a place where they can get medical support and allow them to To leave with dignity and pain-free, which is also supported by national policy.”
Director Wang Xiaodong of the Oncology Department communicates with patients in the ward / photo provided by the interviewee
Second, the newly established palliative care center is like a business card for Shougang Hospital. The awareness of Shougang Hospital among the surrounding people has increased, and the number of patients admitted to other departments has increased, which is an invisible benefit brought by palliative care. Dean Gu Jin once made up his mind to let the palliative care center appear on CCTV within two years.
“When mentioning palliative care, one can think of Shougang Hospital” has been achieved. As a representative of the National People’s Congress, Gu Jin has been calling for the extension of my country’s medical security system in cancer to both early screening and late palliative care, and the inclusion of palliative care wards in hospital performance assessments.
On November 1, 2019, the National Health Commission issued the “Guiding Opinions on Establishing and Improving the Elderly Health Service System”, opening the charging standards for palliative care for the first time. According to the document, for-profit medical institutions can determine their own palliative care services and fees. Palliative care services provided by non-profit medical institutions, which belong to medical services such as treatment, nursing, examination and inspection, shall be charged according to the existing items;Other non-medical services are not managed as a medical service price item, and the charging standard is determined by the medical institution.
After the opening of the palliative care fee standard, in November 2021, the bed fee of the palliative care center will be adjusted from 200 yuan per day to 600 yuan per day. “After achieving basic profitability, the biggest difficulty is also Solved.” Gu Jin said.
What kind of palliative care do we need?
The palliative care center is located on the west side of the 14th floor of the inpatient building of Shougang Hospital. There are 14 single wards and 1 suite ward, and now there is never a shortage of patients.
It feels like home rather than a ward. The walls are painted light blue, and the house number is in the shape of a red apple, which means peace. There are a chat room, a library, a simple pantry, and a SPA room in the center. There is a corridor in the ward where you can bask in the sun. Pots of green plants carefully cared for by nurses.
Photo courtesy of the ward of Shougang Hospital Palliative Care Center/respondent
A young child donates his cornea after he dies, a husband gives his wife a Valentine’s Day rose from a medical worker, a bedridden man is happy like a child after trying a sorbet he desperately wants… In the nursing ward, in addition to the sadness of the loss of life, there is also the most primitive warmth of life.
“People who don’t engage in palliative care don’t know that it has a magic power that makes you like it more and more.” Sun Wenxi, head nurse of the palliative care center of Shougang Hospital, from the beginning of its establishment, Always serve here.
She was first introduced to palliative care in 2016. In the early stage of preparation, Shougang Hospital sent her and 2 other doctors and nurses to Taiwan Mackay Memorial Hospital to study. The hospital opened the first hospice ward in Taiwan in 1990.
In the early days of its establishment, the palliative care center of Shougang Hospital treated patients with advanced cancer who had entered the final stage of life and whose active treatment was meaningless; will also be treated. The medical care team is undertaken by the oncology department.
Wang Xiaodong, director of the Oncology Department of Shougang Hospital, also serves as the director of the palliative care center. She said that the training and work goals of the medical staff on both sides are different, and the work of the oncology department downstairs emphasizes the treatment of tumors. , Upstairs palliative care pays more attention to humanistic care, symptomatic treatment and pain relief care before dying.
“The nurses on both sides will rotate on a regular basis. The concept of palliative care needs not only to be implemented in the hospice ward, but we hope to penetrate further, for patients who have just started chemotherapy, and even those who have just been diagnosed with malignant tumors. The patient, we all instill the concept of palliative care in him. It may be difficult for the patient and family members to accept it until the end-stage contact.”
Since its establishment in 2017, Sun Wenxi has been serving in the palliative care center. She said that since its establishment five years ago, all aspects of the center have undergone great changes. The medical staff are more and more agreeable with the concept of palliative care, and the medical care for patients has become more standardized. understanding is also deeper.
“At the beginning of the establishment, when patients came in and were hospitalized, they did not understand what palliative care was. Because the environment here is good, the family has economic conditions, and patients with advanced cancer thought about having a place to live. hospital, while other hospitals only treat patients undergoing chemotherapy.”
“Most of the patients who are admitted to our ward now may be rushing to the concept of palliative care. That is to say, to reduce pain as much as possible, they are not very concerned about the length of life. , more pursuit of no pain before death, more pursuit of quality death.”
Photo courtesy of the medical team/respondent of Shougang Hospital Palliative Care Center
In Wang Xiaodong’s view, palliative care has a long-term development prospect, but there are still some problems that need to be solved urgently: domestic palliative care is not a professional discipline. , Pain specialists are doing it. If a doctor is fully engaged in palliative care, what kind of specialty should be counted in terms of professional title promotion? “A palliative care specialty that is barely placed in the oncology department? We are all trying to make palliative care an independent discipline, and hope that colleges and universities will offer corresponding courses.”
On September 28, 2020, the inauguration ceremony of the palliative care expert committee of Beijing Medical Doctor Association was held at Peking University Cancer Hospital, which is the first academic platform in the field of palliative care in Beijing.
Three-level management mode, involving thousands of households
Wang Xiaodong often encountered an embarrassing situation when he went to the community free clinic.
After hanging up the banner “Free Clinic of Oncology Department and Palliative Care Center of Peking University Shougang Hospital”, community residents were scared away when they saw these words and dared not come, especially those older people.
Older people shy away from talking about death and see banners as “unlucky”. In fact, birth, aging, sickness and death are an inevitable process of life. All we can choose is how to die.
The concept of life and death is another challenge in the promotion of palliative care.
Many people have misunderstandings about palliative care. “They understand that palliative care is giving up, but in fact it is not completely giving up, but actively alleviating symptoms to achieve a hospitable death,” said Wang Xiaodong On the premise of controlling pain and ascites and abdominal distension, the oncologist will scientifically judge whether the patient still has the possibility of anti-tumor treatment, and will not give up any chance.
Palliative care is not just about doctorsThe hospital can do it. In December 2020, the “Hospital-Community-Home-based Hospice Care Hierarchical Standardized Management Model Promotion Plan” by Wang Xiaodong’s team of Shougang Hospital Hospice Care Center became the only hospice care achievement promotion project approved by the Beijing Municipal Health Commission.
“We want to pass on the concept and experience of palliative care to the community, and from the community to the residents in the jurisdiction.” Wang Xiaodong said.
Peking University Shougang Hospital has 4 community health service centers and 3 community health service stations under its jurisdiction. People, finance and materials are managed in a unified manner, forming a close medical alliance. “The information of the community health hospital and the information system of our hospital are interconnected, and the test results of patients in the community and their significance can be shared, which provides great convenience for doctors in medical institutions at different levels to manage the health of patients.”
“After all, wards and medical resources are limited. After conditioning in our hospital, patients can go home and be managed by the community health center. If the patient chooses to stay at home, the community can follow up regularly and deal with it in the community. If the problems that cannot be solved will be referred to our hospital, a closed-loop management will be formed.”
Ultimately, at every stage, patients are cared for by doctors and nurses. “From the level of medical care, it is decreasing level by level, but in terms of the number of people cared for, the base of patients at the bottom is larger, and the base at the top is smaller, so that palliative care can be delivered to thousands of households.”
Source: Medicine
Editor in charge: Zheng Huaju
Proofreading: Zang Hengjia