Turkish community-based palliative care model: a unique design

Abstract

An organized palliative care system was lacking in Turkey before 2010. One of the pillars of Turkish Cancer Control Programme is palliative care. The Pallia-Turk project in this respect has been implemented by the Ministry since 2010. The project is unique since it is population based and organized at the primary level. This means, the whole population (>70 million) will have the quickest and easiest way for access to palliative care. This manuscript briefly summarizes the situation before the project and updates what has been done in last 2 years with the project.

Palliative Care Ethics

“…Sağlık Bakanlığı Kanser Daire Başkanlığı'nın 2011 yılında başlattığı Palya Türk projesinin amaçları, yönetim şeması, Sağlık Bakanlığı'nın proje içindeki görevlerinin açıklandığı makalede amaçlar ağrı yönetiminde önemli bir yere sahip morfinin ulaşılabilirliğini arttırmak, morfin reçeteleme için yeni düzenleme getirmek, tıbbi ekibi opiofobiye karşı eğitmek, toplum tabanlı palyatif bakım modeline aile hekimlerini yerleştirmek olarak verilmiştir (36). 2012 yılında yayınlanan bir diğer makalede ise, Türkiye'de uygulanmaya başlanan toplum tabanlı palyatif bakım modelinin başarılı olduğu, hastaların gereksinim duyduğu hizmeti sağladığı, daha ekonomik olduğu belirtilmiştir (37). Türkiye İstatistik Kurumu'nun verilerine göre, 2014 yılında ölüm nedenleri incelendiğinde, ikinci sırada iyi huylu ve kötü huylu tümörlerden ölümler (%20,7) gelmektedir (38).…”

Cultural Challenges in Implementing Palliative Services in Turkey

“…When the patient has a chronic disease such as diabetes, hypertension or cancer, the patient receives full reimbursement. 2,5 World Palliative Care Alliance (WPCA) like WHO, is an organization that promotes activism, monitors progresses and provides resources on education and policy to countries developing PC. WPCA in 2011 updated a global inventory of hospice and palliative care development with multiple factors and assigned the countries to six categories.…”

“…In an evaluation done in 2011, the majority of almost 40,000 patients who received home care had neurological disease (45%), cardiovascular disease (21%) and other chronic diseases, only 4% had cancer. 2,5,10 Thus, most patients with cancer have not received home care. The number of patients receiving home care has increased significantly to 760.645 in 2016.…”

“…2,19 The Ministry of Health, has organized PC educations for nurses and doctors since 2010. 2,5,15 There are perminent psychologists and psychiatrists as a part of PC only in a few oncology centers. In most centers, psychology/psychiatry consultation is requested from the related department as needed.…”

“…Opioids can be prescribed by all physicians including family physicians. 2,5,10 The Ministry of Health has also planned to decrease the unnecessary legislation according to European Union guidelines by 2015 and e-prescriptions, like the prescriptions of other drugs, are also planned for opioids. 2,5 Since the end of 2014, slow releasing morphine is being produced in Turkey.…”