In front of the next step in palliative care in Poland

Speaking at a conference in Poland earlier this year, EAPC President, Professor Sheila Payne, met Dr Tomasz Gradalski, Medical Director of St Lazarus Hospice in Kraków, Poland, and invited him to contribute to the blog. Dr Gradalski talks about some of the challenges that confront palliative care in Poland today.

Dr Tomasz Gradalski

Dr Tomasz Gradalski

Since Dame Cicely Saunders inspired our pioneers in the development of palliative care, Poland has made impressive progress in this field. Nowadays, in terms of the number of palliative care units, we are in third position in Europe and the number of specialists (physicians and nurses) is increasing. This field of medicine has already been integrated into mainstream healthcare provision.

The first multiprofessional voluntary palliative care service was started at St Lazarus Hospice in 1988. In 1993 home care began with employed staff, and dozens of patients received help each year. From that time, tremendous progress has been made and recently we have managed to care for more than 1,300 people a year.

St Lazarus Hospice: members of the hospice inpatient team

St Lazarus Hospice: members of the hospice inpatient team

But there is still a lot to do. Up to 10% of patients still have to seek palliative care on their own, without any support from their doctors. The majority of patients admitted to our hospice are referred from local hospitals when they are in the advanced stage of their disease. A minority are admitted from the community and (the smallest number) come from the long-term care facilities. There is no actual connection between palliative care and long-term care fields, aside from a few patients that we have in nursing homes within our home care service. We are very concerned that most of the long-term care units’ residents are dying during needless hospitalisation at the end of life and we have therefore begun an ongoing training programme for GPs.

St Lazarus Hospice: members of the outpatient team

St Lazarus Hospice: members of the outpatient team

A lot of challenges are ahead of us. In my opinion, one of the biggest challenges is the financial one: maintaining the delivery of proper quality of care is impossible by relying only on health insurance resources, thus it is necessary to raise additional money from charitable sources. Another problem is the severe lack of beds for long-term patients in Poland (in fact, we need four times the existing number of beds). Hospices are not able to discharge patients whose conditions remain stable without a delay. Consequently, there are several persons every month who die while waiting for admission. We are aware that many people suffer needlessly in hospitals. Some are diagnosed and documented by physicians as being in pain, but they are still left without analgesics. Others, during the last period of their life, receive medication with a high risk of side effects and no certain benefits A further challenge that we face is related to patient safety, where there is rather poor correlation between documented complaints and the patient’s real presentation of his/her situation.

The way ahead is not easy partly because the hospice movement in Poland is perceived as a social rather than as a medical service. But we have the potential to overcome the challenges – now is the time for action!

Links and resources…


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