NECPAL Tool Aids Early Identification of Palliative Care Needs.

Background: A key issue in the development of population-based access to palliative care is identification of appropriate patients. Objective: To evaluate the NECPAL (NECesidades Paliativas) tool to identify unmet palliative care needs in the Czech Republic in regional hospitals of the Vysocina region. Methods: We used the End-of-Life care information system (ELFis) to evaluate prognostication to aid the identification of palliative care needs. The evaluation process was developed in cooperation with the regional government and central health care insurance agency as a step toward the development of a nation-wide palliative care program. Results: Our results demonstrate that the NECPAL tool successfully identified palliative care needs in specifically prepared clinical environment. An important part of this is a support of main stakeholders and an effective leadership. Conclusion: An unexpected finding was the role that leadership played in testing the tool, and very short time (10 months) needed for statistically visible changes in a regional system of care.

Factors influencing the end-of-life decisionmaking process about care in hospitalized patients.

The quality of end-of-life care of hospitalized patients is an important topic, but so far little explored in the Czech Republic. The aim of this study was to map the factors influencing the end-of-life care decision-making process in selected Czech hospitals and to describe it based on data from medical records and from the perspective of a doctor. The research included data obtained from the medical records of 240 deceased patients (mean age 76.9 years, 41.6% women). The research sample of medical doctors who commented on the decision-making about end-of-life care for these patients consisted of 369 physicians (mean age 35.9 years, 61% women). The results pointed to persistent deficiencies in the written recording of the care goals, prognosis, and possible decision to limit care. Medical doctors limit health care primarily based on consensus among physicians, the patient is usually not invited to the decision-making process. Patient preferences for the end-of-life period are in most cases not ascertained or this question is postponed. The institute of a previously stated wish did not appear in the examined group at all. It can be concluded that decisions about end-of-life care usually take place without knowledge of patients' values ​​and preferences. The results indicate the need to improve the training of doctors and medical students, which should, in addition to building professional competencies, include training in effective communication with patients at the end of life.

Building Specialized Palliative Care for the Czech Republic: A Fifteen-Year Leadership Journey in a Developing Country.

Since its creation, the Czech Republic has developed an advanced health system and social system. Life expectancy at birth has increased by an average of 7 years in only 20 years. However, polymorbidity and multicausality have now become topics of concern. In some ways they are products of our success. Yet, the health system and social system were not designed for these patients nor are health care professionals trained and willing to assess and address clinical needs of fragile, chronically ill, and incurable patients. This is true in much of the developing world where initial improvements have led to this new population-based challenge. In that sense, the Czech Republic is an example of what needs to happen in developing countries. Inpatient hospice care, which has been developing in the Czech Republic since 1993, is not the answer to this problem. Rather, approaches to ensure that the early introduction of palliative care in the course of serious illness care, personalized medicine, and a multidisciplinary approach in the system is required. Focusing only on terminal illness care is insufficient. Beginning in 2005-2006, we have worked to create a system of education and clinical services in specialized palliative care in the health and social system. This article seeks to describe the leadership steps of this systemic change in the Czech Republic with the objective of helping others make the same journey.

[Geriatric palliative care]. / Geriatrická paliativní péce.

Geriatric palliative care must be based on quality geriatric medicine. This applies in particular the multidisciplinary care of patients with geriatric frailty syndrome, most often associated with the polymorbidity of chronic diseases. The model of early indication of the needs of fragile geriatric patients is not more widely available in the current Czech health and social system. Therefore, the necessary early indication of specialized palliative care is not available in hospital facilities. Regional models of conceptual solutions are a necessary next step in development. Education and, last but not least, the economic and personnel provision of new services are key.

Complex decision making in patients with dementia in an internal medicine department.

With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists. Case reports of patients admitted to an internal medicine department. Description of clinical experiences with caring on patients with dementia. In the internal departments of regional hospitals, there is a room for adjustment of the care plan, for comprehensive assessment of the patient and for making crucial decisions regarding nutrition, treatment of chronic diseases, consideration of previously expressed wishes in the context of the patient condition, and potential prognostic indicators. This assessment must result in a comprehensive documentation and communication with patients, and in the case of advanced dementia with their family members. The general internal medicine is very often the first place where the patient has a chance to hear about indication for palliative care. Without the availability of a multidisciplinary assessment, good communication and documentation, it is unrealistic to expect that the hospital would provide comprehensive care for patients with dementia.

[Palliative care in Czech Republic in 2016]. / Paliativní péce v CR v roce 2016.

In the Czech Republic more than 70,000 patients with chronic incurable diseases need palliative care each year. In 50,000 this need is manageable in the context of general palliative care, 20,000 patients would greatly benefited from specialized palliative care. Most chronically ill patients (> 60 %) died in acute or post acute inpatient health care facilities. Here s the availability and quality of palliative care varies substantially. Inpatient hospices provide end of life palliative care to less than 3000 patients each year. Outpatient and mobile specialized palliative care services are available only to a few hundreds of patients.In the year 2016 palliative care at the appropriate professional level ("state of art") is not a generally available and guaranteed within Czech health care and social system. We perceive an urgent need for the systematic development of general and specialized palliative care at the level of education, healthcare organization and the development of new health and social services.

[About pain - otherwise]. / O bolesti trochu jinak.

UNLABELLED: We can speak about palliative medicine from different points of view. Twelve years in hospice care and my clinical, health policy and foreign experiences have ensured me that our medical service is one of the best in the world. Unfortunately, it is not completely balanced to acute care and does not have ability to reflect the needs of chronically ill patients. These patients are now the vast majority of aging population and the topics as (not only) geriatric fragility and palliative care will rise interest in daily clinical practice, in decision making process, in health policy and in economy in the coming 20 years. In this environment, we, the doctors, are the key indicators of quality, because our personality and decisions fundamentally affect the plan of care. The question is whether we know the real needs of patients, whether we look not only for medical but also for general human resources to achieve them, and whether the current system and society allow this. This reflection is about these rather philosophical and moral aspects of our work and about role of doctor in "modern times". KEYWORDS: aging population - geriatric fragility syndrome - health policy - palliative care - socio-economic aspects of care.

[Palliative care and chronic heart failure]. / Paliativní péce a chronické srdecní selhání

Heart failure is a very common clinical syndrome in cardiology which reduces life expectancy and has a significant impact on the quality of life. The treatment of heart failure improves survival thus the number of patients who reach the terminal state increases with this diagnosis. Major symptoms and psychosocial difficulties begin to appear during therapy which aims to prolong life or cure the life limiting illnesses. The World Health Organization (WHO) changed its definition in 2002 and concluded that palliative care should be provided "in the early stages of disease, together with another treatment that prolongs life." Palliative care involves multiple disciplines in order to solve problems caused by the symptoms of the disease and other related aspects of the patient and family who are considered as a one subject, because a feeling of well-being has an impact on others.Key words: heart failure - non-pharmacological treatment - palliative care.

Spiritual support interventions in nursing care for patients suffering death anxiety in the final phase of life.

PURPOSE: To investigate which activities from the 'Spiritual Support' intervention of the Nursing Interventions Classification (NIC) are used in patients with the nursing diagnosis 'Death Anxiety' in the Czech Republic, and which activities could feasibly be implemented into practice. METHOD: The study surveyed 468 Czech nurses using a quantitative questionnaire with Likert scales. RESULTS: The most frequently used activity was 'Treat individual with dignity and respect' and the least frequently used was 'Pray with the individual'. 'Treat individual with dignity and respect' was also thought to be the most feasible activity for Czech nursing practice. Significant differences were found between nurses working in hospices and those in other sites and between religious believers and non-believers. CONCLUSION: Even in the secularised Czech Republic, nurses can make use of the NIC Spiritual Support intervention in end-of-life care.