Dr Ondrej Sláma, Secretary, and Dr Ladislav Kabelka, President, the Czech Society for Palliative Medicine
The Czech Republic is privileged to be a high-income country with a relatively well-functioning healthcare system, good availability of the latest diagnostic and therapeutic technologies, and public health insurance coverage for each citizen. But the quality of end of life care is poor. A lack of interest in the specific needs of patients with advanced serious illness, poor symptom control, and coordination of care are all reflected in the experiences of many patients and their families during the last months of life.
Palliative care began in the Czech Republic in the early 1990s with a vision to develop a network of inpatient hospices. Fourteen inpatient hospices were built in the past 15 years providing 400 beds (four beds: 100,000 inhabitants). Two more inpatient palliative care units with 60 beds have now opened within other hospitals. All this has been achieved thanks to the incredible efforts of local healthcare professionals and volunteers, and with funding from the Ministry of Health. Most of these inpatient hospices are members of the Association of Hospice Palliative Care Providers (APHPP), a collective member of the EAPC.
Budapest Commitments as a framework
In 2009, the Czech Society for Palliative Medicine (CSPM) launched with the aim of promoting palliative care within our healthcare system and the general public. Following the EAPC’s suggested public health approach, we used the Budapest Commitments as a framework to implement and develop palliative care. Below we summarise some achievements and challenges.
Access to drugs
Despite good general availability of all essential drugs in our country, they are not accessible to many patients in need in the ‘real world’. There are two reasons for this. On one side there is ‘opiophobia‘ (ie physicians, patients and their families), while on the other side we see a widespread, oversimplified view of palliative care as just the care of the dying, where the only goal is to relieve pain by not hesitating to give high doses of opioids and sedatives and which should not be too expensive. For some, the label ‘palliative care’ became the euphemistic and socially acceptable way to speak about withdrawal of all life-sustaining therapies. It is obvious that such a discourse may discredit the concept of palliative care and may be dangerous for patients.
The CSPM has contributed to three key policy initiatives:
- National Strategy for Palliative Care (CSPM and APHPP worked with Human Rights Advisory Board of the Czech Government and the Ministry of Health and Ministry of Social Affairs) – now awaiting official adoption by the government.
- Czech National Cancer Programme – CSPM is currently updating a chapter on supportive and palliative care that we hope will lead to better cooperation with oncologists and integration of palliative care into cancer centres.
- Participated in preparation of ‘Rules of decision-making about withholding of life-prolonging therapies in intensive care units’, which the Czech Medical Chamber accepted as an official position paper in 2011.
Various aspects of palliative care are already part of the curricula in nursing and medical schools but these are taught in such a way that does not enable the practical knowledge and skills needed to support patients at the end of life. However, we have made some good progress. In 2007, we introduced palliative medicine in Brno Medical School as an optional course and each year more than 30 students pass (about 20% of all students). A similar course is now available at Charles University Medical School in Prague. In 2011, palliative medicine was recognised as a medical subspecialty with theoretical training organised by the CSPM. Fifteen physicians are now in specialist training – the future of palliative care in our country…
In 2011, several nurses from the Czech Republic took part in The End-of-Life Nursing Education Consortium (ELNEC) Programme in Austria. They translated ELNEC materials into Czech and are teaching the ‘Train the trainer’ programme to our nurses. Together with colleagues from Slovakia we organise an annual Czech-Slovak Conference of Palliative Medicine, which provides a great interdisciplinary platform for exchange of ideas and experience.
We are all looking forward to the EAPC World Congress in Prague in May 2013 – we’ll try to use this as an opportunity to make palliative medicine more visible, both to health professionals and to the general public.
Look out for more posts in the coming weeks to see how other national organisations are implementing the goals they set themselves back in 2007. Dr David Oliver (UK) and Dr Michaela Bercowitz (Israel), board members of the EAPC, have been collating information about the Budapest Commitments, which will also be summarised in the European Journal of Palliative Care in 2013 and presented at the 13th World Congress of the European Association for Palliative Care in Prague 2013.