ORGANIZATION ASPECTS OF THE PALLIATIVE CARE SYSTEM FOR CANCER PATIENTS BASED ON THE OPINION OF RELATIVES AND CLOSEST INCURABLE PATIENTS
neoplasms. Kazakhstan is in its infancy a palliative care service for oncology patients. The lack of rehabilitation assistance significantly worsens the quality of life of patients. In this regard, it is supposed to constantly improve the professional level of specialists in the field of rehabilitation, prevention and palliative care for patients with malignant tumors. Today, patients with malignant neoplasms undergo medical and social rehabilitation. The absence of the psychological and social aspects mentioned above also indicates that these conditions are resolved separately from medical interventions.
Aim: To analyze the organization aspects of the palliative care system for cancer patients based on the opinion of relatives and closest incurable patients
Materials and methods: Information and analytical (review of domestic and foreign literature), sociological (questioning, interviewing), statistical (data processing). The survey was carried out among relatives of sick patients. With the diagnostic purpose, according to the tasks set in the study, we surveyed 46 respondents by questioning. The survey was carried out among relatives of sick patients. For statistical processing of the obtained results, of the SPSS 20.0 statistical package was used (SPSS 20.0 for Windows, SPSS Inc., USA). The average values of the indicators (after confirming the normal distribution) were calculated using 95% confidence intervals (95% CI), in the absence of normal distribution, using the median and quartiles (Me, Q1, Q3). The nominal data are described by frequencies with an indication of the absolute values of the quantities. The critical level of significance was determined to be p = 0.05. For the analysis of nominal data used contingency tables. Differences were analyzed using the Pearson’s Chi-square test (χ2). The encoding of dichotomous signs was made in the standard way: 1 is a sign, 0 is not sign.
Research results: The average age of respondents was 41 years old (Q1 = 37 years; Me = 40 years; Q3 = 47 years). Respondents are represented by 2 age groups according to the WHO classification (2015). Persons caring for seriously ill patients are not sufficiently aware of the approaches to providing assistance to this category of patients (the majority of respondents (43.5%) believe that patients should continue to be actively treated and 6.5% of respondents believe that they need help to die ) and need to be informed about some aspects of the organization of palliative care. 1/5 of the respondents (19.6%) rated the level of palliative care as unsatisfactory.
Сonclusion: Based on the results, it is desirable that relatives who care for patients at the terminal stage of the disease receive psychological and social. assistance and have the opportunity to use various opportunities to care for such patients (volunteers, representatives of religious denominations, priests). Relatives of patients with terminal stage need support in all three aspects of palliative care. In this regard, we have introduced the elective subject “Organization of Palliative Care” to the 4th year of the faculty “Nursing” and the 5th year of the faculty “Public Health”. The work program of the discipline is approved by the protocol of educational and methodical department No. 6 of May 25 2016. Introducing an elective subject is an examination of students with the basics and organization of palliative care that they need in practical activities.
Aigerim A. Mukusheva 1, https://orcid.org/0000-0002-7046-4375
Umutzhan S. Samarova 1, http://orcid.org/0000-0003-3320-7115
Zaituna A. Khismetova 1, http://orcid.org/0000-0001-5937-3045
Alyia K. Atabayeva 1, http://orcid.org/0000-0001-7725-2255
1 Department of Public health and evidence based medicine, Semey State Medical University,
Semey city, Republic of Kazakhstan
1. Авхименко М.М. Некоторые факторы риска труда медика // Медицинская помощь. 2003. №2. С. 25-29.
2. Антипин П.А. Медицинский персонал хосписа как объект изучения влияния профессиональной деятельности на личность // Проблемы социальной гигиены, здравоохранения и истории медицины. 2006. № 4. С. 25-28.
3. Апраксина К.В. Волонтеры в хосписах // Медицинская помощь. 1996. №3. С. 19-22.
4. Арутюнов A.B. Изучение синдрома эмоционального выгорания у врачей стоматологов и методы его профилактики. Москва, 2004. 165 с.
5. Батракова Г.А. Мультипрофессиональный и мультидисциплинарный подходы организации комплекс-ной паллиативной помощи ВИЧ инфицированным больным // Матер. 44-й научно-практ. межрегионал. мед. конф. «Развитие системы здравоохранения и аспекты здорового образа жизни». Ульяновск, 2009. С. 597-600.
6. Бахтияров Р.Ш., Гнездилов A.B., Дятченко О.Т. и др. Психологические и социальные аспекты реабили-тации онкологических больных пожилого возраста // Психология зрелости и старения. 2006. №1 64-74c.
7. Биктимиров Т.З., Новиков Г.А., Модников О.П., Чиссова В.И. Национальные системы хосписов и некоторые исторические аспекты их развития. Курс лекций по паллиативной помощи онкологическим больным. Москва, 2004. Т.1. С. 34-46.
8. Биктимиров Т.З. Психоонокология. Медико-психологические и социокультурные основы психологической клиники и паллиативной медицины. Курс лекций по паллиативной помощи онкологическим больным. Москва, 2004. Т.2. С. 342 – 362.
9. Бондарь Г.В. Паллиативная медицинская помощь. Рекомендации для врачей и студентов. – Донецк, 2006. 113 с.
10. Бугорская Т.Е., Копченова A.B. Здоровье-сберегающие технологии в деятельности специалистов паллиативной помощи // Материалы межрегиональной научно-практической конференции с международным участием «Современные проблемы развития паллиативной помощи». Пермь, 2009. С. 142-145.
11. Буда Франческо. Некоторые аспекты терми-нальной фазы онкологического заболевания, а также их влияние на пациента и членов его семьи // Материалы межрегиональной научно-практической конференции с международным участием «Современные проблемы развития паллиативной помощи». Пермь, 2009. С.145-149.
12. Брюзгин В.В. Хронический болевой синдром у онкологических больных (организационно-методические аспекты). Москва, 2010. 450 с.
13. Бялик М.А. Место хосписов в системе паллиативной помощи США // Паллиативная медицина и реабилитация. 2009. №4. С. 53-57.
14. Важенин A.B, Шаназаров H.A. Оптимизация обслуживания онкологических больных на поликлиническом этапе // Паллиативная медицина и реабилитация. 2002г №3-4 46-48с.
15. Василевская И.В. «Трудная» жизнь или «легкая» смерть: нравственно-религиозные основания выбора // Биомедицинская этика: проблемы и перспективы: Матер. Междунар. Конф. Минск, 2000. 50с
16. Введенская Е.С. Паллиативная помощь и биоэтика. Медицинская сестра. 2008. №5. С. 18-20.
17. Введенская Е.С. Социально-гигиенические проблемы здоровья и адаптация лиц старшей возрастной группы Н. Новгород, 1997 20 с.
18. Воронова Е.А. Научное обоснование организации центра паллиативной помощи в условиях крупного промышленного города. Научная библиотека диссертаций и авторефератов disserсat http://www.dissercat.com/content/nauchnoe-obosnovanie-organizatsii-tsentra-palliativnoi-pomoshchi-v-usloviyakh-krupnogo-promy#ixzz5SqDJpV39 (Дата посещения: 03.10.2018г)
19. Қазақстан Республикасының денсаулық сақтау ісiн реформалау мен дамытудың 2005-2010 жылдарға арналған мемлекеттік бағдарламасы туралы (Дата обращения: 24.09.2018г)
20. Қазақстан Республикасы Үкіметінің 2012 жылғы 29 наурыздағы №366 «Қазақстан Республикасында онкологиялық көмекті дамытудың 2012-2016 жылдарға арналған бағдарламасын бекіту туралы» Қаулысы http://base.spinform.ru adilet.zan.kz/kaz/docs/P1200000366 1820 (24.09.2018г)
21. ҚР Президентінің 2010 жылғы 29 қарашадағы №1113 Жарлығымен бекітілген Қазақстан Республикасында денсаулық сақтауды дамытудың 2011 – 2015 жылдарға арналған «Саламатты Қазақстан» Мемлекеттік бағдарламасы. http://online.zakon.kz (Дата обращения: 23.09.2018г)
22. Мошою Д. Букварь по паллиативной медицине 2012. 120с.
References:
1. Avkhimenko M.M. Nekotorye faktory riska truda medika [Some of the risk factors for the work of a medic]. Meditsinskaya pomoshch [Health care] 2003. 2. pp 25-29. [in Russian]
2. Antipin P.A. Meditsinskii personal khospisa kak ob"ekt izucheniya vliyaniya professional'noi deyatel'nosti na lichnost' [Medical personnel of hospice as an object of studying the influence of professional activity on personality]. Problemy sotsial'noi gigieny, zdravookhraneniya i istorii meditsiny [Problems of social hygiene, health and history of medicine]. 2006. № 4. pp. 25-28 p. [in Russian]
3. Apraksina K.V. Volontery v khospisakh [Volunteers in Hospices]. Meditsinskaya pomoshch' [Health care]. 1996. №3. pp.19-22. [in Russian]
4. Arutyunov A.B. Izuchenie sindroma emotsional'nogo vygoraniya u vrachei stomatologov i metody ego profilaktiki [Studying the syndrome of emotional burnout in dentists and methods of its prevention]. Moskva, 2004. 165 р. [in Russian]
5. Batrakova G.A. Mul'tiprofessional'nyi i mul'tidistsiplinarnyi podkhody organizatsii kompleksnoi palliativnoi pomoshchi VICh infitsirovannym bol'nym [Multidisciplinary approaches to the organization of comprehensive palliative care for HIV-infected patients] Mater. 44-i nauchno-prakt. Mezhregional. Med. Konf. «Razvitie sistemy zdravookhraneniya i aspekty zdorovogo obraza zhizni [Materials of the 44th Scientific and Practical Interregional Medical Conference "Development of the Health Care System and Aspects of a Healthy Lifestyle] (21-22.05.2009 g.). Ul'yanovsk, 2009. pp. 597-600. [in Russian]
6. Bakhtiyarov R.Sh., Gnezdilov A.B., Dyatchenko O.T. Psikhologicheskie i sotsial'nye aspekty reabilitatsii onkologicheskikh bol'nykh pozhilogo vozrasta [Psychological and social aspects of rehabilitation of advanced age oncological patients]. Psikhologiya zrelosti i stareniya [Psychology of maturity and aging]. 2006. №1. pp. 64-74. [in Russian]
7. Biktimirov T.Z., Novikov G.A., Modnikov O.P. Chissova V.I. Natsional'nye sistemy khospisov i nekotorye istoricheskie aspekty ikh razvitiya [Psychonocology. Medico-psychological and socio-cultural foundations of the psychological clinic and palliative medicine] Kurs lektsii po palliativnoi pomoshchi onkologicheskim bol'nym [A course of lectures on palliative care for cancer patients]. Moskva, 2004. T.1. pp.34-46. [in Russian]
8. Biktimirov T.Z. Psikhoonokologiya. Mediko-psikhologicheskie i sotsiokul'turnye osnovy psikhologicheskoi kliniki i palliativnoi meditsiny [National Hospice Systems and Some Historical Aspects of Their Development] Kurs lektsii po palliativnoi pomoshchi onkologicheskim bol'nym [Course of Lectures on Palliative Care for Oncological Patients] Moskva, 2004. T.2. pp. 342 – 362. [in Russian]
9. Bondar' G.V. Palliativnaya meditsinskaya pomoshch'. Rekomendatsii dlya vrachei i studentov [Palliative care. Recommendations for doctors and students] – Donetsk, 2006. 113 p. [in Russian]
10. Bugorskaya T.E., Kopchenova A.B. Zdorov'esberegayushchie tekhnologii v deyatel'nosti spetsialistov palliativnoi pomoshchi [Health saving technologies in the activity of specialists in palliative care] Materialy mezhregional'noi nauchno-prakticheskoi konferentsii s mezhdunarodnym uchastiem «Sovremennye problemy razvitiya palliativnoi pomoshchi» [Materials of the interregional scientific and practical conference with international participation "Modern problems of palliative care]. Perm', 2009. pp. 142-145. [in Russian]
11. Buda Franchesko. Nekotorye aspekty terminal'noi fazy onkologicheskogo zabolevaniya, a takzhe ikh vliyanie na patsienta i chlenov ego sem'i [Some aspects of the terminal phase of cancer, as well as their impact on the patient and his family members]. Materialy mezhregional'noi nauchno-prakticheskoi konferentsii s mezhdunarodnym uchastiem «Sovremennye problemy razvitiya palliativnoi pomoshchi» [Materials of the interregional scientific and practical conference with international participation "Modern problems of palliative care]. Perm', 2009. pp. 145-149. [in Russian]
12. Bryuzgin V.V. Khronicheskii bolevoi sindrom u onkologicheskikh bol'nykh (organizatsionno-metodicheskie aspekty) [Chronic pain syndrome in cancer patients (organizational and methodological aspects)]. Moskva, 2010. 450 p. [in Russian]
13. Byalik M.A. Mesto khospisov v sisteme palliativnoi pomoshchi SShA [Place of hospices in the USA palliative care system] Palliativnaya meditsina i reabilitatsiya [Palliative medicine and rehabilitation]. 2009. №4. pp. 53-57. [in Russian]
14. Vazhenin A.B., Shanazarov H.A. Optimizatsiya obsluzhivaniya onkolo-gicheskikh bol'nykh na poliklinicheskom etape [Organization of palliative care in the regional institution of the oncological profile]. Palliativnaya meditsina i reabilitatsiy [Palliative medicine and reabilitation]. 2002. №3-4. pp. 46-48p. [in Russian]
15. Vasilevskaya I.V. «Trudnaya» zhizn' ili «legkaya» smert': nravstvenno-religioznye osnovaniya vybora ["Difficult" Life or "Easy" Death: Moral and Religious Foundations of Choice]. Biomeditsinskaya etika: problemy i perspektivy: Mater. Mezhdunar. Konf. [Biomedical ethics: problems and prospects: Mater. International Conf.] Minsk, 2000. 50p [in Russian]
16. Vvedenskaya E.S. Palliativnaya pomoshch' i bioetika [Palliative care and bioethics]. Meditsinskaya sestra [Nurse]. 2008. №5. pp. 18-20. [in Russian]
17. Vvedenskaya E.S. Sotsial'no-gigienicheskie problemy zdorov'ya i adaptatsiya lits starshei vozrastnoi gruppy [Socio-hygienic health problems and adaptation of older age groups]. N.Novgorod, 1997. 20p. [in Russian]
18. Voronova E.A. Nauchnoe obosnovanie organizatsii tsentra palliativnoi pomoshchi v usloviyakh krupnogo promyshlennogo goroda. Nauchnaya biblioteka dissertatsii i avtoreferatov dissercat http://www.dissercat.com/content/nauchnoe-obosnovanie-organizatsii-tsentra-palliativnoi-pomoshchi-v-usloviyakh-krupnogo-promy#ixzz5SqDJpV39 [Scientific justification of the organization of the center of palliative care in a large industrial city] (03.10.2018г) [in Russian]
19. Kazakstan Respublikasynyn densaulyk saktau іsin reformalau men damytudyn 2005-2010 zhyldarga arnalgan memlekettіk bagdarlamasy turaly [About the State Program of Health Care Reform and Development of the Republic of Kazakhstan for 2005-2010 Decree of the President of the Republic of Kazakhstan dated 13 September 2004 N 1438 http://adilet.zan.kz/eng/docs/U040001438_/links#to] (24.09.2018) [in Kazakh]
20. Kazakstan Respublikasy Ukіmetіnіn 2012 zhylgy 29 nauryzdagy №366 «Kazakstan Respublikasynda onkologiyalyk komektі damytudyn 2012-2016 zhyldarga arnalgan bagdarlamasyn bekіtu turaly» Kaulysy http:// base.spinform.ru adilet.zan.kz/kaz/docs/P1200000366 1820.[ Resolution of the Government of the Republic of Kazakhstan of March 29, 2012 № 376 "On Approval of the Program of Oncological Care Development in the Republic of Kazakhstan for 2012-2016". http: // base.spinform.ru adilet.zan.kz/eng/docs/P1200000366] (23.09.2018) [in Kazakh]
21. KR Prezidentіnіn 2010 zhylgy 29 karashadagy №1113 Zharlygymen bekіtіlgen Kazakstan Respublikasynda densaulyk saktaudy damytudyn 2011 – 2015 zhyldarga arnalgan «Salamatty Kazakstan» Memlekettіk bagdarlamasy. http://online.zakon.kz [The State Program of Health Care Development in the Republic of Kazakhstan for 2011-2015 "Salamatty Kazakhstan" approved by the Decree of the President of the Republic of Kazakhstan dated November 29 2010 №1113] (23.09.2018) [in Kazakh]
22. Moshoyu D. Bukvar' po palliativnoi meditsine [A primer on palliative medicine]. 2012. 120 p. [in Russian]
Bibliography link
Мукушева А.А., Самарова У.С., Хисметова З.А., Атабаева А.К. Организационные аспекты системы паллиативной помощи онкологическим больным на основе мнении родных и близких инкурабельных пациентов // Наука и Здравоохранение. 2018. 6 (Т.20). С. 121-130.
Mukusheva A.A., Samarova U.S., Khismetova Z.A., Atabayeva A.K. Organization aspects of the palliative care system for cancer patients based on the opinion of relatives and closest incurable patients. Nauka i Zdravookhranenie [Science & Healthcare]. 2018, (Vol.20) 6, pp. 121-130.
Мукушева А.А., Самарова У.С., Хисметова З.А., Атабаева А.К. Инкурабельді пациенттердің туыстарының пікірінің негізінде онкологиялық науқастарға паллиативті көмек жүйесін ұйымдастырудың аспектілері // Ғылым және Денсаулық сақтау. 2018. 6 (Т.20). Б. 121-130.