Palliatiivisen hoidon ja saattohoidon järjestäminen. Työryhmän suositus osaamis- ja laatukriteereistä sosiaali- ja terveydenhuollon palvelujärjestelmälle

Osana sosiaali- ja terveysministeriön asettaman valtakunnallisen hoidon saatavuuden ja yhtenäisten hoidon perusteiden työryhmän työtä ministeriö antoi helmikuussa 2016 professori Tiina Saarron johtamalle asiantuntijaryhmälle tehtäväksi laatia ehdotus palliatiivisen hoidon ja saattohoidon järjestämisestä siten, että valmistelussa olleessa valtioneuvoston asetuksessa erikoissairaanhoidon järjestämisestä ja keskittämisestä määritellyt toimijat yhteistyössä huolehtivat palliatiivisen hoidon ja saattohoidon yhdenvertaisesta ja vaikuttavasta toteuttamisesta koko maassa. Palliatiivisen hoidon ja saattohoidon järjestäminen -suositus pohjautuu aikaisempiin vuonna 2010 laadittuihin suosituksiin. Se pyrkii vahvistamaan niissä kuvattujen tavoitteiden toteutumista esittämällä osaamis- ja laatukriteerit sosiaali- ja terveydenhuollon palvelujärjestelmän eri tasoille sekä sosiaali- ja terveydenhuollon ammattihenkilöiden koulutuksen ja osaamisen kehittämiseen tähtääviä toimenpiteitä. Suosituksessa kuvataan vähimmäistaso. Suositus perustuu kolmiportaiseen malliin palvelujen järjestämisestä perustasolla, erityistasolla ja vaativalla erityistasolla. Sen pohjalta voidaan alueellisesti suunnitella palveluketjut ja sopia työnjaosta valtioneuvoston asetuksen (582/2017) mukaisesti. Alueelliset olosuhteet vaikuttavat siihen, minkälaista työnjakoa on tarkoituksenmukaista ylläpitää ja millä keinoin palvelujen tarpeeseen vastataan. Suositusten toimeenpanoon voidaan ryhtyä riippumatta meneillään olevasta sosiaali- ja terveydenhuollon järjestelmän muutoksesta. Ehdotus oli lausuntokierroksella kesällä 2016, ja korjatun luonnoksen kuulemistilaisuus oli 17.10.2017. Saadun palautteen mukaan suosituksen toimenpiteitä pidetään tärkeinä palvelujärjestelmän kehittämiseksi

Suositus palliatiivisen hoidon palveluiden tuottamisesta ja laadun parantamisesta Suomessa : Palliatiivisen hoidon asiantuntijaryhmän loppuraportti

Kaikilla on oikeus tarpeenmukaiseen palliatiiviseen hoitoon. Työryhmien loppuraportissa kuvataan terveyden- ja sosiaalihuollon palliatiivisen hoidon nykytila, kehittämistarpeet, valtakunnallinen palveluketjumalli ja annetaan suositus palveluiden tuottamisesta ja laadun parantamisesta. Terveydenhuollon osalta esitetään erityisvastuualueittain ja sairaanhoitopiireittäin laatukriteereiden mukainen suositus palliatiivisen hoidon kokonaisuudesta. Lisäksi kuvataan palveluketjun integraatio päivystys- ja ensihoidon ja lasten ja nuorten palveluiden sekä iäkkäiden ihmisten sosiaalipalveluiden kanssa. Sosiaalipalvelujen nykytilan kartoituksessa todettiin iäkkäiden ihmisten runsas akuuttipalveluiden käyttö ennen kuolemaa sekä hoitohenkilöstön puutteellinen palliatiivisen hoidon osaaminen, joka korostui erityisesti kotihoidossa. Puutteita havaittiin myös asumispalveluiden kilpailutusasiakirjoissa. Raportissa annetaan iäkkäiden ihmisten palveluihin 21 elämän loppuvaiheen laatukriteeriä perusteineen sisältäen suositukset ulkoistetuille palveluille. Vammaisten henkilöiden sekä kulttuuristen ja etnisten vähemmistöjen palliatiivisen hoidon järjestäminen vaatii vielä tarkempaa selvittelyä. Palliatiivisen hoidon osaamisvajeen korjaamiseksi suositellaan ammattilaisten systemaattisen perusopetuksen sekä täydennys- ja erikoistumiskoulutuksen järjestämistä

The required competencies of physicians within palliative care from the perspectives of multi-professional expert groups : a qualitative study

Background Although statements on the competencies required from physicians working within palliative care exist, these requirements have not been described within different levels of palliative care provision by multi-professional workshops, comprising representatives from working life. Therefore, the aim of this study was to describe the competencies required from physicians working within palliative care from the perspectives of multi-professional groups of representatives from working life. Methods A qualitative approach, using a workshop method, was conducted, wherein the participating professionals and representatives of patient organizations discussed the competencies that are required in palliative care, before reaching and documenting a consensus. The data (n = 222) was collected at workshops held in different parts of Finland and it was analyzed using a qualitative content analysis method. Results The description of the competencies required of every physician working within palliative care at the general level included 13 main categories and 50 subcategories in total. 'Competence in advanced care planning and decision-making' was the main category which was obtained from the highest number of reduced expressions from the original data (f = 125). Competence in social interactions was another strong main category (f = 107). In specialist level data, six main categories with 22 subcategories in total were found. 'Competence in complex symptom management' was the main category which was obtained from the biggest number of reduced expressions (f = 46). A notable association between general level and specialist level data was related to networking, since one of the general level categories was 'Competence in consultations and networking' (f = 34) and one of the specialist level categories was 'Competence to offer consultative and educational support to other professionals' (f = 30). Moreover, part of the specialist level results were subcategories which belonged to the main categories produced from the general level data. Conclusions The competencies described in this study emphasize decision-making, social interactions and networking. It is important to listen to the voices of the working-life representatives when planning curricula. Moreover, the views of the working-life representatives inform how the competencies gained during their education meet the challenges of the ordinary work.Peer reviewe

A Nordic survey of the management of palliative care in patients with head and neck cancer

Background The five Nordic countries with a population of 27M people form a rather homogenous region in terms of health care. The management of Head and Neck Cancer (HNC) is centralized to the 21 university hospitals in these countries. Our aim was to survey the current status of organization of palliative care for patients with HNC in the Nordic countries as the field is rapidly developing. Materials and methods A structured web-based questionnaire was sent to all the Departments of Otorhinolaryngology-Head and Neck Surgery and Oncology managing HNC in the Nordic countries. Results All 21 (100%) Nordic university hospitals responded to the survey. A majority (over 90%) of the patients are discussed at diagnosis in a multidisciplinary tumor board (MDT), but the presence of a palliative care specialist is lacking in 95% of these MDT's. The patients have access to specialized palliative care units (n = 14, 67%), teams (n = 10, 48%), and consultants (n = 4, 19%) in the majority of the hospitals. Conclusion The present results show that specialized palliative care services are available at the Nordic university hospitals. A major finding was that the collaboration between head and neck surgeons, oncologists and palliative care specialists is not well structured and the palliative care pathway of patients with HNC is not systematically organized. We suggest that early integrated palliative care needs to be included as an addition to the already existing HNC care pathways in the Nordic countries.Peer reviewe

Cancer Patients' Symptom Burden and Health-related Quality of Life (HRQoL) at Tertiary Cancer Center from 2006 to 2013 : A Cross-sectional Study

Background/Aim: To observe changes in symptoms and health-related quality of life (HRQoL) over 7 years among cancer patients at different stages of the disease. Patients and Methods: This prospective cross-sectional study at the Helsinki University Hospital Cancer Center, was carried out in 2006 and repeated in 2013. All participants filled in the EORTC-QLQ-C30 questionnaire. Results: Altogether, 581 patients responded (49% in 2006 and 54% in 2013). The disease was local in 51% and advanced in 49% of patients. The HRQoL was significantly lower, except for emotional and cognitive functions, and the symptom burden more severe in advanced cancer. The most prevalent symptoms were fatigue (93% and 85%; moderate/severe 22% and 9%), pain (65% and 47%; moderate/severe 16% and 5%), and insomnia (64% and 60%; moderate/severe 20 and 21%), respectively. No changes in HRQoL or symptoms were found at 7 years. Conclusion: There is a need for early integrated palliative care to improve HRQoL during cancer treatments.Peer reviewe

Elämän loppuvaiheen ennakoiva hoitosuunnitelma

English summaryPeer reviewe

Undergraduate curriculum in palliative medicine at Tampere University increases students' knowledge

Background: Education in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland. Methods: We searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations. Students' knowledge was evaluated using a progress test over three consecutive years. Results: We found 53.5 teaching hours addressing PM issues, which exceeds the recommendation of the EAPC. Basics, symptom management, ethics, and communication skills were well established, while education in psychosocial/spiritual aspects, teamwork and self-reflection failed to reach the recommendations. Out of the maximum of 4.0, the progress test mean scores in PM among the third, fourth, fifth and sixth year students were 0.1 (SD 0.71), 0.69 (SD 1.28), 1.38 (SD 1.46) and 2.53 (SD 1.26), respectively (p <0.001). This growing knowledge was associated with the timely increase in teaching provided through the PM discipline. In addition, the students who completed the optional PM course achieved better mean scores (2.66; SD 1.27) than the others (1.33; SD 1.43) (p <0.001). Conclusions: The curriculum in PM at the University of Tampere is integrated into the teaching of many disciplines and complied well with the EAPC recommendations. This education led to increasing knowledge in PM among medical students.Peer reviewe

Effect of Palliative Care Decision on Use of Hospital Services in Pancreatic Cancer Patients : A Retrospective Study

Peer reviewe

Costs in Different States of Breast Cancer

Background/Aim: This cross-sectional study estimated direct cancer-related health care, productivity and informal care costs for a six-month period for different states of breast cancer (BC). Patients and Methods: A total of 827 BC patients answered a questionnaire enquiring about informal care, work capacity, and demographic factors. Direct health care resource use and productivity costs were obtained from registries. Mutually exclusive groups were formed based on disease state and time from diagnosis: primary treatment (first six months after diagnosis), rehabilitation (>six months after diagnosis), remission (>1.5 years after diagnosis), and metastatic. Results: Mean total costs were: primary treatment (sic)22,876, rehabilitation (sic)3,456, remission (sic)1,728, and metastatic (sic)24,320. Mean direct health care costs were: primary treatment (sic)11,798, rehabilitation (sic)2,398, remission (sic)1,147, and metastatic (sic)13,923. Mean productivity costs varied between 18-39% and indirect costs (productivity and informal care costs) between 31-48% of the total costs. Conclusion: Direct medical costs were highest, but indirect costs constituted up to half of the total costs and are essential when estimating the total cost burden, as many patients are of working age.Peer reviewe