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Forycka M, Liberacka-Dwojak M, Leppert W, Suchecki P, Suchecka N, Ast B. Psychological Factors Influencing Attitudes towards Euthanasia, Assisted Suicide and Palliative Care among Medical Students and Doctors in Training. Healthcare (Basel) 2024; 12:833. [PMID: 38667594 DOI: 10.3390/healthcare12080833] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: This study aimed to analyse the attitudes of medical students, Polish and classical philology students and trainee doctors towards the legalisation and practice of euthanasia and assisted suicide, to explore their beliefs about palliative care and to identify the cognitive, behavioural and emotional factors influencing these attitudes. Methods: An anonymous 22-question survey was sent by email to 670 participants, who comprised students of medicine, students of Polish and classical philology and trainee physicians. Results: Out of the 670 people invited to the survey, 313 (46.72%) responded; 215 (68.69%) and 112 (35.80%) participants supported the legalisation of euthanasia and assisted suicide, respectively. No differences were found between the respondent groups studied. The respondents' attitudes were influenced by religion, place of residence and professed values in the doctor-patient relationship. Among the medical students and trainee doctors surveyed, the declared willingness to perform euthanasia was lower, with 90 (43.7%) people, than the support for its legalisation, with 135 (65.5%) people. Significantly higher support for palliative care was expressed by fifth- and sixth-year medical students and trainee doctors, with 88 respondents (89.89%), less support was expressed by first- and fourth-year medical students, with 74 respondents (68.5%), and the lowest support was observed among Polish and classical philology students, with 63 respondents (58.9%). Conclusions: The legalisation of euthanasia and assisted suicide was supported by more than two-thirds and one-third of all the respondents, respectively, with the majority of medical students and trainee doctors surveyed expressing uncertainty or lack of readiness towards their practice. More than 70% of all the respondents showed a positive opinion towards palliative care, with the lowest support being among Polish and classical philology students.
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Affiliation(s)
- Maria Forycka
- Department of Palliative Medicine, Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland
| | | | - Wojciech Leppert
- Department of Palliative Medicine, Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland
- University Hospital in Poznań, Osiedla Rusa 55, 61-245 Poznań, Poland
| | - Paweł Suchecki
- MediCenter Primary Care Physicians, ul. 3 Maja 13, 99-400 Łowicz, Poland
| | - Natalia Suchecka
- MediCenter Primary Care Physicians, ul. 3 Maja 13, 99-400 Łowicz, Poland
| | - Bartłomiej Ast
- Department of Care and Treatment Facility, Józef Struś Multispecialist Municipal Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland
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Kania K, Pawlak MA, Forycka M, Wiłkość-Dębczyńska M, Michalak S, Łukaszewska A, Wyciszkiewicz A, Wypych A, Serafin Z, Marcinkowska J, Kozubski W, Kalinowska-Łyszczarz A. Predicting clinical progression and cognitive decline in patients with relapsing-remitting multiple sclerosis: a 6-year follow-up study. Neurol Neurochir Pol 2024:VM/OJS/J/97714. [PMID: 38324117 DOI: 10.5603/pjnns.97714] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Cognitive impairment occurs from the earliest stages of multiple sclerosis (MS) and progresses over time. The introduction of disease modifying therapies (DMTs) has changed the prognosis for MS patients, offering a potential opportunity for improvement in the cognitive arena as well. MATERIAL AND METHODS 41 patients with relapsing-remitting multiple sclerosis (MS) were recruited to the study. Thirty patients were available for final follow-up and were included in the analysis. Baseline (BL) brain MRI including volumetry and neuropsychological tests were performed. Blood samples were collected at BL and follow-up (FU) and were tested for: vascular endothelial growth factor (VEGF), soluble vascular cell adhesion molecule-1 (sVCAM1), soluble platelet-endothelial CAM-1 (sPECAM1), and soluble intercellular CAM-1 (sICAM-1). Patients were invited for a final neuropsychological follow-up after a median of 6 years. Disease activity (relapses, EDSS increase, new/active brain lesions on MRI) was analysed between BL and FU. RESULTS The study group deteriorated in the Rey-Osterrieth Complex Figure (ROCF) test (p = 0.001), but improved significantly in three other tests, i.e. semantic fluency test (p = 0.013), California Verbal Learning Test (CVLT, p = 0.016), and Word Comprehension Test (WCT, p < 0.001). EDSS increase correlated negatively with semantic fluency and WCT scores (r = -0.579, p = 0.001 and r = -0.391, p = 0.033, respectively). Improvements in semantic fluency test and WCT correlated positively with baseline deep grey matter, grey matter, and cortical volumes (p < 0.05, r > 0). Higher EDSS on FU correlated significantly negatively with baseline left and right pallidum, right caudate, right putamen, right accumbens, and cortical volume (p < 0.05, r < 0). No significant relationship was found between the number of relapses and EDSS on FU or neuropsychological deteriorations. Improvements in WCT and CVLT correlated positively with baseline sPECAM1 and sVCAM1 results, respectively (r > 0, p < 0.05). Deterioration in ROCF test correlated significantly with higher levels of baseline VEGF and sVCAM1 (p < 0.05). CONCLUSIONS Brain volume is an important predictor of future EDSS and cognitive functions outcome. MS patients have a potential for improving in neuropsychological tests over time. It remains to be established whether this is related to successful disease modification with immunotherapy. Baseline volumetric measures are stronger predictors of cognitive performance than relapse activity, which yet again highlights the importance of atrophy in MS prognosis.
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Affiliation(s)
- Karolina Kania
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland.
| | - Mikołaj A Pawlak
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Forycka
- Chair of Palliative Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
| | - Monika Wiłkość-Dębczyńska
- Department of Health Psychology, Faculty of Psychology, Kazimierz Wielki University in Bydgoszcz, Bydgoszcz, Poland
| | - Sławomir Michalak
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Aleksandra Wyciszkiewicz
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Wypych
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Zbigniew Serafin
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Justyna Marcinkowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Alicja Kalinowska-Łyszczarz
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
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van Riet Paap J, Mariani E, Chattat R, Koopmans R, Kerhervé H, Leppert W, Forycka M, Radbruch L, Jaspers B, Vissers K, Vernooij-Dassen M, Engels Y. Identification of the palliative phase in people with dementia: a variety of opinions between healthcare professionals. BMC Palliat Care 2015; 14:56. [PMID: 26537133 PMCID: PMC4632478 DOI: 10.1186/s12904-015-0053-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with dementia can benefit from a palliative care approach. Recommendations, such as those of the EAPC have been proposed to strengthen the provision of palliative care for this group of patients. Yet, it remains challenging for professionals to identify when a person with dementia is in need of palliative care. The objective of this study therefore was to explore when professionals in long-term care settings consider a person with dementia in need of palliative care. METHODS Teams with in total 84 professionals working in 13 long-term care settings from 6 countries (France, Germany, Italy, Norway, Poland and the Netherlands) received a case-vignette concerning a person with dementia recently admitted to a nursing home. Teams were asked to discuss when they considered people with dementia eligible for palliative care. The constant comparative method was used to analyse their answers. RESULTS Three different time points in the disease trajectory when people with dementia were considered to be eligible for palliative care were extracted: (1) early in the disease trajectory; (2) when signs and symptoms of advanced dementia are present; and (3) from the time point that curative treatment of co-morbidities is futile. Yet, none of these time points was uniformly considered by the professional teams across Europe. In some cases, professionals working in the same nursing home didn't even reach consensus when considering persons with dementia eligible for palliative care. CONCLUSION The results of the study identified that professionals across Europe have different opinions regarding the time point when to consider a person with dementia in need of palliative care.
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Affiliation(s)
- Jasper van Riet Paap
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Elena Mariani
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud university medical center, P.O. 6500 HB, Nijmegen, The Netherlands. .,Radboud Alzheimer Centre, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Joachim en Anna, Centre for specialized geraitric care, Nijmegen, The Netherlands.
| | - Hélène Kerhervé
- Department of Geriatrics, Broca Hospital, AP-HP, 54-56 rue Pascal, 75013, Paris, France.
| | - Wojciech Leppert
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland.
| | - Maria Forycka
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland.
| | - Lukas Radbruch
- Department of Palliative Medicine, Universitätsklinikum Bonn, Sigmund-Freud-Street 25, 53127, Bonn, Germany. .,Department of Palliative Care, Malteser Hospital Bonn /Rhein-Sieg, Bonn, Germany.
| | - Birgit Jaspers
- Department of Palliative Medicine, Universitätsklinikum Bonn, Sigmund-Freud-Street 25, 53127, Bonn, Germany. .,Department of Palliative Care, Malteser Hospital Bonn /Rhein-Sieg, Bonn, Germany.
| | - Kris Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Radboud Alzheimer Centre, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Kalorama Foundation, Nijmegen, The Netherlands.
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Leppert W, Majkowicz M, Forycka M, Mess E, Zdun-Ryzewska A. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center. Onco Targets Ther 2014; 7:687-95. [PMID: 24855379 PMCID: PMC4020899 DOI: 10.2147/ott.s57338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Indexed: 01/29/2023] Open
Abstract
AIM OF THE STUDY To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care center (DCC). PATIENTS AND METHODS QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL), the Edmonton Symptom Assessment System (ESAS), and the Karnofsky Performance Status (KPS) scale. RESULTS A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. CONCLUSIONS QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home.
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Affiliation(s)
- Wojciech Leppert
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Mikolaj Majkowicz
- Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland
| | - Maria Forycka
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Eleonora Mess
- Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland
| | - Agata Zdun-Ryzewska
- Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland
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Leppert W, Majkowicz M, Forycka M. Attitudes of Polish physicians and medical students toward breaking bad news, euthanasia and morphine administration in cancer patients. J Cancer Educ 2013; 28:603-10. [PMID: 24170311 PMCID: PMC3825587 DOI: 10.1007/s13187-013-0553-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Medical students and physicians should possess basic knowledge concerning medical ethics and palliative care. The aim of the study was to explore the knowledge on the end-of-life ethics and palliative care in third-year medical students and physicians during internal medicine specialty training and their attitude towards breaking bad news and euthanasia. A voluntary and anonymous questionnaire survey with the participation of 401 students and 217 physicians filled after lectures concerning ethics for medical students and after palliative medicine course for physicians during internal medicine specialty training. A total of 28 % students and 24 % physicians (p = 0.282) were ready to reveal full information to advanced cancer patients. A total of 82 % of students and 90 % of physicians (p = 0.008) would not practice euthanasia; 67 % of students and 75 % of physicians (p = 0.039) were opponents of euthanasia legalisation. A total of 70 % doctors and 23 % students indicated oral as the most preferable route of morphine administration. A total of 74 % physicians and 43 % students stated that there is no maximal dose of morphine; 64 % of doctors and 6 % of students indicated constipation as a constant adverse effect of morphine. Breaking bad news is a significant difficulty for both students and physicians. There is a small percentage of those tending to practice euthanasia and bigger accepting its legalisation with fewer physicians than students. In contrast to medical students, the majority of physicians have knowledge concerning chronic morphine use in the treatment of cancer patients.
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Affiliation(s)
- Wojciech Leppert
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Osiedle Rusa 25 A, 61-245, Poznan, Poland,
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Leppert W, Gottwald L, Majkowicz M, Kazmierczak-Lukaszewicz S, Forycka M, Cialkowska-Rysz A, Kotlinska-Lemieszek A. A comparison of attitudes toward euthanasia among medical students at two Polish universities. J Cancer Educ 2013; 28:384-391. [PMID: 23055130 PMCID: PMC3664753 DOI: 10.1007/s13187-012-0414-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of the study conducted upon completion of obligatory palliative medicine courses among 588 medical students at two universities was to compare their attitudes toward euthanasia. Four hundred ninety-two (84.97 %) students were Catholics; 69 (11.73 %) declared they would practice euthanasia, 303 (51.53 %) would not, and 216 students (36.73 %) were not sure. The idea of euthanasia legalisation was supported by 174 (29.59 %) respondents, opposed by 277 (47.11 %), and 137 (23.30 %) were undecided. Five hundred fifty-six (94.56 %) students did not change their attitudes toward euthanasia after palliative medicine courses. Students from the two universities were found to have different opinions on practicing euthanasia, euthanasia law and possible abuse which might follow euthanasia legalisation, but they shared similar views on the choice of euthanasia if they themselves were incurably ill and the legalisation of euthanasia. Gender and religion influenced students' answers. Differences observed between medical students at the two universities might be related to gender and cultural differences.
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Affiliation(s)
- Wojciech Leppert
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Osiedle Rusa 25 A, 61-245, Poznan, Poland.
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