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Determining the quality of life of palliative patients is an important indicator of patients' assessment of the quality of medical care in hospice institutions of Ukraine during the change of the palliative and hospice care financing system with the transition to package financing of medical services by the National Health Service of Ukraine under the medical guarantee program. But the standard SF-36 quality-of-life questionnaire contains a number of inappropriate questions about the physical condition of patients that do not correspond to their mobility limitations due to the severity of the disease. Therefore, the SF-36 questionnaire was modified by us while preserving the qualitative weight of the questions. We started determining the quality of life of palliative patients in the patients of the Communal Non-Profit Enterprise of the Kharkiv Regional Council "Regional Center of Palliative Medicine "Hospice" (hereinafter – Kharkiv Hospice) in 2022. The number of surveyed patients in departments of neurological and oncologic profiles did not correspond to the minimum representative number. The minimum required number of patients with an oncological profile treated in the Kharkiv hospice during 2022–2023 was determined by the method of calculating the median of the binomial distribution of the sample to ensure the representativeness of the study. The sample of patients was subjected to randomization, which increased the reliability of the study to a calculatedly proven high level. The minimum required number of patients was 31 people, each of whom had been under treatment for 3–7 months since the first survey. The article also shows the algorithm for modifying the questionnaire depending on the need to change the qualitative weight of the questions. It was concluded that it is necessary to continue the study of the quality of life of palliative oncology patients in the Kharkiv Hospice. Keywords: quality of life, palliative and hospice care, modification of questionnaires, qualimetry.
Determining the quality of life of palliative patients is an important indicator of patients' assessment of the quality of medical care in hospice institutions of Ukraine during the change of the palliative and hospice care financing system with the transition to package financing of medical services by the National Health Service of Ukraine under the medical guarantee program. But the standard SF-36 quality-of-life questionnaire contains a number of inappropriate questions about the physical condition of patients that do not correspond to their mobility limitations due to the severity of the disease. Therefore, the SF-36 questionnaire was modified by us while preserving the qualitative weight of the questions. We started determining the quality of life of palliative patients in the patients of the Communal Non-Profit Enterprise of the Kharkiv Regional Council "Regional Center of Palliative Medicine "Hospice" (hereinafter – Kharkiv Hospice) in 2022. The number of surveyed patients in departments of neurological and oncologic profiles did not correspond to the minimum representative number. The minimum required number of patients with an oncological profile treated in the Kharkiv hospice during 2022–2023 was determined by the method of calculating the median of the binomial distribution of the sample to ensure the representativeness of the study. The sample of patients was subjected to randomization, which increased the reliability of the study to a calculatedly proven high level. The minimum required number of patients was 31 people, each of whom had been under treatment for 3–7 months since the first survey. The article also shows the algorithm for modifying the questionnaire depending on the need to change the qualitative weight of the questions. It was concluded that it is necessary to continue the study of the quality of life of palliative oncology patients in the Kharkiv Hospice. Keywords: quality of life, palliative and hospice care, modification of questionnaires, qualimetry.
Background. Palliative and Hospice Care (PHC) aims to prevent premature death of patients from complications of serious illnesses and their comorbid impact on vital functions. As well as adequate pain relief, treatment should be aimed at alleviating suffering and improving the quality of life of such patients. The causes of death of palliative patients, which are closely related to the PHC organization, in particular to the package budget financing of inpatient and mobile palliative care for adults and children, the leading needs of palliative patients, remain insufficiently studied. Aim. Analysis of the main causes of death of palliative patients depending on the diagnosis and determination of their impact on the organization of palliative and hospice care. Materials and Methods. The method of system analysis, comparative method and bibliosemantic method were used for the research. Results and Conclusions. Causes of death were studied for diseases listed as palliative in severe cases and in the presence of complications. The analysis allows us to deepen our understanding of the practical aspects of organizing palliative and hospice care in meeting the needs of palliative patients, adults and children. The summary of the causes of death allows us to group these causes into organ and system failure; vascular crises; asphyxia; thromboembolic conditions; infectious complications up to sepsis; chronic intoxication; tumor growth in other organs with disruption of their vital functions, metastasis; malignancy of benign tumors; complications of treatment; brain and spinal cord lesions due to epileptic seizures, injuries, inflammatory processes; endocrine comas; gangrene and bedsores; severe immunodeficiency; underdevelopment or absence of organs in congenital malformations; prematurity; suicides in depressive states. Keywords: palliative and hospice care, primary palliative diagnosis, comorbidity.
In press This short scientific report reveals important aspects of palliative medicine use of narcotic and non-narcotic analgesics, antidepressants, and anticonvulsants. Specific indications and restrictions on their use, routes of drug administration (oral, intravenous, intramuscular, subcutaneous, transdermal, intrarectal) are defined. The issues of monitoring the dosage of narcotic painkillers by medical personnel and patients themselves, the administration of bolus doses, and the medical equipment necessary for this were discussed. Special attention is paid to such pharmaceuticals as morphine, oxycodone, buprenorphine, butorphanol, morphine. The study of pathogenesis, clinical manifestations, diagnostic methods and the arsenal of therapeutic agents for overcoming acute and chronic pain in palliative patients is important for the organization of hospice and palliative care (HPC). Different types of pain are described depending on the nosological forms, individual sensitivity to pain, sensitization to pain, ways of transmitting the pain signal from the peripheral to the central part of the nervous system, humoral mechanisms of increasing and decreasing the sensation of pain, pain assessment on the Visual Analogue Scale. The need for organizational solutions to improve the situation with analgesia in Ukrainian palliative and hospice institutions, in particular to increase the availability of effective analgesia for palliative patients, was identified. Improving the situation with pain relief corresponds to the national strategy of Ukraine for the development of the HPC system. The report makes a comparison with the development of such a system in Great Britain on the way to one of the best systems of medical care for palliative patients, and on the basis of the futuristic development models described in the literature, it is assumed that Ukraine is on a similar path. Keywords: nociception, somatic pain, visceral pain, neuropathic pain, narcotic analgesics, non-narcotic analgesics.
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