The role of family medicine physician in the palliative care system

Palijativna skrb je pristup koji poboljšava kvalitetu života bolesnika i njihovih obitelji, suočenih s problemom neizlječivih, uznapredovalih bolesti, putem sprječavanja i ublažavanja patnje pomoću ranog prepoznavanja, prosudbe te liječenja fizičkih, psihosocijalnih te duhovnih problema. Ona je interdisciplinarna te obuhvaća bolesnika, obitelj i zajednicu. Obiteljska medicina je temeljna djelatnost u primarnoj zdravstvenoj zaštiti, koja provodi kurativnu i preventivnu zdravstvenu za štitu, ali i opću palijativnu skrb, u populaciji za koju skrbi. U palijativnoj skrbi liječnik obiteljske medicine u okviru svojih kompetencija pruža trajnu skrb bolesniku i njegovoj obitelji. Pri pružanju palijativne skrbi radi timski te surađuje sa službama specijalističke palijativne skrbi kako bi bile zadovoljene sve potrebe bolesnika i obitelji koje nisu samo zdravstvene već i socijalne, psihološke i duhovne. U europskim državama, vrijednosti koje su prepoznate među ekspertima za palijativnu skrb su: autonomija pacijenta, dostojanstvo, potreba za individualnim planiranjem i donošenjem odluka te holistički pristup. Opća palijativna skrb promiče snažniji odnos liječnik pacijent te smanjuje fragmentaciju skrbi. Svi kliničari koji skrbe za ozbiljno bolesne pacijente trebali bi razumjeti osnovna područja opće palijativne skrbi te dobiti osnovno osposobljavanje vezan o uz palijativnu skrb. Vještine potrebne za obavljanje opće palijativne skrbi dijele se na četiri glavna dijela: procjenjivanje i liječenje fizičkih simptoma, brižan odnos prema psihološkim, sociološkim, kulturološkim te duhovnim potrebama pacijenta, komunikacijske vještine kod ozbiljnih boles ti te koordinacija skrbi. Prema “The Gold Standards Framework Proactive Identification Guidance (GSF PIG)” objavljenog od strane Royal College of General Practitioners, postoje kriteriji za rano prepoznavanje osoba kojima je potrebna palijativna skrb. Rani je prepoznavan je pogoršanja s tanja vodi d o ranijeg predviđanja mogućih potreba, boljeg planiranja, manjeg broja kriznih hospitalizacija te skrbi prilagođenoj željama ljudi. To dovodi do boljih ishoda te više ljudi živi i umire na mjestu i na način na koji želi.Palliative care is an approach that improves the quality of life of the patients and their families, that are facing the problems of incurable, advanced diseases, through the suffering prevention and alleviation by means of early identification, judgement and management of physical, psychosocial and spiritual issues. It is an interdisciplinary field and it includes the patient, family and the communi y. Family medicine is a core service in the primary healthcare field, which provides curative and preventive health care services, but also palliative approach and basic palliative care in population that it cares for. In field of palliative care, family medicine physician provides permanent care for the patient and his family within his competences. In providing palliative care, family medicine physician works in the team and cooperates with specialist palliative care services, in the way that all patient and family needs are met: health, social, psychological and spiritual needs. In the European countries, a set of common values is acknowledged among palliative care experts: patient autonomy and dignity, the need for individual planning and decision making and holistic approach. Basic palliative care promotes stronger patient physician relationship and reduces the fragmentation of care. All clinicians that care for seriously ill patients should understand essential fields of basic palliative care and receive essential training that includes skills related to palliative care. Skills needed for providing basic palliative care can be divided into four main parts: assessment and management of physical symptoms, careful approach to psychological, sociological, cultural and spiritual needs of the patient, serious illness communication skills and coordination of care. According to “The Gold Standards Framework Proactive Identification Guidance” that was published by Royal College of General Practitioners, there are criteria for early identification of people who are thought to reach the end of their life within a 1 year . Earlier recognition of decline leads to earlier anticipation of likely needs, better planning, fewer crisis hospital admissions and care tailored to the peoples’ wishes. This in turn results in better outcomes with more people living and dying in the place and manner of their choice