[Hyponatraemia in palliative care regarding a case report]

Hyponatremia is a very common abnormality in palliative care which can cause a sudden decline in the patient's general condition. The diagnostic and therapeutic procedures are based on the patient's symptoms and life-expectancy. The inadequate diagnostic and therapeutic interventions result in an unnecessary burden, while the adequate treatment could improve the quality of life. In palliative care, acute hyponatremia is very rare, the chronic form without any symptoms or mild complaints is more common. Asymptomatic patients should be observed. In patients with mild symptoms and months or years plus prognosis contributing factors should be discontinued. The electrolyte abnormality of patients with moderate or severe symptoms and at least weeks prognosis should be treated. Patients with day prognosis needs no treatment. This case report of an early palliative care patient with moderate symptoms caused by chronic, severe hyponatremia aims to give a suggestion for the management of the most common electrolyte abnormality in everyday palliative care. Orv Hetil. 2023; 164(18): 713-717.

When and how to integrate oncology and palliative care?

Összefoglaló. A palliatív ellátások korai bevonása az onkológiai betegek ellátásába előnnyel jár mind a beteg életminősége, mind a kezelés színvonala, mind a költséghatékonyság szempontjából. Szükség van egy olyan modellre, mely alapján a megfelelő időben, a megfelelő beteg a megfelelő minőségű palliatív ellátásban részesül. Ebben a közleményben a palliatív ellátás korai integrációjának előnyei, szintjei és a speciális palliatív ellátás fogalmának ismertetése után a leginkább elterjedt beutalási modellek előnyeit és hátrányait mutatjuk be a nemzetközi szakirodalom alapján. A speciális palliatív ellátást igénylő betegek kiszűrésére szolgáló, prognózisalapú modellek hátránya, hogy nincs elég kapacitás az ilyen módon beutalt nagyszámú beteg ellátására, ezért széles körben nem terjedtek el. A tüneteken alapuló modellek sokszor bonyolultak és a mindennapi klinikai gyakorlatban nem használatosak. Az új kutatások alapján egyszerű, gyakorlatias kérdéssorokat alkalmaznak, melyekkel könnyen kiemelhetők, akik profitálnak a speciális palliatív intervencióból. Ezek közül a Yale egyetemi és a PALLIA -10 modellt ismertetjük részletesen. Amennyiben az aktív onkológiai ellátást végzők a megfelelő palliatív beutalási kritériumokat ismerik és alkalmazzák, a betegek időben jutnak a megfelelő komplex kezeléshez anélkül, hogy a palliatív ellátórendszer túlterhelődne. Orv Hetil. 2021; 162(44): 1769-1775. Summary. Early integration of palliative care into the trajectory of cancer care brings advantages into the patients' quality of life, the level of care and cost-efficiency, too. On the basis of a predefined model, the right patient may receive the right level of palliative care at the right time. Having defined the advantages, the levels of early integration of palliative care and the concept of special palliative care, we also aim to describe the advantages and disadvantages of the most common referral models on the basis of international literature in this article. The drawback of prognosis-based models to identify patients needing special palliative care is the lack of capacity to provide care for the large number of patients so recognised; therefore they have not become widespread. Needs-based models tend to be complicated and thus rarely applied in everyday clinical practice. On the basis of new researches, simple, pragmatic questionnaires are utilised through which the patients who could benefit from special palliative care interventions are easy to identify. Here we give a detailed report of the Yale University and PALLIA-10 models. On condition that appropriate palliative referral criteria are known and applied by active oncology care providers, patients may receive adequate complex care without the palliative care system being overloaded. Orv Hetil. 2021; 162(44): 1769-1775.

[Special aspects of medical communication in the field of pediatric oncology focusing on palliative care]

Relation between the treating physician, the child with cancer and his/her parents is decisive in the field of pediatric oncology. Medical communication plays a crucial role in this relation. The quality of communication is particularly emphasized during the phase of palliative care in the case of children with incurable malignant disease. The proper medical communication during pediatric palliative care is subject of intensive research which is hindered by the sensitivity of the topic and the difficulties with inclusion of parents whose child has been lost or receiving palliative treatment and of health-care providers, respectively. In the present work, we review the publications focusing on palliative care in the field of pediatric oncology. Despite extensive research, only few investigations focus on the practical aspects of medical communication. Reports on the effectiveness of practical implementation of the existing theories are lacking. Drawing general conclusions is highly hindered by socio-cultural differences, including the diverse parental expectations towards doctors in different cultural and religious settings. However, there is a general agreement that early, simultaneous integration of palliative care at the time of diagnosis sharing is crucial. With the current knowledge, it is essential to conduct further research in this field considering the different socio-cultural backgrounds as well. Orv Hetil. 2020; 161(9): 323-329.

[Validation of the Hungarian version of the Professional Quality of Life Scale]

INTRODUCTION

The Professional Quality of Life Scale, measuring the quality of professional life, has been developed to examine the positive and negative changes in the work of those who have undergone extremely stressful experiences. The quality of life of the personnel of palliative-hospice teams may be influenced physically as well as emotionally by their every-day experiences of suffering, death, dying and the patients' traumas.

AIM

The aim of the study was the examination of the psychometric features and factor structure of the Hungarian version of the Professional Quality of Life Scale questionnaire, which can measure compassion fatigue and satisfaction, secondary traumatisation and burnout. Our long-term objective is the development of formative and intervention strategies for hospice workers in order to increase their satisfaction, physical and mental well-being and their willingness to work in hospice.

METHOD

The cross-sectional, questionnaire study was made with hospice workers. The questionnaires were available in an anonym, printed form. We used the Hungarian versions of the Shortened Maastricht Vital Exhaustion Questionnaire and of the Shortened Beck Depression Scale, of the CES-D Depression Scale and of the Shortened WHO General Well-Being Scale to validate.

STATISTICAL ANALYSIS

IBM SPSS 23.0© software was used for the analysis. To explore the factor structure of the measurement scale, explorative factor analysis was made (analysis of the main component, Varimax rotation); subsequently, 4 scales were prepared the Cronbach-alpha values of which were suitable for further examination.

RESULTS

188 questionnaires were sent back (female 86.2%, male 13.8%); the majority work as nurses and in home hospice care (94 people). The inner consistency of the created 4 scales is acceptable according to the Cronbach-alpha values. The inner consistency of the questions regarding burnout is low. The correlation of our measurement scales with the standardised scales for outer validity has sufficient strength and direction.

CONCLUSIONS

Our questionnaire can measure the phenomena under examination according to the expected values, with suitable consistency on the basis of the inner and outer indicators. Orv Hetil. 2018; 159(35): 1441-1449.

[Difficulties in communication with parents of pediatric cancer patients during the transition to palliative care]

INTRODUCTION

Adequate communication by medical personnel is especially important at certain points during the treatment of childhood cancer patients.

AIM

To investigate the timing and manner of communication with parents concerning the introduction of palliative care in pediatric oncology.

METHOD

Structured interviews, containing 14 questions, were carried out with physicians working in pediatric oncology (n = 22). Codes were generated inductively with the aid of Atlas.ti 6.0 software.

RESULTS

Interviews show a tendency of a one-step transition to palliative care following curative therapy. Another expert is usually involved in communication, most likely a psychologist. Regarding communication, there are expressions utilized or avoided, such as expressing clarity, self-defense and empathy. The communication of death and dying was the most contradictory.

CONCLUSION

This was the first investigation regarding communication in pediatric palliative care in Hungary. Our results show that a modern perspective of palliative communication is present, but necessitates more time to become entrenched. Orv Hetil. 2017; 158(30): 1175-1181.

[Management of secondary lymphedema in patients with cancer]

Due to the increased number of cancer patients and the progress in cancer treatment, there are more cases with cancer-related lymphedema. Lymphedema treatment became part of oncological patients' care. Basic therapy for lymphedema is the complex decongestive therapy, which should be embedded into the patient's comprehensive medical care and should always be determined individually. Results of therapy are influenced by the experience of the doctor and the physiotherapist in lymphedema care, patient's complience, tumor behavior and the accompanying diseases. Lymphedema is a chronic disease, requires lifelong follow-up and treatment. For prevention and better care, it would be important to inform patients about lymphedema risk and appropriate life-style (e.g. weight control) preoperatively and during oncological follow-up. Early diagnosis is important. Lymphedema treatment should be integrated into palliative programmes. If therapy is started in time, complications may be avoided, healthcare costs may be reduced and better quality of life may be achieved.

[Palliative care in non-cancer, chronic, progressive diseases]

Malignant and other chronic diseases cause the death of 2.5 million people in Europe annually. It is anticipated that this number will grow due to the aging of the European population. The death of a significant proportion of patients having progressive chronic disease is preceded by an extended end of life stadium. In this stage the patients have severe symptoms and pain that necessitate their symptomatic treatment and palliative care. The assessment of the life expectancy of patients, estimation of the prognosis of their illness and, therefore, selection of patients with a need of intensified palliative care often pose difficulties. This paper provides a summary on the basic elements of "good palliative care". It introduces the most frequent models for the procession of chronic diseases and those indicators that help practicing doctors to recognise easier patients with a need of intensified palliative care, and as a result provides more adequate medical attendance that is better suited to the specific needs of the patients.