The importance of international definitions, approaches and standards for the optimization of palliative care in Ukraine
Keywords:palliative care, hospice care, system of palliative and hospice care, palliative patients, multidisciplinary and intersectoral approach, palliative and hospice care model, specialized palliative care, palliative care multidisciplinary outreach team
AbstractBaskground. The analysis of medical and statistical data сoncerning the development of a medical and demographic situation in the world and in Ukraine, scientific literature, normative legal documents of Ukraine and authoritative international organizations shows the rapid aging of population, the spread of morbidity and mortality from chronic non-infectious and infectious diseases, low availability of palliative and hospice care (PHC) for the population in Ukraine. Objective: to determine the best models for the PHC in Ukraine based on a medical and social analysis of current international definitions, approaches and standards of palliative care. Materials and methods. The legal documents of international organizations and Ukraine, informational and analytical materials of activities of palliative and hospice care institutions, statistic data and scientific literature were used. Common methods were used. Results. A comparative analysis of the normative legal documents of Ukraine and authoritative international organizations shows that the definition of palliative care in the Ukrainian legislation is somewhat inconsistent with modern international practice; in accordance with the legal and regulatory framework of Ukraine, the definition of palliative care is a kind of medical care and relates only to terminally ill patients with predicted (limited) longevity and their family members, while World Health Organization (WHO) defines palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness. Of course, such approach greatly expands the cohort of patients and increases the need for PHC. Medico-statistical data testify to the rapid aging of the population in Ukraine and in the world, the spread of mortality from life-threatening and incurable diseases, in particular from cancer and chronic non-infectious and infectious diseases, low availability of palliative care for the population. The article substantiates multidisciplinary and intersectoral model of the palliative care in in-patient and out-patient settings, including home care, the conditions for the creation and implementation of affordable, high-quality and efficient palliative care system in Ukraine. The authors demonstrate the importance and implications of a strategy of PHC development in Ukraine based on internationally recognized definitions, and discuss possible models and levels of PHC integration in health care practice. Conclusions. According to the WHO definition, palliative care is an approach that can improve the quality of life of patients (children and adults) and their families facing with life-threatening illnesses that significantly expands the cohort of patients and increases the need for PHC. Now, PHC is a modern multidisciplinary patient-family-oriented approach that most adequately provides the needs and quality of life of palliative patients and their families, promotes the protection of rights and the preservation of the human dignity of the severely ill persons, including incurable patients with limited life expectancy. A comparative analysis of the normative legal documents of Ukraine and authoritative international organizations shows that the definition of palliative care in Ukrainian legislation is not entirely consistent with current international practice, because in Ukraine, palliative care is a kind of medical care and applies only to incurable patients with a limited prognosis of a life length and members of their families. The government officials, politicians, PHC specialists, human rights defenders and public organizations representatives should take responsibility for the creation and implementation of an innovative approach — an affordable, high-quality, and efficient PHC system for the population and optimization of regulatory documents in accordance with international approaches and standards in the context of reforming the public health system in Ukraine. PHC service, based on international standards and approaches, should become an integral part of the health care system and social protection for Ukraine population.
ВОЗ. Укрепление паллиативной медицинской помощи в качестве одного из компонентов комплексного лечения на протяжении всего жизненного цикла // Доклад Секретариата 134-й сессии Исполнительного Комитета ВОЗ. EB134/28. 20 декабря 2013 г. — 9 с. — [Електронний ресурс]. — Режим доступа: http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_28-ru.pdf.
ВОЗ. Укрепление паллиативной медицинской помощи в качестве одного из компонентов комплексного лечения на протяжении всего жизненного цикла // Резолюция 67-й сессии Всемирной ассамблеи здравоохранения, WHA 67.19, 24 мая 2014 г. — 7 с. — [Електронний ресурс]. — Режим доступа: http://apps.who.int/medicinedocs/documents/s21454ru/s21454ru.pdf.
ВОЗ. Паллиативная медицинская помощь. Информационный бюллетень №°402. Июль 2015 г. — [Електронний ресурс]. — Режим доступа: http://www.who.int/mediacentre/factsheets/fs402/ru/.
WHO. National cancer control programmes: policies and managerial guidelines. // 2-nd ed. — Geneva: World Health Organization; 2002. — P. 83. — [Електронний ресурс]. — Режим доступа: http://www.who.int/cancer/media/en/408.pdf.
ВОЗ. Паллиативная помощь. — [Електронний ресурс]. — Режим доступа: http://www.who.int/cancer/palliative/ru/.
Закон України «Основи законодавства України про охорону здоров’я» від 19.11.1992 р. № 2801-XII зі змінами і доповненнями. — [Електронний ресурс]. — Режим доступу: http://zakon5.rada.gov.ua/laws/show/2801-12.
Наказ МОЗ України від 21.01.2013 р. № 41 «Про організацію паліативної допомоги в Україні». — [Електронний ресурс]. — Режим доступу: http://moz.gov.ua/ua/portal/dn_20130121_0041.html.
Наказ Міністерства соціальної політики України від 29.01.2016 р. № 58 «Про затвердження Державного стандарту паліативного догляду» (зареєстрований в Міністерстві юстиції України 17 лютого 2016 р. за № 247/28377). — [Електронний ресурс]. — Режим доступу: http://zakon2.rada.gov.ua/laws/show/z0247-16.
Copyright (c) 2018 Health of Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.