[Palliative care]

WHO describes palliative care as the approach to patients with incurable illnesses. It covers identification and treatment of pain and other physical symptoms, psychological, social, and spiritual difficulties. A tight cooperation between the family doctor, the hospital (medical clinic with the subspecialists, geriatric and palliative care centre), the Spitex, the social, psychological, and the pastoral workers is needed. The family doctor needs to know much about medication and specific interventions in order to alleviate the patients' symptoms such as pain, breathlessness, cough, difficulties to swallow, nausea, vomiting, constipation, ileus, nutritional problems, fear, depression, and fatigue. The specific interventions may include irradiation, stenting of bile ducts, oesophagus or colon, hormonal treatment etc. A very important aspect is pain control and the correct handling of non-opioid analgesics, opioids, and co-analgesics. The terminal phase at home is a special challenge for the family doctor acting as a palliative physician.