International Journal Rehabilitation and Palliative Medicine. 2023. 1(8): 29-36; doi 10.15574/IJRPM.2023.8.29
Tsarenko A. V., Moiseyenko R. O., Goyda N. G.
Shupyk National University of Healthcare of Ukraine, Kyiv

Purpose – to carry out medical and social analysis of conditions and organizational aspects of the Palliative and Hospice Care (PHC) System implementation and development in Ukraine.
Materials and methods. There were analyzed: domestic and foreign scientific literary sources; data of official statistics of the State Statistics Service and the Ministry of Health of Ukraine; normative-legal documents of Ukraine and authoritative international professional organizations. Аnd the following research methods were applied: bibliosemantic, system approach and system analysis, comparative content analysis and generally accepted medical-statistical methods.

• The peculiarities of the medical and demographic situation in Ukraine in recent decades are the rapid population aging, high morbidity and mortality from cancer and severe complications of chronic noncommunicable diseases, significant spread of HIV/AIDS, tuberculosis, viral hepatitis B and C etc. This requires the creation and improvement of an adequate regulatory framework (RF), which regulates the development of an accessible multidisciplinary, interagency and intersectoral PHC System, which requires the development of outpatient PHC services and inpatient PHC facilities, coordination of institutions and agencies subordinate to various ministries and agencies, first of all, the Ministry of Health of Ukraine and the Ministry of Social Policy of Ukraine; introduction of a system of motivation and training of PHC providers and involvement primary health care facilities medical staff in the palliative care provision at home. Thus, affordable and high-quality PHC should be integrated into the Health Care and Social Protection System, as PHC in the early stages of a life-threatening or incurable disease can significantly reduce suffering and improve the quality of life for both palliative patients (PPs) and their families.
• The urgency of the problem of creating and developing a System of affordable, high quality and effective PHC in Ukraine is due to the unfavorable medical and demographic situation – population aging, increasing morbidity and mortality from cancer and chronic diseases, often accompanied by chronic pain syndrom and other severe symptoms that significantly reduce the quality of life of PPs.

  The implementation of the PHC System for the population requires political support from the Government of Ukraine, Regional and Local Authorities, appropriate financial support and the whole society participation. Implementation and development of the PHC System in Ukraine with adequate funding from the State Budget (National Health Service of Ukraine), as well as through state, regional and local targeted PHC Programs will provide quality and effective multidisciplinary and interagency palliative care on equal terms, regardless of the nosology of the disease, PPs place of residence/stay and social status.

The results of the study allowed to adapt international experience and identify different forms of PНC, which, depending on the severity of the disease and at the request of PPs and their families, can be provided in specialized inpatient PНC facilities, PНC departments of secondary and tertiary health care facilities or outpatient settings, including at home, as well as in PHC facilities of any form of ownership and departmental affiliation, subject to compliance with the standards and requirements of the RF.

No conflict of interests was declared by the authors.

• Palliative and Hospice Care System; multidisciplinary, interagency and intersectoral approach; palliative patients; regulatory framework.

REFERENCES

1. Chaikovska V, Vialykh T, Tsarenko A. (2018). Estimation of need for staff care training for the elderly persons. International journal Rehabilitation and Palliative Medicine. International journal Rehabilitation and Palliative Medicine. 1 (7): 43-50.

2. Chaikovska V, Vialykh T, Tsarenko A. (2018). Methodological basis for the course «Fundamentals of long-term and palliative care for elderly patients and internally displaced persons» (to help educational institutions of the 2nd-4th accreditation levels). International journal Rehabilitation and Palliative Medicine. 1 (7): 36-46.

3. Council of Europe. (2014, Oct). European Declaration on Palliative Care. Launched in Brussels. URL: http://palliativecare2020.eu/declaration/.

4. Detsyk OZ, Melnyk RM. (2018). Analiz bachennia medychnykh pratsivnykiv shchodo problem orhani-zatsii pediatrychnoi paliatyvnoi dopomohy v Ukraini. Ekonomika i pravo okhorony zdorov’ia. 2 (8): 17-22.

5. Detsyk OZ, Zolotareva JhM. (2015). Palliative care: problems of incurable patients’ families. International journal Rehabilitation and Palliative Medicine. 1 (1): 55-59. doi: 10.15574/IJRPM.2015.01.55.

6. Diachuk DD. (2003). Orhanizatsiini pidkhody do nadannia paliatyvnoi medychnoi dopomohy inkurabelnym onkolohichnym khvorym. Visnyk sotsialnoi hihiieny ta orhanizatsii okhorony zdorov’ia Ukrainy. 2: 48-54.

7. EAPC. (2014). Specialisation in Palliative Medicine for Physicians in Europe – presenting a new EAPC publication. Europ J of Palliative Care. 21: 6. URL: http://www.eapcnet.eu/Portals/0/Clinical/Publications/EJPC21(6)_Centeno.pdf.

8. Gubskiy Yu, Serdiuk W, Martyniuk-Gres S, Tsarenko A, Wolf A. (2007). Opieka paliatywna na Ukrainie: osiagniecia I perspektywy. Clinical and Experimental Letters. 48: 23-24.

9. Hoida NH, Tsarenko AV, Kniazevych VM, Hubskyi YuI. (2015). Orhanizatsiini aspekty stvorennia systemy paliatyvnoi ta khospisnoi dopomohy v Ukraini. U zb.: Aktualni pytannia nadannia paliatyvnoi ta khospisnoi dopomohy v Ukraini. Orhanizatsiini, medyko-iurydychni ta kliniko-farmatsevtychni pytannia. Materialy III Vseukr. nauk.-prakt. konfer. 22-24.04.2015. Za red. YuV Voronenka, YuI Hubskoho. Kyiv: Talkom: 32-48.

10. Hubskyi YuI, Hoyda NH, Tsarenko AV. (2015). Development of palliative and hospice care in Ukraine: institutional, legal and medical aspects. International journal Rehabilitation and Palliative Medicine. 1 (1): 68-74. doi: 10.15574/IJRPM.2015.01.68.

11. Hubskyi YuI, Tsarenko AV, Skoryna OO et al. (2009). Aktualni pytannia vprovadzhennia systemy paliatyvnoi dopomohy ta zabezpechennia prav patsiientiv z obmezhenym prohnozom zhyttia v Ukraini. U zb. Pravo na medychnu dopomohu v Ukraini. Kharkivska pravozakhysna hrupa. Kharkiv: Prava liudyny: 224-266.

12. Hubskyi YuI, Tsarenko AV. (2017). Paliatyvna dopomoha ta eutanaziia: medyko-sotsialni, bioetychni, pravovi aspekty. Zdorov’ia suspilstva. 6 (1-2): 87-97.

13. Ivolhin VI, Voronenko YuV, Moiseienko RO, Kniazevych VM et al. (2017). Stan, problemy ta perspektyvy rozvytku paliatyvnoi ta khospisnoi dopomohy v Ukraini. Zb. Shchorichna dopovid pro stan zdorov’ia naselennia, sanitarno-epidemichnu sytuatsiiu ta rezultaty diialnosti systemy okhorony zdorov’ia Ukrainy. 2016 rik. MOZ Ukrainy, DU «UISD MOZ Ukrainy». Kyiv: 266-293.

14. Kniazevych VM, Tsarenko AV, Yakovenko IV, Bratsiun OP. (2013). Natsionalna Stratehiia stvorennia ta rozvytku systemy paliatyvnoi dopomohy v Ukraini (proekt). Materialy Pershoho Natsionalnoho Konhresu z paliatyvnoi dopomohy. (m. Irpin, 26–27.09.2012 r.). K.: Vydavnychyi dim «Kalyta»: 7-14.

15. Kniazevych VM. (2015). Perspektyvy rozvytku paliatyvnoi dopomohy v Ukraini. International journal Rehabilitation and Palliative Medicine. 2: 131-134.

16. Kriukov SA. (2002). Derzhavne upravlinnia v sferi medyko-sotsialnoi dopomohy beznadiino khvorym. Avtoref. dys. kand. nauk z derzh upravl. Donetska derzhavna akademiia upravlinnia Ministerstva osvity i nauky Ukrainy. Donetsk: 20.

17. Lekhan VM, Diachuk DD. (2003). Orhanizatsiina model systemy paliatyvnoi medychnoi dopomohy inkurabelnym onkolohichnym khvorym. Okhorona zdorov’ia Ukrainy. 3: 35-42.

18. Matiukha LF, Medvedovska NV, Matviiets LH. (2018). Features of the psychological aspect of the work of initial contact physicians in providing palliative care to the patient and their family. International journal Rehabilitation and Palliative Medicine. 1 (7): 24-30. doi: 10.15574/IJRPM.2018.7.24.

19. Moiseenko RA. (2016). The social pediatrics: a focus on medical and social support for children with special needs and palliative care in pediatrics. International journal Rehabilitation and Palliative Medicine. 1 (4): 10-13.

20. Moskviak YeY, Bilynskyi BT. (2000). Orhanizatsiini problemy nadannia dopomohy inkurabelnym onkolohichnym khvorym dopomohy. Likarska sprava. 2: 28-29.

21. Sovet Evropyi. (2004). Rekomendatsii Komiteta Ministrov Soveta Evropyi k gosudarstvam-chlenam po organizatsii palliativnogo uhoda. Sovet Evropyi: 89.

22. Tsarenko A, Serdiuk V, Martyniuk-Gres S, Shkoba L. (2008). Improving of palliative care specialists’ training in Ukraine. Palliative Care in Different Cultures. The 2-nd International Conference in Palliative Care. Eilat, Israel: 80.

23. Tsarenko AV, Hoida NH, Hubskyi YuI. (2019). Obgruntuvannia kontseptualnoi modeli systemy paliatyvnoi i khospisnoi dopomohy naselenniu na rivni pervynnoi medychnoi dopomohy. Zdorov’ia suspilstva. 8 (2): 49-57.

24. Voronenko YuV, Hubskyi YuI, Tsarenko AV. (2014). Stvorennia systemy paliatyvnoi ta khospisnoi dopomohy v umovakh reformuvannia okhorony zdorov‘ia v Ukraini: medychni ta sotsialni aspekty. Nauka i praktyka. Mizhvidomchyi medychnyi zhurnal. 1 (2): 63-75.

25. Voronenko YuV, Kniazevych VM, Zavoloka OV et al. (2016). Sotsialno-medychni aspekty rozvytku paliatyvnoi ta khospisnoi dopomohy v Ukraini. Zb.: Shchorichna dopovid pro stan zdorov’ia naselennia, sanitarno-epidemichnu sytuatsiiu ta  rezultaty diialnosti systemy okhorony zdorov’ia Ukrainy. 2015 rik. Za red. VV Shafranskoho; MOZ Ukrainy; «DU UISD MOZ Ukrainy». Kyiv: 284-301.

26. VOZ. (2014). Ukreplenye pallyatyvnoi medytsynskoi pomoshchy v kachestve odnoho yz komponentov kompleksnoho lechenyia na protiazhenyy vseho zhyznennoho tsykla. Rezoliutsyia 67-i sessyy Vsemyrnoi assambley zdravookhranenyia, № A67/31 ot 4 aprelia 2014 h. Zheneva: 11. URL: http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_31-ru.pdf.

27. WHO. (2004). What are palliative care needs of older people and how might they be met? – Copenhagen: WHO Regional Office for Europe: 16. URL: http://www.euro.who.int/ document/E83747.pdf.

28. WHO. (2014). Global Atlas of Palliative Care at the End of Life. Edited by SR Connor, MCS Bermedo: 111.

29. WHO. (2016). Planning and implementing palliative care services: a guide for programme managers. Geneva, Switzerland: 92.

30. Wodarg W. (2008, Nov 4). Palliative care: a model for innovative health and social policies. Report. Doc. 11758. Council of Europe. Parliament Assembly. Social, Health and Family Affairs Committee. URL: http://assembly.coe.int/Main.asp?link/Documents/WorkingDocs08/EDOC11758. htm.