E.S. Vvedenskaya
Nizhny Novgorod Regional Center for AIDS Prevention and Control, Nizhny Novgorod

Summary. Progressive development of palliative treatment for incurable malignant neoplasm is strongly needed by such patients in Russia. Aim of the study: to raise certain organizational problems on this way at a regional level, as far as it concerns patients with generalized malignant neoplasm.

Main indicators of the last decade of oncologic morbidity and mortality were analyzed as concerns the region of Nizhny Novgorod, as well as Russia as a whole. These epidemiologic indicators were used for the calculation of regionally required inpatient bed fund specially designed for such palliative treatment.

Sociological survey was staged to investigate into self-evaluation of the physicians for own skills in rendering medical assistance at the terminal period of a patient’s life, as well into physicians' self-assurance in clinical decision-making. Rating of main clinical symptoms from which such patients were suffering during their last year of lifespan was determined. Main endpoints in urgent alleviation of suffering of incurable oncologic patients, as well as in rendering support for relatives were scrupulously pointed out. The main part (50%) of the interviewed physicians insisted on the desirability of experienced advice, while 32% of them expressed their definite resolution to implement such pieces of advice (in all that concerns the terminal period of lifespan of incurable oncologic patients). 98% of interviewed staff wished that issues of pain allaying (as well as certain additional problems of this carrier) were included in the learning curve of medical student. This study prompts the necessity of the development of intervention approaches and, most of all, skills and techniques for the pain allaying. Calculation of regionally required inpatient bed fund specially designed for such palliative treatment was performed for the region of Nizhny Novgorod.

This study only but confirms the rationales for the acknowledgement (for the first time in modern history) of palliative treatment as a means of medical care for the population which has been previously outlined in the Federal Law entitled: On the principles of health protection of the citizens of the Russian Federation. The latter proclaimed inclusion of palliative treatment in oncology framework of every Constituent Territory (with due control for proper execution of all Federal Orders and Recommendations); incorporation of the whole set of palliative treatment in the educational curves of the students of medical institutes, schools, and colleges; introduction of medical standards for palliative treatment with due locally organized control for it; qualification of general practitioners for the special skills and knowledge in the techniques of pain allaying and measures for other health phenomena at the terminal stage of lifespan of incurable patients in outpatient setting; provision of outpatient settings with sufficient opioid  intake doses and transdermal analgesics; obligatory certification of physicians and nurses for palliative treatment that are employed in the healthcare settings specially designed for it (hospices including).

Keywords. Palliative care, cancer, malignant neoplasms, mortality, end-of-life care, pain control, physicians’ competences in end-of-life care.

References

1. Dolgova S.V., Denisenko A.N. Zabolevayemost zlokachestvennymi novoobrazovaniyami v Nizhegorodskoy oblasti. Sostoyaniye onkologicheskoy sluzhby i puti eye uluchsheniya [Malignant tumors morbidity in Nizhni Novgorod region. The state of oncologic service and ways for its improving]. Meditsinskiy almanakh 2010;(3):42-45.
2. Chissov V.I., Starinskiy V.V., Kovalev B.N., Novikov G.A. Mediko-statisticheskiye predposylki sovershenstvovaniya palliativnoy pomoshchi onkologicheskim bolnym [Health and statistical preconditions for advancing palliative care to oncologic patients] Palliativnaya meditsina i reabilitatsiya 2001;(2-3):8-11.
3. Ekkert N.V., Novikov G.A., Khetagurova A.K., Sharafutdinov M.G. Metodicheskiye rekomendatsii po organizatsii palliativnoy pomoshchi [Methodical recommendation on organization of palliative care]. Moscow: MMA im. I.M. Sechenova; 2008. 58 p.
4. Natsionalnaya onkologicheskaya programma «Meropriyatiya po sovershenstvovaniyu meditsinskoy pomoshchi onkologicheskim bolnym» [“Measure on development of medical care to oncologic patients” National Oncologic Program]. [Internet] [cited 2011 Oct 01]. Available from: http://www.minzdravsoc.ru/health/oncology/11
5. Osipova N. A., Abuzarova G. R. Lecheniye khronicheskoy boli u inkurabelnykh onkologicheskikh bolnykh v domashnikh usloviyakh [Treatment of chronic pains in incurable oncologic patients at home]. Vrach 2002;(4):7-9.
6. Osnovnyye pokazateli zdorovya naseleniya i deyatelnosti uchrezhdeniy zdravookhraneniya Nizhegorodskoy oblasti za 2010 god: Statisticheskiy sbornik [Basic indicators of population health and activity of healthcare facilities in Nizhni Novgorod region in 2010]. Nizhniy Novgorod: Ministerstvo zdravookhraneniya Nizhegorodskoy oblasti. GUZ NO «MIATs»; 2011. P. 59-62.
7. Prikaz Ministerstva zdravookhraneniya RSFSR ot 01.02.1991 g. ¹ 19 «Ob organizatsii domov sestrinskogo ukhoda, khospisov i otdeleniy sestrinskogo ukhoda mnogoprofilnykh i spetsializirovannykh bolnits» [“On organization of nursing homes, hospices, and nursing units in multi-field and specialized hospitals”, Order of the MH&SD of the RF ¹ 19 of 01.12.1991]. [Internet] [cited 2012 Jun 05]. Available from: http://www.bestpravo.ru/sssr/eh-zakony/s8w.htm
8. Prikaz Minzdravsotsrazvitiya RF ¹ 944n ot 03.12.2009 g. «Ob utverzhdenii Poryadka okazaniya meditsinskoy pomoshchi naseleniyu pri onkologicheskikh zabolevaniyakh» [“On approving the Order of delivering medical care to population with oncologic diseases”, Order of the MoH&SD of the RF ¹ 944í of 03.12.2009]. [Internet] [cited 2011 Oct 01]. Available from: http://www.minzdravsoc.ru/docs/mzsr/orders/973
9. Rekomendatsii Rec. (2003) 24 Komiteta ministrov Soveta Yevropy gosudarstvam-uchastnikam po organizatsii palliativnoy pomoshchi [Recommendations Rec. (2003) 24 of the Committee of Ministers of the Council of Europe to the member-states on organization of palliative care]. Moscow: Meditsina za kachestvo zhizni; 2005. 30 p. [Internet] [cited 2011 Oct 01]. Available from: http://pallcare.ru/ru/images/user/Ryskversion3.pdf
10. Sostoyaniye onkologicheskoy pomoshchi naseleniyu Rossii v 2010 godu [Oncologic care to population of Russia in 2010]. Editors V.I. Chissov, V.V. Starinskiy, G.V. Petrova. Moscow: FGU «MNIOI im. P.A. Gertsena»; 2011. 188 p.
11. Usenko O. I. Organizatsionnyye problemy okazaniya palliativnoy pomoshchi v Rossii [Organizational problems in delivering palliative care in Russia]. [Internet] [cited 2011 Oct 01]. Available from: http://hospiceday.ru/index18.php
12. Federalnyy zakon Rossiyskoy Federatsii ot 21 noyabrya 2011 g. ¹323-FZ «Ob osnovakh okhrany zdorovya grazhdan v Rossiyskoy Federatsii» [“On the basis of population health protection in the Russian Federation”, the Federal Regulation of the Russian Federation of 2011, November 21 ¹323-ÔÇ]. [Internet] [cited 2012 Feb 09]. Available from: http://www.minzdravsoc.ru/docs/laws/104
13. Ekkert N.V. Sovremennyye problemy palliativnoy pomoshchi [The present-day problems of palliative care]. Problemy sotsialnoy gigiyeny, zdravookhraneniya i istorii meditsiny 2007;(5):25-28.
14. Weissman DE, Ambuel B, Norton AJ, Wang-Cheng R, Schiedermayer D. A survey of competencies and concerns in end-of-life care for physician trainees. J Pain Symptom Manage 1998 Feb;15(2):82-90.
15. Higginson IJ. Health care needs assessment: palliative and terminal care. In: Stevens A, Raftery J, editors. Health Care Needs Assessment. Oxford: Radcliffe Medical Press; 1997:183−260.
16. Oxford Textbook of Palliative Medicine. Ed. by Geoffrey Hanks, Nathan I. Cherny, Nicholas A. Christakis, Marie Fallon, Stein Kaasa, and Russell K. Portenoy. Oxford: Oxford University Press; 2011: 587-1093.
17. Palliative Care. (Cancer control: knowledge into action: WHO guide for effective programmes; module 5). World Health Organization, 2007, 43 p.
18. Palliative Care. The Solid Facts (edited by Elizabeth Davies and Irene J Higginson). WHO. 2004:12-13.
19. Sepulveda C., Marlin A., Yoshida T., Ullrich A. Palliative Care: The World Health Organization’s Global Perspective. Journal of Pain and Symptom Management 2002;24:91-96.
20. Urska Lunder, Branka Cerv. Slovenia: Status of Palliative Care and Pain Relief. Journal of Pain and Symptom Management 2002 August;24(2):233-235.
21. Walsh D, Donnelly S, Rybicki L. Support Care Cancer 2000;8:175-17.
22. World Health Organization. National cancer control programmes: policies and managerial guidelines, 2^nd ed. Geneva: World Health Organization, 2002:15-17.

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