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.
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