Articles: palliative-care.
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Pol. Arch. Med. Wewn. · Mar 2022
ReviewMedical referral criteria for palliative care in adults: a scoping review.
Palliative care (PC) is focused on the relief of serious suffering due to severe illness. The Polish health care reimbursement system limits the access to PC to a so-called "basket" of recipients with life‑limiting incurable diseases (mainly cancer), not responding to disease‑modifying therapy. This scoping literature review was aimed to define the criteria of medical referral for PC in the context of the interpretation of the terms life‑limiting illness and disease‑modifying therapy, which may aid in increasing the number of appropriate referrals and patients receiving optimal treatment. ⋯ Equally important as limited survival prognosis is the presence of severe, complex, and persistent symptoms or problems occurring despite optimal treatment and general care. Based on the reviewed literature, the national reimbursement program should be urgently extended to cover more patients who are eligible and could benefit from specialist PC. Additionally, the importance of general PC should be universally acknowledged.
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Opioids are part of the daily routine in anesthesiology and palliative care; however, treatment of dyspnea with opioids is presented heterogeneously in guidelines. This may result in an uncertainty concerning opioid indications and ethical concerns, especially when caring for COVID-19 patients. ⋯ Anesthesiologists perceived considerable uncertainty in using M/O for nonpalliative care medical settings. Highest uncertainty was seen for the care of patients with COVID-19. The prevalent use of the subcutaneous route for M/O application in palliative care can serve as inspiration for areas outside palliative care as well. Uniform interdisciplinary guidelines for symptom control including dyspnea, education and involvement of a palliative care consultation team should be more considered in the future.