Abstract
The objective of the research was to study the opinion of severely ill patients regarding some aspects of providing palliative care to determine the direction of its improvement.
Materials and methods. The sociological survey was performed by interviewing 146 severely ill patients treated in different in-patient health care facilities in Ivano-Frankivsk. The calculation of each factor rates per 100 respondents, the standard error of rates, and Chi-Square Test (χ2) for comparing group differences were used for statistical data analysis.
Results. Most respondents (66.4%) have been ill for several years. Throughout the year, every tenth patient (10.6%) was hospitalized more than four times. Only 49.4% of patients were admitted to the hospital with the referral from physicians. Every fifth respondent (20.5%) was delivered to the hospital by an ambulance, others (17.9%) – by self-referral. Fewer than half of respondents confirmed that their opinion was considered when choosing a medical facility (42.0%), physician (41.3%), place for care (31.9%) and methods of treatment (23.9%). The level of deontological and legal needs of incurably ill patients was found to be 2-6 times higher than the degree of their satisfaction.
Conclusions. High multiplicity of inpatient cases among palliative patients and the importance of improving the criteria and ways of their hospitalization were determined considering the high proportion of their hospitalization by emergency medical services and self-referral. The necessity of developing the standards of palliative care for patients and their families at the level of primary medical care was shown.
References
Hubskyi YuI, Tsarenko AV. Paliatyvna dopomoha ta eutanaziia: medyko-sotsialni, bioetychni, pravovi aspekty. Zdorovia suspilstva. 2017;69(1-2):87-97.
Review of Liverpool Care Pathway for the dying patient. Report on the use and experience of the Liverpool Care Pathway (LCP). Available from: https://www.gov.uk/government/publications/review-of-liverpool-care-pathway-for-dying-patients
Ruijs CD, Kerkhof AJ, van der Wal G, Onwuteaka-Philipsen BD. Symptoms, unbearability and the nature of suffering in terminal cancer patients dying at home: a prospective primary care study. BMC Fam Pract. 2013;14:201. DOI: https://doi.org/10.1186/1471-2296-14-201
Detsyk OZ, Zolotarova J. Medical and social peculiarities of incurable patients as objects of palliative and hospice care. Pharm Innov. 2014;2(1):91-96.
Kniazevych VM. Perspektyvy rozvytku paliatyvnoii dopomohy v Ukraiini. Reabilitatsiia ta paliatyvna medytsyna. 2015;2:131-134.
Forthofer RN, Lee ES, Hernandez M. Biostatistics: A Guide to Design, Analysis, and Discovery. Amsterdam: Elsevier Academic Press; c2007. 502p.
Voronenko YuV, Hubskyi YuI, Tsarenko AV. Creating of the hospice and palliative care system in the conditions of health care reform in ukraine: medical and social aspects. Nauka i praktyka. 2014;1(2):63-75. [published in Ukrainian]
Zhabo TV. Dynamika invalidnosti vnaslidok onkozakhvoriuvan pratsezdatnoho naselennia. Svit medytsyny i biolohii. 2014;2(44):33-36.
Simon ST, Pralong A, Welling U, Voltz R. Healthcare structures in palliative care medicine: Flowchart for patients with incurable cancer. Internist (Berl). 2016;57(10):953-958 [published in German] DOI: https://doi.org/10.1007/s00108-016-0127-6
Nauck F, Alt-Epping B, Benze G. The current situation of palliative medicine in Germany - clinical implications, education and research. Anasthesiol Intensivmed Notfallmed Schmerzther. 2015; 50(1):36-46. [published in German] DOI: https://doi.org/10.1055/s-0040-100205
Shin JA, Parkes A, El-Jawahri A, Traeger L, Knight H, Gallagher ER et al. Retrospective evaluation of palliative care and hospice utilization in hospitalized patients with metastatic breast cancer. Palliat Med. 2016;30(9):854-861. DOI: https://doi.org/10.1177/0269216316637238
Handley NR, Schuchter LM, Bekelman JE. Best Practice for Reducing Unplanned Acute Care for Patients with Cancer. J Oncol Pract. 2018;14(5):306-313. DOI: https://doi.org/10.1200/JOP.17.00081
Detsyk OZ, Melnyk RM, Pokhmurskyi VV. Legal basis of emergency medical care in Ukraine and Poland: similarities and differences. Ekonomika i pravo systemy okhorony zdorovia. 2015;1(1):58-63 [published in Ukrainian]
Ramanayake RP, Dilanka GV, Premasiri LW. Palliative care; role of family physicians. J Family Med Prim Care. 2016;5(2):234-237. DOI: https://doi.org/10.4103/2249-4863.192356
Nowels D, Jones J, Nowels CT, Matlock D. Perspectives of Primary Care Providers Toward Palliative Care for Their Patients. J Am Board Fam Med. 2016;29(6):748-758. DOI: https://doi.org/10.3122/jabfm.2016.06.160054
Skelton L. Ethical Theories and Perspectives on End-of-Life Decisions. Dialogue & Nexus. 2016;4:1-7.
Hadders H, Paulsen B, Fougner V. Relatives' participation at the time of death: Standardisation in pre and post-mortem care in palliative medical unit. Europ J Oncol Nurs. 2014;18(2):159-166. DOI: https://doi.org/10.1016/j.ejon.2013.11.004
Aoun S, Slatyer S, Deas K, Nekolaichuk C. Family Caregiver Participation in Palliative Care Research: Challenging the Myth. J Pain Symptom Manage. 2017;53(5):851-861. DOI: https://doi.org/10.1016/j.jpainsymman.2016.12.327
Recommendations of the European Association for Palliative Care for the Development of Postgraduate Curricula leading to Certification in Palliative Medicine. c2009. 24p. Available from: http://www.eapcnet.eu/LinkClick.aspx?fileticket=2DHXbM1zaMI%3D
Recommendations of the European Association for Palliative Care (EAPC) For the Development of Undergraduate Curricula in Palliative Medicine At European Medical Schools: report of the EAPC Steering Group on Medical Education and Training in Palliative Care. c2013. 24p. Available from: http://www.eapcnet.eu/LinkClick.aspx?fileticket=S1MI-tuIutQ%3D
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.