Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness. It does so by preventing and relieving suffering by means of early identification and thorough assessment of the symptoms and treatment of pain and other physical, psychosocial and spiritual problems. Directive 30/2009 of the director-general of the Ministry of Health required hospitals, nursing institutions and the health plans to establish and provide palliative services within four years and to train specialist staff for the purpose. In the intervening six years, the hospitals have taken steps to develop these services, but until now no up-to-date comprehensive information has been available. The study presents a comprehensive, up-to-date picture of the palliative services in general hospitals and geriatric medical centers six years after the directive was issued. More than 85 face-to-face interviews were conducted with hospital directors, head nurses, heads of departments and units at 25 general hospitals and 10 geriatric medical centers.
General hospitals: Two hospitals have had in-patient hospices and three have had multidisciplinary oncology units (onco-palliative service) for many years. In recent years, ten additional hospitals have opened palliative counseling services. The staffing positions, which are funded by internal resources, are filled by nurses specializing or trained in palliative care or oncology and only in two hospitals is the position filled by a specialist physician. In six other hospitals, most of the small or medium and in the periphery, attempts are made to adopt the palliative approach in various ways, but no specific position has been created. Four hospitals are not addressing these needs at all.
Geriatric medical centers: In four of the centers, the palliative approach is an integral part of general geriatric care. In two of these geriatric centers, the complex nursing wards also function as palliative care wards. Four other centers have “palliative committees,” but little else is done in this area.
Barriers to developing palliative counseling services: No clear requirements in the directive about the structure of the palliative service and no earmarked budgets allocated; grave shortage of specialist physicians and nurses; lack of awareness among medical staff and general public and sometimes opposition to palliative care; legal difficulties in relation to the Dying Patient Act. In addition, in hospitals that have a position for a palliative consultant, s/he works alone without an interdisciplinary staff even though the directive stipulates that the need for a multidisciplinary staff and teamwork is an important part of palliative care.
The study shows that the director-general’s directive has brought about significant change in the provision of palliative care. However, there is a need for proactive steps to promote it further.. These include increasing the number of specialist physicians, investment of resources particularly for staffing positions and increasing awareness and knowledge of hospital medical staff. The study findings are being utilized by the National Committee for Palliative Care, which was set up by the Ministry of Health and have been presented to the Ministry of Health and the National Medical Councils as part of the efforts to promote palliative care. In addition they are being used by a special committee under the auspices of ESHEL and in cooperation with the Ministry of Health and MJB, that is reviewing “end of life care” for the elderly.
The study was funded with a grant from the Israel National Institute for Health Policy Research.
* Not in print, available only on the website
Citing suggestion: Bentur, N., Laron, M., Azoulay, D., & Oberman, A. (2015). Palliative Services in General Hospitals and Geriatric Medical Centers in Israel. RR-704-15. Myers-JDC-Brookdale Institute. (Hebrew)