The topicality of regulatory of general practitioners-family doctors activity regarding of palliative care patients the quality of life the determination and assessment
Keywords:palliative care, quality of life, EORTC QLQ-C30 questionnaire, patient-family-oriented approach, general practitioners-family doctors, legal framework, mobile multidisciplinary palliative care team
Background. Access to palliative care and symptom relief for patients with incurable and serious illnesses remains a pressing issue for the health systems of many countries around the world. It is estimated that more than 40 million patients with serious illnesses and life-threatening and limiting conditions require palliative care (PC) each year. Most of the patients requiring PC are at home, so PC that can alleviate most of the suffering of the patient and his family is provided by general practitioners. Settling the regulatory framework is an important factor in providing quality palliative care. The purpose of the study: to propose amendments to the regulatory documents governing the provision of palliative care to determine and assess the quality of life of patients. Materials and methods. Scientific literature, WHO documents, EORTC QLQ-C30 questionnaire and patient survey results (n = 219). We used the method of system analysis, synthesis, sociological and medical-statistical. Results. We analyzed literature sources regarding a patient-family-centered approach in the health care system. We studied the WHO recommendations for determining the quality of life (QOL) of patients. We identified a gap in the current documents regulating the provision of PC in assessing the QOL of patients. As a result of involving patients (n = 219) in self-assessment of the QOL using the EORTC QLQ-C30 questionnaire and further ensuring the subjective needs of patients, an improvement in their QOL was established. It was proposed to amend the orders of the Ministry of Health of Ukraine, regulating the provision of primary medical care and PС, in order to achieve the main goal of this type of medical care - to ensure the maximum achievable QOL. Conclusions. 1. It has been shown that the regulatory framework for the provision of PС regulates the provision of the most attainable QOL of the patient as the main goal of this type of medical care. However, the use of funds for determining the level of QOL and its components by doctors when providing PС on an outpatient basis, including at home, is not not regulated by law. 2. It has been proven that the use of the EORTC QLQ-C30 questionnaire to determine the QOL of patients receiving PС allows assessing their general and psycho-emotional state, as well as the level of the patient's functioning from his subjective point of view. This ensures the patient's partnership in a multidisciplinary team, his responsibility and participation in the treatment. At the same time, the key need of the patient to be involved in decision-making on diagnostics and the choice of treatment methods in accordance with personal beliefs and expectations is satisfied. 3. It is necessary to amend the order of the Ministry of Health of Ukraine dated 04.06.2020 No. 1308 "On improving the organization of the provision of palliative care in Ukraine" on the procedure for providing PC and the order of the Ministry of Health of Ukraine dated 03.19.2018 No. 504 "On approval of the Procedure for the provision of primary health care" according to the list medical services for the provision of primary health care in terms of using questionnaires to determine QOL and achieve the main goals of PC.
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Copyright (c) 2021 O.P. Bratsyun, O.G. Shekera, L.F. Matyukha, A.V. Tsarenko
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