Updates on Palliative Medicine in the COVID-19 Era

The advances in knowledge in the field of pain medicine in the last half century have recently been reported from both the scientific and the social points of view [...]

Promoting health equity in the health-care system: How can we identify potentially vulnerable patients?

Background: There is documented social inequality in cancer. The health-care system may contribute to health equity by targeting interventions to potentially vulnerable patients who may be at risk of not receiving optimal treatment and care. Aim: This study aimed to develop and pilot test a tool to identify patients who may need additional support. Method: The study took place in a department of palliative medicine and in a team for head and neck cancer within an oncology department. The tool to identify potentially vulnerable patients was developed based on literature reviews and interviews with patients and health-care personnel. It was pilot tested in a six-month period, with subsequent interviews with health-care personnel. Results: In total, 212 consecutive patients referred to the departments were systematically screened with the tool by health-care personnel. Of these, 74 (35%) patients were considered potentially vulnerable. The most frequently reported sign of vulnerability was ‘few supportive relations’ (47% of the vulnerable patients). Most health-care personnel found it relevant to focus systematically on these patients. However, some were concerned that using the tool could prove to be stigmatising and were critical of attributing the vulnerability to the individual. Conclusions: Most patients were considered in need of additional support because they lacked a social network or had difficulties communicating with health-care personnel. Applying a tool to identify potentially vulnerable patients was feasible and increased attention to this group of patients. However, the screening procedure was also questioned.

HISTORICAL DEVELOPMENT OF PALLIATIVE ESTABLISHMENTS IN THE WORLD AND IN UKRAINE

The object of the research is centers of palliative help. The article of research is historical development of establishments of palliative medicine. Global environmental problems of today lead to increase in the incidence of population and increase in incurable cases. The problems of terminally ill patients are been dealt with by palliative medicine, which takes care of the situation of such patients and their families. The article deals with the history of development of palliative care facilities in the world - hospices. The situation of creation of such establishments in Ukraine is analyzed, which indicates the need to revise the state regulatory framework for design. The analysis conducted in the article indicates the inconsistency of the current norms and the absence of special normative bases for the design of hospices. Current situation does not allow for proper development of the construction of palliative care facilities. In addition, the main criteria and needs are discussed in the article: Physical comfort (achieved by creating a home atmosphere in the hospital) Psychological comfort (achieved using the principle of an individual approach to each patient, taking into account all their needs) Social comfort (achieved by designing places for communication with other patients, as well as with relatives and friends. It is important that such places possess and create a positive attitude and distract from negative thoughts) Visual comfort (achieved with the help of thoughtful landscaping and designing places for walks, squares, intimate areas for rest and relaxation, as well as for the hobbies of patients)

Diamorphine for pain and distress in young patients: case examples and discussion of mechanisms

Diamorphine is a strong opioid licensed in the UK for many uses, including moderate and severe pain. In the early 2000s, its use in palliative medicine was widespread before a supply disruption led to preferential use of alternative, cheaper opioids. Though these supply issues were resolved, the use of diamorphine in palliative medicine has remained reduced, particularly with another UK supply disruption in 2021. Following anecdotal reports of good results from diamorphine use in younger patients, this piece discusses two cases of young patients with metastatic cancers suffering significant pain and psychological distress. Both patients were approaching end of life and required high doses of opioids, benzodiazepines and co-analgesics, all given to limited benefit. Both patients were rotated to diamorphine giving objective and subjective improvement in symptoms. These cases are presented in the context of newer information and description of the biochemical actions of diamorphine and its metabolites, which exert their own clinical effect before themselves generating active metabolites. Various trials on, and discussion about, diamorphine’s unique metabolism and subsequent central nervous system effects help argue for its use in situations where extreme pain and psychological distress overlap.

Palliative medicine trainees be should learn about frailty: meta-synthesis and Delphi study to establish curriculum content

ObjectivesFrailty is common and highly associated with morbidity and mortality, a fact that has been highlighted by COVID-19. Understanding how to provide palliative care for frail individuals is an international priority, despite receiving limited mention in Palliative Medicine curricula or examinations worldwide. This study aimed to synthesise evidence and establish expert consensus on what should be included in a Palliative-Medicine Specialist Training Curriculum for frailty.MethodsLiterature Meta-synthesis conducted by palliative medicine, frailty and education experts produced a draft curriculum with Bologna based Learning-Outcomes. A Delphi study asked experts to rate the importance of Learning-Outcomes for specialist-training completion and propose additional Learning-Outcomes. This process was repeated until 70% consensus was achieved for over 90% of Learning-Outcomes. Experts divided Learning-Outcomes into specific (for inclusion in a frailty subsection) or generic (applicable to other palliative conditions). The Delphi panel was Subject Matter Experts: Palliative-Medicine Consultants (n=14) and Trainees (n=10), representing hospital, community, hospice and care home services and including committee members of key national training organisations. A final reviewing panel of Geriatric Medicine Specialists including experts in research methodology, national training requirements and frailty were selected.ResultsThe meta-synthesis produced 114 Learning-Outcomes. The Delphi Study and Review by Geriatric Medicine experts resulted in 46 essential and 33 desirable Learning-Outcomes.ConclusionsThis frailty curriculum is applicable internationally and highlights the complex and unique palliative needs of frail patients. Future research is required to inform implementation, educational delivery and service provision.

THE NEW MODEL OF VALUE ATTITUDE TOWARDS LIFE. HOSPICES AND RELAXING MEDICINE

This article discusses some of the philosophical issues of life and health related to hospice movement and palliative, palliative medicine. Bioethics promotes the formation of new values in social and national consciousness, it stimulates significantly the humanization of natural and social sciences, new technologies, medicine and health care, make a transition between the natural, medical, social and humanitarian knowledge, as well as to establish balance between science and morality. Bioethics as a special form of practical philosophy of life teaches that human inter-relation with his own life, the whole biosphere is not only contemplative, theoretical and emotionless, but, being a practical relation, it constantly involves a certain assessment. The philosophical analysis of the problem of euthanasia has shown that the philosophical mind of the 20–21st centuries doesn’t view death as an alien to human existence, but as an existential component of life itself. Not only the problems of life-death bordering situations are implemented philosophically, but also the existential bases of human life i.e. freedom and responsibility. Today the idea of a human’s dignified death is discussed in two directions: as an euthanasia issue and the problem of hospices. In the article an attempt was to give the palliative medicine a philosophical interpretation, the roots of which can be found the Medieval culture. On the base of the formation and development of bioethics in article is substantiated the position according to which the imperative of the contemporary human existence demands a qualitatively new approach to current complicated, global and various issues.