| Palliative Care Service Provision |
| History and Development of Palliative Care |
| Public Health Context |
| Ethics and Ethnography |
| References and Further Reading |
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| Current services in Serbia and Montenegro |
| The following palliative care services are known to exist in Serbia: |
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Existing Services (2002) |
| Adult |
Inpatient - Freestanding |
0 |
| - Hospital Unit |
0 |
| - Hospital mobile team |
0 |
| Nursing Home |
0 |
| Home Care |
1 |
| Day Care |
0 |
| Total |
1 |
| Paediatric |
Inpatient |
0 |
| Home Care |
0 |
| Day Care |
0 |
| Unspecified |
0 |
| Total |
0 |
| Grand Total |
1 |
|
| Current Projects |
| No palliative care projects, not yet operational services, are known to exist in Serbia. |
| |
Known hospice/ palliative care projects (2002) |
| Adult |
Inpatient - Hospital |
0 |
| - Hospice |
0 |
| Home Care |
0 |
| Unspecified |
0 |
| Total |
0 |
| Paediatric |
Hospital |
0 |
| Hospice |
0 |
| Home Care |
0 |
| Unspecified |
0 |
| Total |
0 |
| Grand Total |
0 |
|
| The only indication of a palliative approach within Serbian health services at this time can be found in the adoption of some of the core principles of 'supportive care' for oncology patients. At the IORS there is no formal supportive care team or unit, 'but we do have a group of people dedicated to supportive care - a 'supportive care oriented group' … we also have an Oncologic Intensive Care Unit with 4 beds where the patients are admitted for active supportive care. The main difficulty in creating a formal team/unit is the idea that supportive care is exclusively the field of the practising oncologist and that it should not be a separate discipline'. Nevertheless, the group hopes to create such a team in the near future and in the meantime it continues to develop its international links, including with Dr Eduardo Bruera in the USA, and with the Italian Group for Anti-emetic Research; with these there is involvement in international, multi-centre research studies2. The IORS team can list a number of other achievements.3 It has had an influence on morphine prescribing policy (previously restricted to 200 mg per prescription). It has developed a formula for the manufacture of morphine syrup ('but this only exists at our Institute!'). It has organised several lectures and seminars and been responsible for some publications and also enabled two nurses to attend international conferences. |
| Serbia has no national guidelines, recommendations, standards or policy concerning palliative care.4 Nevertheless, the Institute for Oncology and Radiology of Serbia (IORS), based in Belgrade, has translated the 1996 WHO publication Cancer Pain Relief and has published its own 'user friendly' handbook for physicians and nurses on the relief of cancer pain, entitled Pharmacotherapy of Cancer Pain. The WHO document Symptom Relief in Terminal Illness (1998) has been translated and presented to GPs and oncologists during 2001 and 2002; the translation of Cancer Pain Relief and Palliative Care in Children (1998) is ongoing. Both translations have been supported by funding from OSI. Since 1993 a series of publications on aspects of supportive care in cancer by the Belgrade group have appeared in Serbian medical journals. Access to oncology journals is improving but there is only limited access to relevant supportive care journals, and palliative care journals appear to be completely unavailable |
| Education |
In Belgrade, Serbia, GPs receive formal training (9 x 45 minutes) in the basic principles of supportive care, general assessment of the patient, the concept of quality of life, emergencies in oncology, treatment of anorexia/cachexia, and principles of cancer pain management. For postgraduate clinicians specialising in oncology, there are sessions (6 x 45 minutes) on similar topics and also the prevention of chemotherapy and radiotherapy induced emesis and psychosocial issues.5 However, for undergraduate medical students, such subjects are dealt with only in the most limited way. A symposium focussing on supportive care is being planned for October 2004
In addition to these activities, we also identified the work of one NGO, based in Albania, but operating in Kosovo (see Albania country report). Ryder Albania Association (RAA) began a home care service in Pristina, Kosovo in April 2000 and cared for 107 patients in its first 9 months.6 |
| Help from EAPC: One questionnaire listed detailed ideas about the help which might be given from EAPC; these included 'A high quality seminar for the country, covering all aspects - medical, organisational, drug policy; establish one comprehensive centre for education - one per country; research projects covering major cancers in the country; finance educational activities, including translation of books.' 7 |
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