The cantonal hospital applied early a strategy of a comprehensive cancer centre with process-based structures. In 1991 a palliative care unit was founded as an inherent part of oncological inpatient care and in 2000 an inpatient consult service was established. Later in 2003 an outpatient clinic focusing on cancer patients and in 2006 a palliative centre focusing on education and hospital wide care were established.
Since 2006 it has been established, that specialist palliative care is an inherent part of department of oncology with inpatient units, outpatients clinics, network and participations in consult service, but at the same time a palliative centre, responsible for specialist palliative care in the whole hospital, seeing also most other diseases of internal medicine and surgery and other disciplines, responsible for education on level A, B and C (according to EAPC), hospital wide quality projects focusing on end of life Liverpool care pathway a hospital wide consult service for all diseases and also an inpatient unit.
The hospital is a regional hospital with 770 beds, with a clear mission for high quality care, interdisciplinary and network approach, research and education. For main diseases in oncology tumour boards are active. For inpatient wards are dedicated to oncology patients (32 beds general oncology, 12 beds haematology oncology, 11 beds palliative care unit oncology, in addition cancer patients are seen in surgical wards and gynaecological wards and radiation oncology wards.
For cancer patients requiring palliative care interventions, there is a philosophy of early integration of palliative care. This achieves by an outpatient clinic oncological palliative medicine, offering ad hoc visits of specialist palliative care, every day a week a clinic staff by doctors and specific and also interdisciplinary with nurses and a interdisciplinary palliative clinic focus on nutrition and fatigue (so called cachexia clinic). There is an own intra hospital palliative care unit oncology, were the full spectrum of dying support with also research on dying processes takes place, at the same time supportive and palliative rehabilitation including chemotherapy and nutrition therapy in palliative intention.
The consult service of the whole hospital is staffed by the palliative centre in another department and a section of oncology; however the collaborations are very close, that same people work in different departments to provide high level care. There is a daily triage meeting of all specialist services of palliative care in the hospital (currently palliative care centre and oncological palliative medicine) to discuss visits, needs of patients and in- and outpatient resources. There is a 24/7 background service of specialist palliative care.
The palliative care centre also has an own inpatient unit, open for all diseases, with en emphasize also on chronic pain patients. There is a regional network oncology serving 6 other hospitals, specialised palliative care is currently provided by case discussions with oncologists travelling to the centres. Also a palliative care centre provides consult service by travelling to the centres for specific cases. The approach to patients follows a modular approach by a generic screening including symptoms, but also aspects on meaning, cognition and family support, followed by modular, more in-depth assessment, priorities and care plans. The section oncology encompasses 23 senior oncologists, 11 fellows. Through continuous education many oncologists provide key interventions of palliative cancer care on a level B1. The specialist palliative care team of both oncological palliative medicine and palliative centre encompasses approximately 6 staff persons, some of them in the education of a 2-year 100% work in palliative medicine.
Early integration of palliative care by specialist palliative care integrated in the department of oncology with consult, outpatient, inpatient and network structures and offers.
Palliative Care Centre for education, quality standards for all diseases including, but not limited to cancer, focus on not oncological diseases to and regional networks.
Education of oncologist: Mandatory rotation to the inpatient palliative care unit oncology for 3 months, also there is a rotation for 6 to 12 months in the outpatient clinic oncological palliative medicine.
Research is closely embedded in clinical care. A current focus is on cachexia, fatigue, symptom management and key interventions of palliative cancer care, processes of dying and diagnosing dying, chemotherapy in palliative intention.
Our centre conducts phase 1 studies in cancer cachexia, an important synthesis of a phase 1 unit and also specialist palliative medicine in a comprehensive way.
Palliative and supportive care
Oncological palliative medicine as part of medical oncology department, palliative care centre for hospital wide and regional palliative care in all diseases. Close collaboration.
- Inpatient unit oncological palliative medicine
- Supportive palliative outpatient clinic oncological palliative medicine
- Palliative Care Centre including consult team
- Oncologists with various decrease of palliative care training
- Bridge service
Additional website: http://www.palliativzentrum.kssg.ch/