Andorra's SAAS Palliative Care Unit Enhances End-of-Life Quality

The palliative care unit at Andorra's SAAS hospital provides comprehensive support to patients facing incurable illnesses, focusing on improving quality of life through a multidisciplinary approach that addresses physical, emotional, social, and spiritual needs.

Dr. Marc Pascual, the unit's coordinator, explained that the team's goal is to help patients live their remaining time as fully as possible. "We accompany them," he said, emphasizing that palliative care aims to alleviate suffering rather than cure the underlying disease, which is typically managed by specialists like oncologists. Nurse Zoe Lamprill echoed this, noting the importance of supporting not just the patient but also their families during difficult periods.

The core team includes a doctor, nurse, psychologist, and social worker, with additional experts such as physiotherapists or nutritionists brought in as needed. Every patient receives care from all four primary professionals, tailored to their individual circumstances. While most cases involve chronic or advanced conditions, the unit does not treat very elderly patients with incurable illnesses, who are handled in other hospital departments.

Annually, the unit cares for around 130 patients, with 85% suffering from cancer and the remainder facing degenerative or neurodegenerative diseases, including younger adults in their 50s and 60s. Patients span all ages, and every few days, the team experiences a patient's passing. Between 10% and 20% prefer to die at home when feasible, with staff providing home visits and telephone support.

Pascual and Lamprill stressed the value of open information and shared decision-making, a shift from past paternalistic models. They noted a lingering "pact of silence" around death, despite progress, with some patients or families avoiding full details of diagnoses. Around 400 advance directive documents are registered with the Ministry of Health, aiding dignified end-of-life choices.

The pair spoke candidly about death as a natural process, acknowledging its fear factor. Lamprill highlighted psychological and spiritual aspects alongside physical pain, while Pascual focused on ensuring the best possible conditions: "We know the illness will lead to death, but we fight for it to happen in the optimal way." Their work empowers patients to guide decisions on treatments, equipment, or life prolongation, fostering dignity even amid profound loss.