Unique cancer centre in Slovenia marks 10 years of palliative care
The Institute of Oncology Ljubljana, in Slovenia, is a unique institution in the country’s national medical setting and a reference centre for the palliative care of cancer patients. It is the only comprehensive cancer centre in this country of two million inhabitants and it provides for the national development of oncology across the multi-professional services for cancer prevention, diagnostics, treatment, rehabilitation, as well as palliative care. (Next year the Institute as a whole will be commemorating its 80th anniversary.)
Around 19,000 people die each year in Slovenia and only 43% of them die at home. Most patients die in acute care hospitals, where standards and pathways for palliative care are not set; and we also face inadequately developed palliative care networks across the country and a lack of 24-hour quality palliative care. To improve palliative care, the institute started to implement modern principles of palliative care in 2005 with a palliative care team. At the beginning of 2007, a six-bed unit was opened – the Acute Palliative Care Department. The department has been led by a physician – a medical oncologist. Other team members include: two advanced practice registered nurses, assistant nurses, and two team coordinators (one a social worker, the other a registered nurse).
Nowadays, palliative care at the Institute is performed on two levels: primary palliative care – at all hospital departments, outpatient clinics and on a consultation basis; and specialised palliative care at the Department for Acute Palliative care. The later serves for more demanding and specialised care of patients with complex symptoms that cannot easily be managed. Very important is also its consultation and advice role to the primary level (about symptom management and psychosocial support). The coordinator of palliative care also assists with the discharge planning for patients. A multidisciplinary team today includes experts from different units, including: surgery, radiotherapy and medical oncology, pain control unit, health and social care counselling, spiritual support, clinical nutritional support and dietotherapy, physiotherapy, pharmacy and volunteers. Active involvement of family doctors or clinicians in regional hospitals means that palliative care is continued after the patient is discharged from our hospital.
As a part of the only tertiary cancer center in Slovenia, the department also performs research and educational work, playing a specific role in the development of palliative care for the whole country.Among others things, members of the the team are preparing national treatment guidelines and clinical pathways in the field of palliative care – the unit serves as a learning base for training staff at the institute and other health care institutions in Slovenia.
In 2009, the institute received recognition as an “ESMO Designated Centre of Integrated Oncology and Palliative Care” for achieving a high standard of integration of medical oncology and palliative care, and renewed the accreditation in 2012 and 2016.
The Acute Palliative Care Department at the Ljubljana Institute of Oncology