The guidelines ‘Smernice za klinicku praksu u palijativnom zbrinjavanju’ were developed through the EU-funded project ‘The Development of Palliative Care Services in the Republic of Serbia’ which is managed by a consortium led by Oxford Policy Management. The project is providing technical assistance to the Ministry of Health for the establishment of a comprehensive system of palliative care in Serbia.
These best practice guidelines reflect a consensus of opinion about good practice in the management of adults with a life limiting illness and are based on available evidence. They are the first of their kind developed in Serbia, and complement the Clinical Guidelines for oncology patients in primary care, published in 2004. The areas covered in the guidelines are comprehensive, covering physical, psychological and spiritual issues such as anorexia and cachexia, anxiety and depression, breaking bad news, communication, delirium and confusion, emergencies in palliative care, fungating wounds, pain and spiritual support amongst others. The guidelines draw upon good practice but also upon available medications in Serbia, and have been published shortly after the acceptance of amendments to the essential medicines list for palliative care by the Health Insurance Fund.
Distribution of the guidelines began last week at the launch of local palliative care co-ordinating bodies in Loznica, Cacak and Cuprija. Guidelines were handed out to clinicians working in the local palliative care units and in the home care teams through the Dom zdravilja. One doctor commented that “we have been waiting for these – they will help us in our practice as we care for individuals in the palliative care unit. It is great to have guidelines based on our practice here in Serbia and the medications that we have available.” In particular, the section on subcutaneous infusion of medications was seen to be important as this is something that they have only just started doing, and so will be referring to the guidelines in their practice.
Dr Natasa Milicevic, National Co-ordinator for the project said: “these guidelines will help our doctors and nurses to improve their everyday practice so it is in line with international best practice.”
The guidelines will be distributed around the health centres and hospitals in Serbia, and copies will be available at the palliative care conference to be held in Belgrade on the 10th October 2014. The guidelines have been developed as part of a wider model for palliative care service delivery in the country, which has also included the development of quality indicators, instruments of use in palliative care and standards of care.
Dr Perisa Simonovic, Former State Secretary for Health said in the forward to the guidelines: “I hope that the guidelines for clinical practice in palliative care will be useful and give help in decision-making to professionals who are constantly confronted with patients who need this type of care, as well as those who only occasionally care for these patients. Therefore, I strongly recommend them.”