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Main arrow Archive of previous Issues arrow ¹3 2012 (25) arrow Organisational problems of palliative care for noncurative cancer patients at a regional level
Organisational problems of palliative care for noncurative cancer patients at a regional level Print
Monday, 02 July 2012

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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