Dr. Adrian Chaurand Morales.
Mexico lives in shortage of palliative/hospice care services and physicians are underusing this few existing specialized programs
With March being colorectal cancer month, the connection between oncological processes and palliative care carries a much greater sense of urgency.
Many medical professionals particularly those in the field of palliative care have the perception that physicians specially oncologists avoid recommending hospice and palliative care for their patients.
Why is this lack of programs & lack of use such a problem?
Nearly 600,000 people die every year in Mexico, almost half as a result of chronic diseases such as cardiovascular and lung problems, diabetes, HIV or cancer. Other hundreds of thousands of Mexicans and expats living in the country suffer previous stages of these and other chronic diseases. In the course of their illness, many of these people experience debilitating symptoms such as pain, dyspnea, anxiety and depression. To ensure adequate medical care for many of these people, access to palliative care and pain medication is essential. Without these services they will suffer unnecessarily, undermining their quality of life and that of their relatives in their last days of life.
The lack of programs and the Underlying Reasons for Underutilization
- 1. In Mexico, access to palliative care services and essential drugs for the treatment of pain is very limited. In 2014, Human Rights Watch found that only a few dozen public health institutions in the country offer palliative care and that the presence of hospice home care services at the patient’s home is even lower, that had not changed much since. The fact that palliative care is available in some places is often due to the efforts of the doctors or advocates themselves rather than to the existence of a deliberate policy of the government, health system or insurance companies.
- 2. In terms of training, most health profesionals have not received training in the discipline. Less than 15 of the 102 faculties of medicine in Mexico offer courses on palliative care for undergraduate medical students. As a result, many doctors and other health workers lack even the most basic preparation in the care of patients who require palliative/hospice care, so they don´t even know about the scope of a specialized care multidisciplinary/holistic palliative care program.
- 3. “Physicians are trained to save people’s lives,” As mentioned above: The lack of training on end of life issues in combination with the unwillingness of doctors to accept that a patient’s death is inevitable, gets doctors into “therapeutic obstinacy”, so they prescribe unnecessary treatments that are necessary to keep the patient alive instead of using hospice care services.
- 4. Unfortunately, in private healthcare the lack of ethics & the economic glare also block referring to specialized services. The great benefit obtained by private practice and hospitalization make some doctors to continue treating a patient even when they know specialized hospice and palliative care services are available for this families/patients.
Palliative Care Pros
This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.
Palliative care had significant benefits:
- A. For patients. -In terms of quality of life, symptoms relief, depression, anxiety, and spiritual well-being. It has proven effective in reducing hospital readmissions, it also comes to the patient whether they are in a nursing home, assisted living facility, or his or her own home. This allows the patient to remain where they are most comfortable while a team of hospice professionals supports the care being provided by family or facility caregivers.
- B. For the family. Because the team will…
Knowing what to expect can help you to prepare appropriately for the ups and downs of an illness.
-Help you to deal with stress
Palliative care specialists know that if a caregiver is not being treated for their issues, it can affect the patient’s well-being. That’s why they make caregiver stress a serious focus in their care.
-Give you practical tips
Patients may have to change the way they eat, walk, or go to the bathroom. Palliative care specialists provide caregivers with methods to better assist their loved ones in these tasks.
The provisions of palliative care in the mexican law are ambitious, since they seek the full integration of palliative care in health services that exist in Mexico and base their success on achieving almost universal health coverage for their population, through a combination of private, public and employer-financed health insurance
The need to educate physicians as well as developing more specialized services are important requisites to move forward. In response, private, public and NPOs are working on training programs, hospital units and home care programs.
Although Mexico remains a relatively young nation, a quick demographic change is anticipated in the coming decades. In 2010, only 7.1 million Mexicans were 65 or older. By 2020, that figure will have reached 9.8 million, and by 2050, to 23.1 million. Meanwhile, the prevalence of chronic diseases, such as cancer, cardiovascular diseases and diabetes, is rising and will continue to rise as a result of, among other factors, the aging process. Thanks to the development of palliative care services nowadays, the health system of Mexico can prepare itself for the wave of patients with chronic diseases that will turn to their health services in the coming years.
In the future, All practitioners should incorporate Palliative Care practices into their care
of patients with cronic advanced diseases, nowaday, Chapala Med palliative care program is an example that Mexico is working on it.