1
|
Szczeklik W, Krajnik M, Pawlikowski J, Szeroczyńska M, Gajewski P, Kotlińska-Lemieszek A, Aszyk P, Muszala A, Imiela J, Imiela T, Górka J, Kübler A, Owczuk R, Duława J. The concept of medical futility is not similar to the concept of persistent therapy. Authors' reply. Pol Arch Intern Med 2024; 134:16667. [PMID: 38284871 DOI: 10.20452/pamw.16667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Małgorzata Krajnik
- Department of Palliative Care, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium
Medicum in Bydgoszcz, Bydgoszcz, Polan
| | - Jakub Pawlikowski
- Department of Humanities and Social Medicine, Medical University of Lublin, Lublin, Poland
| | | | - Piotr Gajewski
- Department of Medicine, McMaster University, Hamilton, Canada
- Polish Institute of Evidence Based Medicine, Kraków, Poland
| | | | - Piotr Aszyk
- Catholic Academy in Warsaw – Collegium Bobolanum, Warsaw, Poland
| | - Andrzej Muszala
- Interfaculty Institute of Bioethics, The Pontifical University of John Paul II in Krakow, Kraków, Poland
| | - Jacek Imiela
- Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Imiela
- Department of Cardiology of the Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jacek Górka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
- Fifth Military Clinical Hospital with Polyclinic in Krakow, Kraków, Poland
| | - Andrzej Kübler
- Center for Pain Treatment and Palliative Care, Clinical University Hospital in Wroclaw, Wrocław, Poland
| | - Radosław Owczuk
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Gdańsk, Poland
| | - Jan Duława
- Department of Internal and Metabolic Diseases, Medical University of Silesia in Katowice, Katowice, Poland
| |
Collapse
|
2
|
Szczeklik W, Krajnik M, Pawlikowski J, Szeroczyńska M, Gajewski P, Kotlińska-Lemieszek A, Aszyk P, Muszala A, Imiela J, Imiela T, Górka J, Kübler A, Owczuk R, Duława J. Avoiding medical futility in patients dying in a hospital: a position statement of the Polish Society of Internal Medicine Working Group on Medical Futility at Internal Medicine Units. Part 1: A dying patient who is not legally incapacitated but is incapable of making informed decisions regarding treatment that is considered medically futile. Pol Arch Intern Med 2023; 133:16567. [PMID: 37733218 DOI: 10.20452/pamw.16567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland; Fifth Military Clinical Hospital with Polyclinic in Krakow, Kraków, Poland.
| | - Małgorzata Krajnik
- Department of Palliative Care, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Jakub Pawlikowski
- Department of Humanities and Social Medicine, Medical University of Lublin, Lublin, Poland
| | | | - Piotr Gajewski
- Department of Medicine, McMaster University, Hamilton, Kanada
- Polish Institute of Evidence Based Medicine, Kraków, Poland
| | | | - Piotr Aszyk
- Catholic Academy in Warsaw – Collegium Bobolanum, Warsaw, Poland
| | - Andrzej Muszala
- Interfaculty Institute of Bioethics, The Pontifical University of John Paul II in Krakow, Kraków, Poland
| | - Jacek Imiela
- Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Imiela
- Department of Cardiology of the Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jacek Górka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
- Fifth Military Clinical Hospital with Polyclinic in Krakow, Kraków, Poland
| | - Andrzej Kübler
- Center for Pain Treatment and Palliative Care, Clinical University Hospital in Wroclaw, Wrocław, Poland
| | - Radosław Owczuk
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Gdańsk, Poland
| | - Jan Duława
- Department of Internal and Metabolic Diseases, Medical University of Silesia in Katowice, Katowice, Poland
| |
Collapse
|
3
|
Fopka-Kowalczyk M, Best M, Krajnik M. The Spiritual Supporter Scale as a New Tool for Assessing Spiritual Care Competencies in Professionals: Design, Validation, and Psychometric Evaluation. J Relig Health 2023; 62:2081-2111. [PMID: 35881265 PMCID: PMC10133369 DOI: 10.1007/s10943-022-01608-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 05/04/2023]
Abstract
This study aimed to design, validate and standardize the Spiritual Supporter (SpSup) Scale, a tool designed to assess competency to provide spiritual care including knowledge, sensitivity to spiritual needs and spiritual support skills. This instrument can be used by all those engaged in or training for caregiving roles. The study was conducted in Poland in the Polish language. The SpSup Scale demonstrates high overall reliability (Cronbach's α = 0.88), a satisfactory diagnostic accuracy (0.79), and a satisfactory discriminatory power of the items. Given the psychometric properties of SpSup Scale demonstrated here, the scale is recommended for the assessment of the competency to provide spiritual care in both clinical and research settings in Poland.
Collapse
Affiliation(s)
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, Australia
| | - Małgorzata Krajnik
- Department of Palliative Care, Nicolaus Copernicus University in Toruń, Collegium Medicum, Bydgoszcz, Poland
| |
Collapse
|
4
|
Sobanski PZ, Krajnik M, Goodlin SJ. Editorial: Palliative care for people living with heart and lung disease. Front Cardiovasc Med 2023; 9:1127688. [PMID: 36704459 PMCID: PMC9872112 DOI: 10.3389/fcvm.2022.1127688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Piotr Z. Sobanski
- Palliative Care Unit, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland,*Correspondence: Piotr Z. Sobanski ✉
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Sarah J. Goodlin
- Oregon Health and Science University, Portland, OR, United States,Patient-centered Education, Portland, OR, United States
| |
Collapse
|
5
|
Kotlińska-Lemieszek A, Fopka-Kowalczyk M, Krajnik M. Spirituality in people with advanced chronic obstructive pulmonary disease - challenge for more effective interventions, support, and healthcare education: Mini-review. Front Med (Lausanne) 2022; 9:954519. [PMID: 36561722 PMCID: PMC9763313 DOI: 10.3389/fmed.2022.954519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
More recently there has been a growing interest in spirituality in medicine, especially in the field of palliative care, oncology, intensive care, and cardiology. However, according to literature, it seems to be a limited number of researches on how healthcare professionals should provide spiritual care (SC) for people with non-malignant lung diseases and what kind of education for them enables them to do it efficiently. This mini-review aims to provide an overview of current knowledge of an area of spirituality and SC for people with advanced chronic obstructive pulmonary disease, including spiritual well-being and religious/spiritual coping, their relations with the quality of life and symptom burden, exercise capacity and daily functioning, mental health, or medication adherence. It also analyses the use of interventions to meet patients' spiritual needs and patients' expectations regarding SC provided by professional careers. Based on the literature authors try to show the fields that should be improved and proposed future research directions.
Collapse
Affiliation(s)
- Aleksandra Kotlińska-Lemieszek
- Pharmacotherapy in Palliative Care Laboratory, Chair and Department of Palliative Medicine, Poznań University of Medical Sciences, Poznań, Poland,Outpatient Palliative Medicine Clinic, Heliodor Swięcicki University Hospital, Poznań, Poland,*Correspondence: Aleksandra Kotlińska-Lemieszek,
| | | | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| |
Collapse
|
6
|
Fopka-Kowalczyk M, Groves R, Larkin P, Krajnik M. A training programme for medical students in providing spiritual care to people with advanced diseases and their loved ones: A case study from the Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland. Front Cardiovasc Med 2022; 9:909959. [PMID: 36247435 PMCID: PMC9558733 DOI: 10.3389/fcvm.2022.909959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/12/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose This article presents the first programme on spiritual care particularly for people with advanced life-limiting illness including heart failure, lung disease or cancer for medical students in Poland implemented at the Collegium Medicum in Bydgoszcz of the Nicolaus Copernicus University in Toruń. Methods and materials Several steps were identified for the development of the first programme on spirituality for medical students at the Collegium Medicum in Bydgoszcz including preliminary work on the content of the programme, agreement on key concepts, terms, and definitions; consultations with teachers and review of the literature. Results The first Polish spiritual curriculum for medical students was implemented. The spirituality curriculum will potentially contribute to better care for the people with advanced illnesses such as heart failure, chronic lung disease or cancer and improve the quality of relationships between professionals and patients. Conclusion The article presents the content of the program, the expected learning objectives and ascribed teaching methods, along with the preliminary evaluation made by students.
Collapse
Affiliation(s)
| | | | - Philip Larkin
- Palliative and Supportive Care Service, Chair of Palliative Care Nursing, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Philip Larkin
| | - Małgorzata Krajnik
- Department of Palliative Care, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| |
Collapse
|
7
|
Krajnik M, Hepgul N, Wilcock A, Jassem E, Bandurski T, Tanzi S, Simon ST, Higginson IJ, Jolley CJ. Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians. BMC Pulm Med 2022; 22:41. [PMID: 35045847 PMCID: PMC8768441 DOI: 10.1186/s12890-022-01835-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/31/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Respiratory medicine (RM) and palliative care (PC) physicians' management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey. METHODS A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists. RESULTS 450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018). CONCLUSIONS These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled.
Collapse
Affiliation(s)
- Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Andrew Wilcock
- Palliative Medicine, Hayward House Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Bandurski
- Department of Radiology, Informatics and Statistics, Medical University of Gdańsk, Gdańsk, Poland
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Caroline J Jolley
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, Shepherd's House, Rm 4.4, Guy's Campus, London, SE1 1UL, UK.
| |
Collapse
|
8
|
Drat-Gzubicka J, Pyszora A, Budzyński J, Currow D, Krajnik M. Is Neuropathic Pain a Good Marker of Peripheral Neuropathy in Hospice Patients with Advanced Cancer? The Single Center Pilot Study. Diagnostics (Basel) 2021; 11:diagnostics11081377. [PMID: 34441311 PMCID: PMC8391735 DOI: 10.3390/diagnostics11081377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/17/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
Neuropathic pain (NP) affects approximately 30% of patients with advanced cancer. The prevalence of neuropathic pain related to peripheral neuropathy (NP-RPN) in these patients is not known. The aim of the study was to evaluate NP-RPN prevalence in hospice patients and to find out whether the absence of this pain is sufficient to rule out peripheral neuropathy. The study included a total of 76 patients with advanced cancer who were cared for at inpatient hospices. All patients were asked about shooting or burning pain (of the feet and hands), were examined systematically for sensory deficits and had a nerve conduction study performed. NP-RPN was found in 29% of the patients. Electrophysiologically-diagnosed peripheral neuropathy was found in 79% of patients, and the diagnostic electrophysiological criteria for neuropathy were met by one half of the patients without NP-RPN. The severity of NP-RPN was correlated with the clinically assessed severity of sensory neuropathy and the Karnofsky score, but was not correlated with the intensity of the clinical signs of motor neuropathy. The presence of NP-RPN did not reflect greater prevalence of motor and sensory abnormalities in neurological and electrophysiological examinations. The absence of NP-RPN did not rule out polyneuropathy in hospice patients.
Collapse
Affiliation(s)
- Joanna Drat-Gzubicka
- Neurology Department, Specialist Hospital, ul. Leśna 10, 89-606 Chojnice, Poland
- Correspondence:
| | - Anna Pyszora
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (A.P.); (M.K.)
| | - Jacek Budzyński
- Department of Vascular and Internal Diseases, Collegium Medicum in Bydgoszcz, Jan Biziel University Hospital No 2, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168 Bydgoszcz, Poland;
| | - David Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, 2007 Ultimo, Australia;
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (A.P.); (M.K.)
| |
Collapse
|
9
|
Pawlikowski J, Muszala A, Gajewski P, Krajnik M. Discontinuation of hydration and nutrition in vegetative or minimally conscious state: no straightforward answer. Authors' reply. Pol Arch Intern Med 2021; 131:211-212. [PMID: 33641322 DOI: 10.20452/pamw.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jakub Pawlikowski
- Department of Humanities and Social Medicine, Medical University of Lublin, Lublin, Poland; Faculty of Medicine, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland.
| | - Andrzej Muszala
- Interdisciplinary Institute of Bioethics, the Pontifical University of John Paul II in Kraków, Kraków, Poland
| | - Piotr Gajewski
- Polish Institute for Evidence Based Medicine, Kraków, Poland
| | - Małgorzata Krajnik
- Department of Palliative Care, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Toruń, Poland
| |
Collapse
|
10
|
Pawlikowski J, Muszala A, Gajewski P, Krajnik M. Discontinuation of hydration and nutrition in vegetative or minimally conscious state: position statement of the Polish Association for Spiritual Care in Medicine 2020. Pol Arch Intern Med 2021; 131:111-113. [PMID: 33449612 DOI: 10.20452/pamw.15746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Krajnik M, Currow DC, Sobański P. Appropriate pharmacotherapy at the end of life: prescribing safely and only what is needed as part of whole-person care. Pol Arch Intern Med 2019; 129:654-656. [PMID: 31670723 DOI: 10.20452/pamw.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - David C Currow
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
| |
Collapse
|
12
|
Sobanski PZ, Alt-Epping B, Currow DC, Goodlin SJ, Grodzicki T, Hogg K, Janssen DJA, Johnson MJ, Krajnik M, Leget C, Martínez-Sellés M, Moroni M, Mueller PS, Ryder M, Simon ST, Stowe E, Larkin PJ. Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement. Cardiovasc Res 2019; 116:12-27. [DOI: 10.1093/cvr/cvz200] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/19/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social, or spiritual nature. This document encourages the use of validated assessment tools to recognize such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional, and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons’ needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.
Collapse
Affiliation(s)
- Piotr Z Sobanski
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Spital Schwyz, Waldeggstrasse 10, 6430 Schwyz, Switzerland
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Medical Center Göttingen Georg August University, Robertkochstrasse 40, 37075 Göttingen, Germany
| | - David C Currow
- University of Technology Sydney, Broadway, Ultimo, Sydney, 2007 New South Wales, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Sydney, New South Wales, Australia
| | - Sarah J Goodlin
- Department of Medicine-Geriatrics, Portland Veterans Affairs Medical Center and Patient-cantered Education and Research, 3710 SW US Veterans Rd, Portland, 97239 OR, USA
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-531 Kraków, Śniadeckich 10, Poland
| | | | - Daisy J A Janssen
- Department of Research and Education, CIRO, Hornerheide 1, 6085 NM Horn, The Netherlands
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Allam Medical Building University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Carlo Leget
- University of Humanistic Studies, Chair Care Ethics, Kromme Nieuwegracht 29, Utrecht, The Netherlands
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Matteo Moroni
- S.S.D. Cure Palliative, sede di Ravenna, AUSL Romagna, Via De Gasperi 8, 48121 Ravenna, Italy
| | - Paul S Mueller
- Mayo Clinic Health System, Mayo Clinic Collage of Medicine and Science, 700 West Avennue South, La Crosse, 54601 Wisconsin, USA
| | - Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland St. Vincent’s University Hospital Dublin,Belfield, Dublin 4, Ireland
| | - Steffen T Simon
- Department of Palliative Medicine, Medical Faculty of the Universityof Cologne, Köln, Germany
- Centre for Integrated Oncology Cologne/Bonn (CIO), Medical Faculty ofthe University of Cologne, Kerpener Strasse 62, 50924 Köln, Germany
| | | | - Philip J Larkin
- Service des soins palliatifs Lausanne University Hospital, CHUV, Centre hospitalier univeritaire vaudois, Lausanne Switzerland
- Institut universitaire de formation et de recherche en soins – IUFRS, Faculté de viologie et de medicine – FBM, Lausanne, Switzerland
| |
Collapse
|
13
|
Krajnik M, Currow DC, Brożek B, Damps-Konstańska I, Pierzchała W, Barczyk A, Jassem E. End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease. Authors' reply. Pol Arch Intern Med 2019; 129:436-437. [DOI: 10.20452/pamw.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
14
|
Brożek B, Damps-Konstańska I, Pierzchała W, Barczyk A, Currow DC, Jassem E, Krajnik M. End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: survey among Polish pulmonologists. Pol Arch Intern Med 2019; 129:242-252. [PMID: 30833536 DOI: 10.20452/pamw.4478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end‑of‑life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. RESULTS Properly completed questionnaires were returned by 174 respondents (27.2% of those proved to be contacted by email). In COPD, 32% of respondents always or often used opioids in chronic breathlessness and 18.3% always or often referred patients to a palliative care (PC) specialist. Nearly 80% of the respondents claimed that bedside discussions on EOL issues with people with COPD are essential, although only 20% would always or often initiate them. In people with lung cancer, opioids were routinely used for relief of chronic breathlessness by 80% of physicians; 81.7% referred patients to a PC specialist. More than half of the respondents always or often discussed EOL issues only with the patient's caregivers or relatives. Younger physicians, those at an earlier stage of their career, those caring for higher numbers of patients with lung cancer, and those who were better acquainted with Polish Respiratory Society recommendations for PC in chronic lung diseases seemed to provide better EOL care for COPD patients. CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists.
Collapse
Affiliation(s)
- Beata Brożek
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | | | | | - Adam Barczyk
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - David C Currow
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Sydney, New South Wales, Australia
| | - Ewa Jassem
- Department of Pneumonology, Medical University in Gdansk, Gdańsk, Poland
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| |
Collapse
|
15
|
Różycka K, Jakubczyk M, Rozowicz A, Krajnik M. Evaluation of nutritional status and analysis of body composition in cancer patients admitted to the department of otolaryngology for radical treatment. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
16
|
Wordliczek J, Kotlińska-Lemieszek A, Leppert W, Woroń J, Dobrogowski J, Krajnik M, Przeklasa-Muszyńska A, Jassem J, Drobnik J. Pharmacotherapy of pain in cancer patients – recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. Pol Przegl Chir 2018; 90:55-84. [PMID: 30293970 DOI: 10.5604/01.3001.0012.2904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Guidelines for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association
for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family
Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. During a series of
meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying
particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was
performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as
“pain”, “cancer”, “pharmacotherapy”, “analgesics”, and similar. The overviewed articles included studies of pathomechanisms
of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy
of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory
drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor
antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of
the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid
rotation and the management of patients with opioidophobia were discussed and recommendations for the management
of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including
neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common
interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the management
of crisis situations. In the final part of the recommendations, the issues of pain and care in dying patients are discussed.
Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer
in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations
would become helpful in everyday medical practice and thus contribute to the improvement in the quality
of care and the efficacy of pain treatment in this group of patients.
Collapse
Affiliation(s)
- Jerzy Wordliczek
- Klinika Intensywnej Terapii Interdyscyplinarnej, Uniwersytet Jagielloński, Collegium Medicum, Kraków Kliniczny Oddział Anestezjologii i Intensywnej Terapii, Szpital Uniwersytecki, Kraków
| | | | - Wojciech Leppert
- Katedra i Klinika Medycyny Paliatywnej, Uniwersytet Medyczny im. Karola Marcinkowskiego, Poznań
| | - Jarosław Woroń
- Zakład Farmakologii Klinicznej, Katedra Farmakologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków
| | - Jan Dobrogowski
- Zakład Badania i Leczenia Bólu, Katedra Anestezjologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków
| | - Małgorzata Krajnik
- Katedra i Zakład Opieki Paliatywnej, Uniwersytet Mikołaja Kopernika w Toruniu, Collegium Medicum, Bydgoszcz
| | - Anna Przeklasa-Muszyńska
- Zakład Badania i Leczenia Bólu, Katedra Anestezjologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków
| | - Jacek Jassem
- Katedra i Klinika Onkologii i Radioterapii, Gdański Uniwersytet Medyczny, Gdańsk
| | - Jarosław Drobnik
- Katedra i Zakład Medycyny Rodzinnej, Uniwersytet Medyczny, Wrocław
| |
Collapse
|
17
|
Graczyk M, Borkowska A, Krajnik M. Why patients are afraid of opioid analgesics: a study on opioid perception in patients with chronic pain. Pol Arch Intern Med 2017; 128:89-97. [PMID: 29240048 DOI: 10.20452/pamw.4167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Opiophobia is deemed one of the key barriers in effective pain management. OBJECTIVES The study aimed to assess the overall perception of opioids in cancer patients treated for chronic pain, as well as to determine the nature of their most common related fears. PATIENTS AND METHODS The study included 100 palliative care patients who suffered from chronic cancer or noncancer pain. Initially, they had to complete a survey exploring their knowledge on analgesics and potential fear of using opioids. The second phase was based on in‑depth interviews with 10 palliative care patients suffering from cancer pain who were reluctant to use opioids. RESULTS Of the 100 patients, 43 expressed concerns over commencing the treatment with opioids. Fear was reported more often in patients already on strong opioids, who either overtly expressed it (group C) or not (group B), as compared with patients treated with weak opioids (group A) (50%, 48%, and 19% of groups C, B, and A, respectively). The main concerns were drug addiction, fear of death or dying, and undesirable side effects. A qualitative study revealed similar types of fear among patients expressing concerns prior to being put on strong opioids. CONCLUSIONS Opiophobia seems to be common among palliative care patients (up to 50%) treated with strong opioids. They mainly fear drug addiction, undesirable effects, and death or dying. Better awareness of patients' preconceptions about opioids may become instrumental to alleviating their suffering through enhanced pain management.
Collapse
|
18
|
Janowiak P, Krajnik M, Podolec Z, Bandurski T, Damps-Konstańska I, Sobański P, Currow DC, Jassem E. Dosimetrically administered nebulized morphine for breathlessness in very severe chronic obstructive pulmonary disease: a randomized, controlled trial. BMC Pulm Med 2017; 17:186. [PMID: 29228935 PMCID: PMC5725796 DOI: 10.1186/s12890-017-0535-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/29/2017] [Indexed: 01/08/2023] Open
Abstract
Background Systemic morphine has evidence to support its use for reducing breathlessness in patients with severe chronic obstructive pulmonary disease (COPD). The effectiveness of the nebulized route, however, has not yet been confirmed. Recent studies have shown that opioid receptors are localized within epithelium of human trachea and large bronchi, a target site for a dosimetric nebulizer. The aim of this study was to compare any clinical or statistical differences in breathlessness intensity between nebulized 2.0% morphine and 0,9% NaCl in patients with very severe COPD. Methods The study was a double-blind, controlled, cross-over trial. Participants received morphine or NaCl during two 4-day periods. Sequence of periods was randomized. The primary outcome measure was reduction of breathlessness intensity now by ≥20 mm using a 100 mm visual analogue scale (VAS) at baseline, 15, 30, 60, 120, 180 and 240 min after daily administration, during normal activities. Results Ten of 11 patients included completed the study protocol. All patients experienced clinically and statistically significant (p < 0.0001) breathlessness reduction during morphine nebulization. Mean VAS changes for morphine and 0.9% NaCl periods were 25.4 mm (standard deviation (SD): 9.0; median: 23,0; range: 14.0 to 41,5; confidence interval (CI): 95%) and 6.3 mm (SD: 7.8; median: 6.8; range: −11,5 to 19,5; CI: 95%), respectively. No treatment emergent adverse effects were noted. Discussion Our study showed superiority of dosimetrically administered nebulized morphine compared to NaCl in reducing breathlessness. This may have been achieved through morphine’s direct action on receptors in large airways, although a systemic effect from absorption through the lungs cannot be excluded. Trial registration Retrospectively registered (07.03.2017), ISRCTN14865597
Collapse
Affiliation(s)
- Piotr Janowiak
- Department of Pneumonology and Allergology, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland
| | - Małgorzata Krajnik
- Department of Palliative Care, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, M. Curie Skłodowskiej 9, 85-094, Bydgoszcz, Poland
| | - Zygmunt Podolec
- Department of Aerosology and Aerosol Bioengineering, Research and Development Centre of MEDiNET, Juliusza Lea 114, 30-133, Kraków, Poland
| | - Tomasz Bandurski
- Department of Radiology Informatics and Statistics, Medical University of Gdańsk, Tuwima 15, 80-210, Gdańsk, Poland
| | - Iwona Damps-Konstańska
- Department of Pneumonology and Allergology, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland
| | - Piotr Sobański
- Palliativzentrum Hildegard, Sankt Alban-Ring 151, 4020, Basel, Switzerland.,Gynaecological Cancer Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - David C Currow
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Ewa Jassem
- Department of Pneumonology and Allergology, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland
| |
Collapse
|
19
|
|
20
|
Pyszora A, Budzyński J, Wójcik A, Prokop A, Krajnik M. Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial. Support Care Cancer 2017; 25:2899-2908. [PMID: 28508278 PMCID: PMC5527074 DOI: 10.1007/s00520-017-3742-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/04/2017] [Indexed: 12/17/2022]
Abstract
Purpose Cancer-related fatigue (CRF) is a common and relevant symptom in patients with advanced cancer that significantly decreases their quality of life. The aim of this study was to evaluate the effect of a physiotherapy programme on CRF and other symptoms in patients diagnosed with advanced cancer. Methods The study was designed as a randomized controlled trial. Sixty patients diagnosed with advanced cancer receiving palliative care were randomized into two groups: the treatment group (n = 30) and the control group (n = 30). The therapy took place three times a week for 2 weeks. The 30-min physiotherapy session included active exercises, myofascial release and proprioceptive neuromuscular facilitation (PNF) techniques. The control group did not exercise. The outcomes included Brief Fatigue Inventory (BFI), Edmonton Symptom Assessment Scale (ESAS) and satisfaction scores. Results The exercise programme caused a significant reduction in fatigue scores (BFI) in terms of severity of fatigue and its impact on daily functioning. In the control group, no significant changes in the BFI were observed. Moreover, the physiotherapy programme improved patients’ general well-being and reduced the intensity of coexisting symptoms such as pain, drowsiness, lack of appetite and depression. The analysis of satisfaction scores showed that it was also positively evaluated by patients. Conclusion The physiotherapy programme, which included active exercises, myofascial release and PNF techniques, had beneficial effects on CRF and other symptoms in patients with advanced cancer who received palliative care. The results of the study suggest that physiotherapy is a safe and effective method of CRF management.
Collapse
Affiliation(s)
- Anna Pyszora
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland.
| | - Jacek Budzyński
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Agnieszka Wójcik
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968, Warszawa, Poland
| | - Anna Prokop
- The Blessed Father Jerzy Popiełuszko Hospice in Bydgoszcz, Ks. Prałata Biniaka 3, 85-862, Bydgoszcz, Poland
| | - Małgorzata Krajnik
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej - Curie 9, 85-094, Bydgoszcz, Poland
| |
Collapse
|
21
|
Krajnik M. Learning to touch the patient’s soul: a difficult lesson from the Netherlands. Pol Arch Intern Med 2017; 127:289-290. [DOI: 10.20452/pamw.4014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
22
|
Graczyk M, Krajnik M, Woroń J, Wordliczek J, Malec-Milewska M. Use of opioids as one of the causes of fever in patients with advanced cancer. Int J Immunopathol Pharmacol 2017; 30:98-104. [PMID: 28059575 PMCID: PMC5806778 DOI: 10.1177/0394632016686088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Michał Graczyk
- Department of Palliative Care, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Małgorzata Krajnik
- Department of Palliative Care, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Jarosław Woroń
- Department of Pain Treatment and Palliative Care, Jagiellonian University College of Medicine, Cracow, Poland
- Department of Clinical Pharmacology, Jagiellonian University College of Medicine, Cracow, Poland
| | - Jerzy Wordliczek
- Department of Anesthesiology and Intensive Care, Jagiellonian University College of Medicine, Cracow, Poland
| | - Małgorzata Malec-Milewska
- Pain Clinic, Department of Anesthesiology and Intensive Care, Medical centre for Postgraduate Education, Warsaw, Poland
| |
Collapse
|
23
|
Szeroczyńska M, Czarkowski M, Krajnik M, Krajewski R, Pawłowski L, Adamczyk A, Barczak-Oplustil A, Aszyk P, Kobyliński A, Pasierski T, Sobański P, Bołoz On Behalf Of The Polish Working Group On End-Of-Life Ethics W. Institution of the health care agent in Polish legislation: position of the Polish Working Group on End-of-Life Ethics. Pol Arch Intern Med 2016; 126:313-20. [PMID: 27149104 DOI: 10.20452/pamw.3405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In numerous countries legislation has been put in place allowing citizens to appoint persons authorized to make medical decisions on their behalf, should the principal lose such decision‑making capacity. OBJECTIVES The paper aimed to prepare a draft proposal of legal regulations introducing into Polish legislation the institution of the health care agent. PATIENTS AND METHODS The draft proposal has been grounded in 6 expertise workshops, in conjunction with several online debates. RESULTS The right to appoint a health care agent should apply to all persons of full legal capacity, and to minors over 16 years of age. Every non-legally incapacitated adult person would be eligible to be appointed a health care agent. Appointment of substitute agents should also be legally provided for. The prerogatives of health care agents would come into effect upon the principals' loss of their decisionmaking capacity, or upon the principals' waiving their right to be provided with pertinent information on their health status. The health care agents would make decisions in all matters pertaining to medical treatment, while remaining under no obligation to perform any hands-on caring duties for their principals. The term of medical power-of-attorney should be discretionary, while its revocation or resignation should be possible at any time. In the event of health care agents' inactivity, or in the event that their actions should appear contrary to the principals' best interests, an attending physician should notify a pertinent court of law whose prerogatives would facilitate revocation of a medical power-of-attorney. CONCLUSIONS Statutory appointment of a health care agent allows every citizen to appoint in this capacity a person who, to the best of his or her knowledge, would best represent his or her interests in the event that the principal should ultimately lose the capacity to make medical decisions on his or her own behalf.
Collapse
|
24
|
Nowicki A, Farbicka P, Krajnik M. Dejection and self-assessment of quality of life in patients with lung cancer subjected to palliative care. Contemp Oncol (Pozn) 2016; 19:491-5. [PMID: 26843849 PMCID: PMC4731445 DOI: 10.5114/wo.2015.53250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY To evaluate the intensity of dejection and self-assessment of quality of life in patients with lung cancer from the start of palliative care until death. MATERIAL AND METHODS The study included 63 patients with lung cancer from the start of care until death in palliative medicine centers in Bydgoszcz in 2012-2013. The visual-analogue scale constituting part of the ESAS scale was used to assess dejection, while question number 30 of the EORTC QLQ-C30 was used for self-assessment of quality of life. RESULTS "Moderate" and "very" intense dejection initially occurred in 19 (30%) and 24 (38%), and in the 2(nd) assessment in as many as 23 (36%) and 30 (48%) patients. Average quality of life deteriorated in this respect by 0.09 in the two-step scale (p = 0.005). Increase in the intensity of "moderate" dejection occurred between the 1(st) and 3(rd) assessment. Initially it occurred in 2 (9%) patients and in 14 (66%) during the 3(rd) assessment. In contrast, the levels of "very" severe dejection did not change significantly between the 1(st) and the 3(rd) assessment. The average quality of life deteriorated by 0.23 points (p = 0.004). A significant relationship was found only between analgesic treatment and quality of life (p < 0.0005). Other factors such as age, time from diagnosis to start of treatment, place of residence, sex, or financial condition did not affect the quality of life. CONCLUSIONS Self-assessment of the quality of life worsens with time. The intensity of dejection does not change in the last 3 weeks of life. In multivariate analysis, among the selected variables such as age, sex, place of residence, time from diagnosis to start of palliative care, financial condition, and type of painkillers used, only the latter has an impact on self-assessed quality of life.
Collapse
Affiliation(s)
- Andrzej Nowicki
- Department of Oncology Nursing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Paulina Farbicka
- Department of Oncology Nursing, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Małgorzata Krajnik
- Department and Unit of Palliative Care, Collegium Medicum, Nicolaus Copernicus University in Torun, Poland
| |
Collapse
|
25
|
Jassem E, Batura-Gabryel H, Cofta S, Doboszyńska A, Farnik M, Górecka D, Korzeniewska-Koseła M, Kozielski J, Krajnik M, Krakowiak P, Słomiński JM, Śliwiński P, Wordliczek J, Szułdrzyński K, Królikowski W, Zajączkowska R, Dobrogowski J, Krzyżanowski D. [Reccomendation of Polish Respiratory Society for palliative care in chronic lung diseases]. Pneumonol Alergol Pol 2012; 80:41-64. [PMID: 22187179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
|
26
|
Jassem E, Kozielski J, Górecka D, Krakowiak P, Krajnik M, Słomiński JM. Integrated care for patients with advanced chronic obstructive pulmonary disease: a new approach to organization. Pol Arch Med Wewn 2010; 120:423-428. [PMID: 20980949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) affects approximately 10% of the population aged above 40 years. In advanced COPD (forced expiratory volume in 1 second <50% of the predicted value), patients suffer from severe pulmonary symptoms including dyspnea, chronic cough, poor exercise tolerance, which are commonly associated with systemic disorders, such as osteoporosis, loss of fat-free body mass, fatigue, anxiety, and depression. Moreover, patients with advanced COPD experience annually an average of 2 to 3 episodes of exacerbations requiring hospitalization. We present here a model of integrated care based on the cooperation between medical staff, social workers, volunteers and patients and their families. The essential components of this model are intensive education, treatment supervision, and support in self-management as well as coping with the disease and its consequences. It is expected that these measures will result in a decreased number of exacerbations requiring hospitalization, improved disease course, and better quality of life.
Collapse
Affiliation(s)
- Ewa Jassem
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | | | | | | |
Collapse
|
27
|
Jassem E, Kozielski J, Górecka D, Krakowiak P, Krajnik M, Słomiński JM. Integrated care for patients with advanced chronic obstructive pulmonary disease: a new approach to organization. Pol Arch Intern Med 2010. [DOI: 10.20452/pamw.987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
28
|
Jassem E, Górecka D, Krakowiak P, Kozielski J, Słomiński JM, Krajnik M, Fal AM. Integrated Care for Patients with Advanced Chronic Obstructive Pulmonary Disease. Adv Respir Med 2010. [DOI: 10.5603/arm.27740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV1 = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient’s status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists’ consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease).
Collapse
|
29
|
Jassem E, Górecka D, Krakowiak P, Kozielski J, Słomiński JM, Krajnik M, Fal AM. [Integrated care for patients with advanced chronic obstructive pulmonary disease]. Pneumonol Alergol Pol 2010; 78:126-132. [PMID: 20306424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assessed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV(1) = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient's status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists' consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease).
Collapse
Affiliation(s)
- Ewa Jassem
- Klinika Alergologii Gdańskiego Uniwersytetu Medycznego, ul. Debinki 7, Gdańsk.
| | | | | | | | | | | | | |
Collapse
|
30
|
Krajnik M, Podolec Z, Siekierka M, Sykutera M, Pufal E, Sobanski P, Makarewicz R, Neef C, Punt N, Zylicz Z. Morphine inhalation by cancer patients: a comparison of different nebulization techniques using pharmacokinetic, spirometric, and gasometric parameters. J Pain Symptom Manage 2009; 38:747-57. [PMID: 19783397 DOI: 10.1016/j.jpainsymman.2009.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 02/22/2009] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
Abstract
Despite numerous case reports suggesting the value of morphine (M) nebulization in the treatment of breathlessness, only a few clinical trials have been able to support this. The reason for this could lie in the lack of understanding of the localization of opioid receptors in the airways and the biopharmaceutics and pharmacokinetics of nebulized morphine. In the present study, we compared two different methods of pneumodosimetric nebulization: the Bronchial Control Treatment System-Sidestream (BCTS-S) and the Bronchial Control Treatment System-Micro Cirrus (BCTS-MC). The first method delivers relatively large aerosol particles (2-5microm) preferentially to the bronchial tree and trachea. In the BCTS-MC method, small aerosol particles (0.5-2microm) mostly reach the alveoli. Ten patients with cancer were randomly assigned to either the BCTS-S or BCTS-MC inhalation of 5 mg morphine HCl. Patients using the BCTS-S method inhaled a morphine dose in 6.6+/-2 minutes, whereas with the BCTS-MC method, the inhalation time was 28.8+/-8 minutes. The areas under the curve of morphine and glucuronides were several times higher after BCTS-S than after BCTS-MC. The proportion of morphine-3-glucuronide to morphine-6-glucuronide (M6) was, on average, close to one for both methods. From the same amount of morphine in the BCTS-S method, five times more M6 was produced. In both methods, the time to maximum concentration for morphine metabolites was 20-40 minutes, much shorter than expected from oral, intranasal, or intravenous administration. The study shows that the method of inhalation may have a profound effect on the pharmacokinetics of morphine. It is possible that the lungs metabolize morphine to glucuronides themselves and in different proportions from those seen after systemic administration. The BCTS-S method was found to be potentially superior to the BCTS-MC method in local action in the lungs.
Collapse
Affiliation(s)
- Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum, Nicolas Copernicus University, Bydgoszcz, Poland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Reddy L, Krajnik M, Zylicz Z. Transdermal buprenorphine may be effective in the treatment of pruritus in primary biliary cirrhosis. J Pain Symptom Manage 2007; 34:455-6. [PMID: 17900853 DOI: 10.1016/j.jpainsymman.2007.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 08/03/2007] [Indexed: 11/16/2022]
|
32
|
Pyszora A, Krajnik M, Graczyk M, Adamczyk A, Budzyński J, Lukowicz M, Zylicz Z. 828 ANALGESIC EFFICACY OF APS (ACTION POTENTIAL SIMULATION). PILOT STUDY AT THE PATIENTS WITH CHRONIC PAIN IN MUSCULOSKELETAL DISORDERS. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60831-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
|
34
|
Abstract
Severe pruritus is a frequent complication of cholestasis. Both serotonin and opioids play an important role in the development of this symptom. Guidelines to provide rational management of pruritus of cholestasis do not exist. We describe a patient with complex and malignant course of pruritus. She responded to several measures proposed (among other naltrexone), but rapidly became tolerant to them. Buprenorphine with an ultra low dose of naloxone was able to control her symptoms without development of tolerance until her death.
Collapse
Affiliation(s)
- Zbigniew Zylicz
- Comprehensive Cancer Center, University of Nijmegen, Nijmegen, The Netherlands.
| | | | | |
Collapse
|
35
|
Abstract
Distressing persistent dry cough is commonly the consequence of sensitization of the cough reflex. A slight and transient peripheral nociceptive impulse, such as bronchitis, may be perpetuated for weeks because of sensitization of the cough reflex. Cough usually can be inhibited by opioids, but some types of cough can be out of opioid control or even be induced by opioids. We describe here a series of 5 patients with dry cough that did not respond to codeine. Because two of these patients also suffered with pruritus, paroxetine was tried. In all patients, cough ceased within hours to days. The only observed adverse effect was sleepiness in the first days of therapy. Paroxetine should be investigated as antitussive in cases of opioid-resistant cough. The putative mechanism of action of paroxetine on pruritus and rough is discussed.
Collapse
|
36
|
Zylic Z, Krajnik M. Treatment of nausea and vomiting in long-term survivors of pancreatic cancer. J Pain Symptom Manage 2001; 21:366-7. [PMID: 11398790 DOI: 10.1016/s0885-3924(01)00276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
Abstract
Many pruritic conditions do not originate in the skin, but are the result of systemic abnormality. Among the diseases that can cause pruritus are renal insufficiency, cholestasis, Hodgkin's lymphoma, polycythemia vera, solid tumors, and many others. Other pruritic conditions appear to be iatrogenic; opioid-induced pruritus may be the most important in palliative medicine. Successful treatment of the underlying condition usually relieves itch. But, with time, many diseases progress and treatment of the cause will be impossible. Topical treatments may be of limited value. Strategies involving systemic treatments include use of antidepressants, oral opioid antagonists, or cholestyramine. There is no one cure for all pruritic symptoms. Better understanding of mechanisms of pruritus may help develop better treatments.
Collapse
Affiliation(s)
- M Krajnik
- Department of Palliative Medicine, The Ludwik Rydygier University of Medical Sciences, Bydgoszcz, Poland
| | | |
Collapse
|
38
|
Affiliation(s)
- M Krajnik
- Department of Palliative Medicine, The Ludwig Rydygier University of Medical Sciences, Bydgoszcz, Poland
| | | |
Collapse
|
39
|
Zylicz Z, Krajnik M. [Pruritus in cancer: uncommon, but sometimes worse than the pain]. Ned Tijdschr Geneeskd 1999; 143:1937-40. [PMID: 10526610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Three patients, two females aged 45 and 56 years with metastasized breast carcinoma and one man aged 88 years with inoperable bronchial carcinoma, suffered from severe pruritus. This was only alleviated after treatment with paroxetine, a serotonin re-uptake inhibitor, or with tropisetron, a serotonin antagonist. The youngest woman then could be given chemotherapy, after which clinical recovery occurred, the other patients died, one week and 3 months, respectively, after start of the treatment. Pruritus is a relatively rare symptom in malignancies, but may be worse than pain. In the development and transmission of pruritus signals, in cholestatic icterus as well, serotonin appears to play a more important part than histamine.
Collapse
|
40
|
|
41
|
|
42
|
Abstract
Opioids used topically may exercise several useful clinical effects. Opioids may cause immediate local analgesia and also may work indirectly through decreasing the inflammation process. In this article we describe six patients treated with topical opioids because of cutaneous pain due to tumor infiltration. skin ulcers of malignant and non-malignant origin, severe oral mucositis, pain due to knee arthrosis and severe tenesmoid pain. In all but one case, topical morphine provided rapid relief which lasted usually for 7-8 h. The side effects of topical opioids were none or minimal. Possible mechanisms of topical analgesia are discussed.
Collapse
Affiliation(s)
- M Krajnik
- Department of Palliative Care, The Ludwig Rydygier Medical University, Bydgoszcz, Poland
| | | | | | | | | |
Collapse
|
43
|
Abstract
Pruritus associated with malignancy may be one of the most bothersome symptoms in advanced cancer. Its control is still difficult to achieve and is a challenge to palliative medicine specialists. We describe five patients suffering from pruritus of different etiologies who responded rapidly to administration of paroxetine, a serotonin reuptake inhibitor, in a dose-dependent manner. Two patients experienced transient but severe nausea and vomiting. We suggest that paroxetine's antipruritic effect may be explained by rapid downregulation of the 5-HTs receptors, which may have an important role in the generation of pruritus and pain.
Collapse
Affiliation(s)
- Z Zylicz
- Hospice Rozenheuvel, Rozendaal, The Netherlands
| | | | | |
Collapse
|
44
|
Krajnik M, Zylicz Z. Topical morphine for cutaneous cancer pain. Palliat Med 1997; 11:325. [PMID: 9373587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
45
|
|
46
|
Krajnik M. There is a difference. Minn Nurs Accent 1966; 38:20-1. [PMID: 4285118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|