The palliative care is a regulatory determined form of medical care in the Russian Federation since 2011. Until now, no complex analysis was applied to problems occurring during provision of the given form of care. The actual study provides analysis of the results of questionnaire survey of population of Russia with the purpose of determining public demand in development of palliative care (level of awareness, social cultural attitudes and main needs of population). And also, concepts of effective forms of its development. The article presents and considers data obtained during the study.
The article substantiates actuality of elaboration of the concept of development of palliative care of children and adolescents. The analysis of legislative and normative legal base, international documents, scientific studies related to this issue are analyzed. The situation in the regions ofthe Russian Federation is examined concerning organization of palliative care of children and its forms, provision of pharmaceuticals and specialized equipment and professional training of specialists. The demand of children population in palliative care in Russia is calculated according data of 2012. The results of carried out study are used as a basis of determining measures of development of system of palliative care of children and adolescents in the Russian Federation to propose as a foundation for the National concept as a necessary condition for organization of effective and efficient service.
Creation of a system of palliative care in the Russian Federation is a pressing problem of public health, which at present is going through the first stage of development. According to WHO estimations, at least 75% cancer patients need palliative care. The system of medical care to cancer patients functioning in countries with well-developed economy (United Kingdom, USA, Canada, Australia) intends equal distribution of resources between radical treatment and palliative care (including analgesia) and reflects the actual requirements of patients. The scope of care should be extended from symptomatic treatment to comprehensive (medical, psychological, social, and spiritual) care of patients and their families.
The report deals with basement of development of palliative and psychotherapeutic measures aimed at relieving the condition of patients with tumors at stage IV who cannot be cured by special antitumor procedures. Such measures are of considerable practical importance. They are intended to ensure the biological, psychological and social adaptation of incurable patients to the terminal course of malignant disease. Some approaches to the solution of the problem are outlined.
In Russia, the medical social, organizational and ethic principles of palliative care of the incurable patients are developed. The theoretical aspects of the tanatological issues of terminally ill patients are covered. The focus is made on the organization of palliative care at the stages of social and psychological death.
The article emphasizes that the palliative medical care is considered in the Federal law "On the fundamentals of health care of citizen in the Russian Federation" (2011)as one of the types of medical care of population. The Orders of delivery of palliative care to adult population and children are in the process of development to determine in perspective the formation of palliative care services in the regions. The successful development of this service needs a clear-cut definition of palliative care to formulate the corresponding tasks and contingents of patients. The Preference is to be given to the definition which considers palliative medical care as a medical care of patients with diagnosis of active incurable progressing disease at the stage when possibilities of specialized/radical treatment are exhausted or limited.
The system of palliative care to the population is being formed in Russia. This article considers stages of this work and results of research on organizational and socio-medical aspects of palliative care. Scientifically substantiated proposals on the development of the hospice service in all territorial units of the Russian Federation based on recommendations of the World Health Organization are presented.
The share of patients, who apply to oncology facilities with advanced pathologies, shapes up a new situation for oncologists: the sphere of palliative care of both managerial and methodological types must be promoted. Thus, 451299 patients with malignant neoplasms, including those with wide-spread forms (i.e. stages III-IV: 59.1%), were registered in Russia in 2001. One hundred and thirty structural subunits of palliative care were set up in Russia's regions for today; another 58 are being established: however, none of them could be referred to as a perfect one because the role and functions have not yet been defined for palliative care, while all subject-related publications are isolated and scanty. The functioning of hospices and palliative-care subunits is not as a rule coordinated with the oncology service or with oncology experts. This problem should be resolved through setting up the palliative-care regional systems with the role and functions of palliative care being specified for them on the basis of the existing oncology institutes, hospitals and other patient-care facilities. This would maintain the continuity of medical care rendered to oncology patients at all disease stages.