2018; Volume 19, No 11, November
Introducing... Siun Sote
The staff at Siun Sote Palliative Care Center in Finland.
One of Finland’s Newest Palliative Care Centers Aims High
Palliative care services are at their best when tailored to the people and the communities they serve, and this is evident in every aspect of the care provided by the newly-established Siun Sote Palliative Care Center in Finland.
The center is a tax-funded organization that delivers both inpatient and outpatient palliative care and end-of-life care, including specialist services.
Reaching beyond the tip of the iceberg
Thank-you card from a young patient.
‘We believe that physical symptoms are only a “tip of the iceberg” and we must be able to deal with the mental and social aspects of suffering and dying as well,’ says Dr. Minna Kiljunen, one of Siun Sote’s palliative consultant physicians who also works as a senior emergency physician in North Karelian Central Hospital. ‘Multi-professional teamwork is the key to success, and we are constantly trying to think “outside the box” and enable as many ways as possible to make the patients and their loved ones feel safe and cared for.’
Here are a few ways in which Siun Sote achieves those goals:
- Subcutaneus infusions via patient-controlled analgesia (PCA) pumps are widely used in both in- and outpatient settings. Safe and easy to program, the pumps have replaced traditional subcutaneous syringe drivers in Finland.
- Palliative physicians on site perform the most common palliative procedures (peritoneal and pleural fluid drainage, PleurX- drainage catheter insertions, etc.) using an ultrasound probe that connects to any electronic device. For patients too ill to travel, some procedures (i.e., ascites drainage) have been done at home.
- A sauna is part of the inpatient unit. In Finland saunas are a necessity, a place for physical and mental relaxation.
- One doctor is attending an acupuncture course to learn supportive methods to relieve symptoms, such as nausea and pain.
Most Finnish palliative care patients wish to stay at home as long as possible; many wish to die at home. Geographically, the rural North Karelia region that Siun Sote serves is challenging. Distances can be long and stressful for the often symptomatic patient.
At-home drugs and procedures
‘Most modern palliative symptom-relieving drugs and procedures (stents, nerve blocks, palliative radiation therapy, etc.) are available in Finland and we use them liberally to make patients feel better and support their normal life at home as long as possible,’ says Kiljunen. ‘We believe that all people regardless of their terminal diagnosis or place of residence are entitled to receive high-quality palliative care and end-of-life care.’
The Siun Sote Palliative Care Center, located in the city of Joensuu, consists of:
Paramedics are a key component of services necessary for the region Siun Sote serves.
- an outpatient clinic
- hospice at-home services (24/7 within Joensuu)
- consultation services
- a 16-bed inpatient unit with specialist care
The Centre is a hub that also:
- offers palliative consultation services to all levels of health and social care in North Karelia
- organizes continuous education and training for local professionals
- works in close cooperation with the local teaching hospital, urban and rural health care centers, paramedics, and residential care services.
Pressure to prove every penny well spent
‘In Finland, the cost of health care is rising and we must constantly show that the work we do and the care we provide is worthwhile and “a euro well spent.” This is not always easy.’ Demographics indicate that North Karelia’s older population is growing. ‘The EduPal-project will hopefully promote the future health care professionals’ knowledge and competence to deal with these growing needs.’
Lake Pielinen in North Karelia, where Siun Sote Palliative Care Center is located.
EduPal is a country-wide initiative to study palliative nursing and medicine education, establish competencies, foster multidisciplinary links, and create a national recommendation to include basic palliative care in undergraduate nursing and medical programs, as well as a specialist program. The aim is to achieve a national, multidisciplinary network of palliative care experts, educators, and researchers.
Extra layer of paramedic support
Thanks to a previous project, PALETTI, trained paramedics offer an extra layer of 24/7 support to local district nurses and other carers. Dr. Leena Surakka, chief physician at Siun Sote Palliative Care Center and the inventor of the PALETTI protocols, is preparing her PhD thesis on the experiences and costs of the emergency care and end-of-life care given at home by paramedics.
Raising awareness is necessary
More public education, however, remains to be done. ‘In Finland,’ says Kiljunen, ‘it is important to raise awareness of advance care planning, palliative care, and end-of-life care issues in the general population.’