Palliatiivisen lääketieteen opetus lääketieteen kandidaattien arvioimana

Lähtökohdat Palliatiivinen lääketiede on lääkärin ydinosaamista, mutta alan professuuri ja opetussuunnitelma ovat vain Helsingin ja Tampereen yliopistoissa. Menetelmät Lukuvuonna 2018–2019 kaikissa Suomen lääketieteellisissä tiedekunnissa kysyttiin kysely­lomakkeella valmistuvien kandidaattien näkemyksiä palliatiivisen lääketieteen opetuksesta. Tulokset Vastaajista (n = 502) lähes kaikki (98 %) pitivät palliatiivisen lääketieteen opetusta hyödyllisenä. Opetus oli kattanut parhaiten kivun hoidon, heikoimmin psyykkiset oireet ja psykososiaalisen tuen. Lisäopetusta olisi kaivattu eniten hoitolinjauksista ja psykososiaalisista seikoista. Tampereen ja Helsingin yliopistojen vastaajat kokivat opetuksen kattaneen paremmin lähes kaikki osa-alueet verrattuna muiden yliopistojen vastaajiin. Helsingin ja Tampereen opiskelijoista 80–90 % kertoi kohdanneensa saattohoitopotilaan opetuksessa, kun muista näin arvioi noin kolmannes. Avoimissa vastauksissa korostui tarve opetukseen ennen ensimmäisiä lääkärin työtehtäviä. Päätelmät Kokemukset palliatiivisen lääketieteen opetuksesta vaihtelivat yliopistojen välillä. Valtakunnallisen palliatiivisen lääketieteen opetussuunnitelman käyttöönotto on tarpeen.</p

Palliatiivisen lääketieteen opetus lääketieteen kandidaattien arvioimana

Vertaisarvioitu. English summary.Lähtökohdat : Palliatiivinen lääketiede on lääkärin ydinosaamista, mutta alan professuuri ja opetussuunnitelma ovat vain Helsingin ja Tampereen yliopistoissa. Menetelmät : Lukuvuonna 2018–2019 kaikissa Suomen lääketieteellisissä tiedekunnissa kysyttiin kysely¬lomakkeella valmistuvien kandidaattien näkemyksiä palliatiivisen lääketieteen opetuksesta. Tulokset : Vastaajista (n = 502) lähes kaikki (98 %) pitivät palliatiivisen lääketieteen opetusta hyödyllisenä. Opetus oli kattanut parhaiten kivun hoidon, heikoimmin psyykkiset oireet ja psykososiaalisen tuen. Lisäopetusta olisi kaivattu eniten hoitolinjauksista ja psykososiaalisista seikoista. Tampereen ja Helsingin yliopistojen vastaajat kokivat opetuksen kattaneen paremmin lähes kaikki osa-alueet verrattuna muiden yliopistojen vastaajiin. Helsingin ja Tampereen opiskelijoista 80–90 % kertoi kohdanneensa saattohoitopotilaan opetuksessa, kun muista näin arvioi noin kolmannes. Avoimissa vastauksissa korostui tarve opetukseen ennen ensimmäisiä lääkärin työtehtäviä. Päätelmät : Kokemukset palliatiivisen lääketieteen opetuksesta vaihtelivat yliopistojen välillä. Valtakunnallisen palliatiivisen lääketieteen opetussuunnitelman käyttöönotto on tarpeen.Peer reviewe

Palliatiivisen lääketieteen perusopetus : Suositus opetussuunnitelmasta yliopistojen lääketieteellisissä tiedekunnissa

Palliatiivisen hoitotyön ja lääketieteen koulutuksen monialainen ja työelämälähtöinen kehittäminen (EduPal)-hanke on opetus- ja kulttuuriministeriön (OKM) rahoittama korkeakoulutuksen kehittämisen kärkihanke. Hankekonsortioon kuuluvat kaikki Suomen lääketieteelliset tiedekunnat. Hankkeen asiantuntijaryhmä on laatinut tämän valtakunnallisen suosituksen palliatiivisen lääketieteen opetussuunnitelmasta lääketieteen lisensiaatin tutkintoon johtavassa perusopetuksessa. Opetussuunnitelman tavoitteena on yhdenmukaistaa lääketieteen lisensiaatin tutkinnon suorittaneiden suomalaisten lääkäreiden palliatiivisen hoidon osaaminen. Opetussuunnitelman laajuus on 3 opintopistettä (81 tuntia) jaettuna erikseen kontaktiopetustunteihin ja muuhun opiskeluun. Tuntimäärät on jaettu aihealueittain. Eri aihealueiden yksityiskohtaisten sisältöjen ja osaamistavoitteiden keskeisyys on määritelty kolmiportaisesti. Suunnitelmassa on myös esitetty sisältöjen ajoitus lääketieteen lisensiaatin opetusohjelmassa, palliatiivisen lääketieteen integraatio eri oppiaineiden opetukseen, opetusmenetelmät ja arviointi

Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital : a historic cohort study

Background: To avoid aggressive treatments at the end-of-life and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative goal of the treatment in time. This single center study assesses the practices used to make the decision that leads to treatment with a palliative goal, i.e., the PC decision and its effect on anti-cancer treatments at the end of life. Material and methods: Patients with a cancer diagnosis treated in tertiary hospital during 1st January 2013 - 31st December 2014 and deceased by the end of 2014 were identified in the hospital database (N = 2737). Of these patients, 992 were randomly selected for this study. The PC decision was screened from patient records, i.e., termination of cancer-specific treatments and a focus on symptom-centered PC. Results: The PC decision was defined in 82% of the patients during the last year of life (49% >30 days and 33%Peer reviewe

The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death : a retrospective cohort study

Background In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death. Methods A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 -Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death. Results A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and <14 days 10%). The number of ED visits and inpatient days were highest for patients with no PC decision and lowest for patients with both a PC decision and an PC unit appointment (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p <0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and an appointment to a PC unit). Conclusions The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.Peer reviewe

Spiritual well-being correlates with quality of life of both cancer and non-cancer patients in palliative care - further validation of EORTC QLQ-SWB32 in Finnish

Publisher Copyright: © 2023. The Author(s).BACKGROUND: The European Organisation for Research and Treatment of Cancer (EORTC) has developed the Spiritual Well-being Questionnaire (EORTC QLQ-SWB32), a measure of spiritual well-being validated with people receiving palliative care for cancer, although its usefulness is not restricted to that population. We aimed to translate and validate this tool in Finnish and to study the relationship between spiritual well-being (SWB) and quality of life (QOL). METHODS: A Finnish translation was produced according to the guidelines of EORTC and included forward- and back-translations. Face, content, construct and convergence/divergence validity and reliability were studied in a prospective manner. QOL was assessed with EORTC QLQ-C30 and 15D questionnaires. Sixteen individuals participated in the pilot testing. 101 cancer patients drawn from oncology units, and 89 patients with other chronic diseases drawn from religious communities in different parts of the country participated in the validation stage. Retest was obtained from 16 individuals (8 cancer and 8 non-cancer patients). Inclusion criteria included patients with either a well-defined palliative care plan, or who would benefit from palliative care, as well as the capacity to understand and communicate in Finnish. RESULTS: The translation appeared understandable and acceptable. Factorial analysis identified four scoring scales with high Cronbach alfa values: Relationship with Self (0.73), Relationship with Others (0.84), Relationship with Something Greater (0.82), Existential (0.81), and, additionally, a scale on Relationship with God (0.85). There was a significant correlation between SWB and QOL in all participants. CONCLUSIONS: The Finnish translation of EORTC QLQ-SWB32 is a valid and reliable measure both for research and clinical practice. SWB is correlated with QOL in cancer and non-cancer patients undergoing palliative care or who are eligible for it.Peer reviewe

The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study

Background: In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death. Methods: A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 -Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death. Results: A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and Conclusions: The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.</div

Evaluation of tumor suppressor gene p53, oncogene c-erbB-2 and matrix-metalloproteinase-9 as prognostic and predictive factors in breast carcinoma

Abstract Breast carcinoma is the most common malignancy in females in western countries. Classical prognostic factors such as the size of a primary tumor and the presence or absence of axillary lymph node metastases, malignancy grade and hormone receptor status reflect the subsequent risk of disease recurrence after primary therapy and the need for adjuvant therapies. However, most breast carcinomas are detected in the early stage of the disease and the value of these classical prognostic factors is limited. There is also a great need to find new factors predicting the clinical efficacy of the anticancer drugs available. In this thesis tumor suppressor gene p53, oncogene c-erbB-2 and matrix metalloproteinase-9 were evaluated for their prognostic relevance in breast carcinoma patients treated in Oulu University Hospital, and matrix metalloproteinase-9 was also analyzed in women with premalignant lesions in the breast tissue in order to examine its role in breast carcinogenesis. Histological analyses were carried out from formalin-fixed, paraffin-embedded primary tumor specimens and p53, c-erbB-2 and matrix metalloproteinase-9 (MMP-9) statuses were systematically analyzed by immunohistochemistry. P53 expression correlated with disease-free survival and overall survival in patients with early-stage breast carcinoma, regardless of adjuvant antiestrogen therapy. The co-expression of p53 and c-erbB-2 characterizes a tumor type with a clinically aggressive course of breast carcinoma. The clinical efficacy of anthracyline-based chemotherapy in metastatic carcinoma might be limited in patients with p53 expression in a primary tumor. When postmenopausal patients with lymph node metastases and receiving adjuvant antiestrogen therapy were examined, MMP-9 expression indicated a slightly greater risk of breast carcinoma recurrence in patients with estrogen receptor negative tumors. Hyperplastic breast tissue and invasive breast carcinoma lesions expressed some MMP-9 immunopositivity. However, the strongest positivity was seen in ductal carcinoma in situ samples, suggesting that MMP-9 participates in breast carcinogenesis in the preinvasive phase