Professor Arvydas Seskevicius, President of Palliative Medicine Association of Lithuania, continues our series of posts on the Budapest Commitments and looks at how his country has used them as a framework to develop palliative care.
In January 2009, the Palliative Medicine Association of Lithuania signed up to the Budapest Commitments. Palliative care had been introduced only two years before, so the need for palliative care was huge, and there was much work to do…
Our goals were:
- To implement a palliative care system in Lithuania
- To implement palliative care education programmes for all healthcare specialists.
Lithuania is in Eastern Europe with a population of about three million people. Each year, about 17,000 people are diagnosed with cancer with 8,000 deaths annually. In 2007, indications for palliative care were set depending on the disease and Karnofsky and Bartell indices: palliative care is provided to a wide range of patients with Karnofsky index <50% and Bartell’s index ≤40 points. In 2012, palliative care was provided to 2,027 patients.
Palliative patients prefer to receive care at home, but if this is unavailable treatment is provided in hospital settings: oncology hospitals, hospices and regional hospitals. Thirty-two institutions are licensed to provide state-financed palliative care, providing about 230 beds. We’re now discussing with our Ministry of Health the creation of specialised palliative care units with a minimum of eight beds. All outpatient palliative care services are financed by the state; only Caritas receives funding from various projects and from the Church. Home visits are made by a nurse and volunteer and, if needed, a physician and/or a social worker.
The use of volunteers in palliative care (typically retirees, students and medical specialists) has been going on for several years, and annual training is provided. The number of volunteers is higher in large cities with too few in rural areas. Palliative care is not very popular among medical professionals because of the emotional burden, and also because salaries for staff in some palliative care units are lower than in other inpatient/outpatient units.
Access to medication
With increasing availability of medication in recent years, we can provide the medications suggested in the IAHPC Essential Medicines for Palliative Care.
Palliative care is integrated into the National Cancer Control and Prevention Program. Following a Ministry of Health decree in 2008, palliative care in inpatient units, at home, and day-cases have been financed by the state so that patients receive the services free of charge.
There is no education in palliative care for medical undergraduates, although it is available for resident family physicians. Palliative care as a subject is included in the nursing undergraduate programme. We have a postgraduate course on ‘Palliative care’ for physicians, nurses, social workers, psychologists, and physiotherapists. Learning is based on teamwork.
The Ministry of Education and Science has not included scientific research in palliative care into their plans; such research is conducted at the initiative of individual researchers. However there have been several studies undertaken within the country and international research projects are ongoing with partners in the Netherlands and Poland.
The Lithuanian Society of Palliative Medicine cooperates with several organisations including The Tiltas Trust, St Christopher’s Hospice and St Luke’s Hospice in the UK; and Poznan University of Medical Sciences, Department of Palliative Medicine and Hospice ‘Pallium’ in Poland.
We continue to strive for centralised palliative care, with separate units in hospitals or hospice units (currently, we have 2-4 beds dispersed among different hospitals) and we will seek better financing and finally we will try to ensure that palliative care becomes a priority field of medicine.
Find out more…
- Read about the background to the Budapest Commitments on the EAPC website.
- Click here to read how other national organisations have used the framework of the Budapest Commitments to develop palliative care.
- All published material will be summarised by Dr David Oliver in his guest editorial in the May/June 2013 issue of the European Journal of Palliative Care and will be presented at the 13th World Congress of the European Association for Palliative Care in Prague 2013.