{"id":19254,"date":"2026-10-20T11:55:53","date_gmt":"2026-10-20T09:55:53","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=19254"},"modified":"2026-10-20T11:55:53","modified_gmt":"2026-10-20T09:55:53","slug":"paliatia-trebuie-integrata-in-parcursul-obisnuit-al-pacientului","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/paliatia-trebuie-integrata-in-parcursul-obisnuit-al-pacientului\/","title":{"rendered":"Palia\u021bia trebuie integrat\u0103 \u00een parcursul obi\u0219nuit al pacientului"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong>Prof. dr. Vladimir Poroch<\/strong><\/p>\n<ul style=\"text-align: justify;\">\n<li><strong>Medic primar chirurgie general\u0103, atestat \u00eengrijiri paliative<\/strong><\/li>\n<li><strong>Pre\u0219edinte Asocia\u021bia Na\u021bional\u0103 de \u00cengrijiri Paliative \u2013 ANIP<\/strong><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><em>\u00cengrijirea paliativ\u0103 \u00eenseamn\u0103 mai mult dec\u00e2t controlul simptomelor \u00een stadiile avansate ale bolii. \u00censeamn\u0103 acces la servicii adecvate, sprijin pentru pacien\u021bi \u0219i familii \u0219i integrarea \u00eengrijirii paliative \u00een parcursul terapeutic, c\u00e2t mai devreme. Despre evolu\u021biile din domeniu, obiectivele Asocia\u021biei Na\u021bionale de \u00cengrijiri Paliative \u0219i provoc\u0103rile dezvolt\u0103rii unei re\u021bele accesibile la nivel na\u021bional am discutat cu domnul profesor dr. Vladimir Poroch, medic primar chirurgie general\u0103, cu atestat \u00een \u00eengrijiri paliative \u0219i pre\u0219edintele ANIP.<\/em><\/p>\n<p><strong>Conferin\u021ba Na\u021bional\u0103 de \u00cengrijiri Paliative a devenit un reper pentru profesioni\u0219tii din domeniu. Ce aduce nou edi\u021bia din acest an \u0219i care sunt principalele teme pe care le considera\u021bi relevante pentru practica \u00eengrijirilor paliative din Rom\u00e2nia?<\/strong><\/p>\n<p style=\"text-align: justify;\">Tema edi\u021biei din acest an, \u201eDe la nevoie la acces \u0219i integrare \u00een sistemul sanitar\u201d, exprim\u0103 foarte bine etapa \u00een care ne afl\u0103m. Nevoia de \u00eengrijiri paliative este ast\u0103zi recunoscut\u0103, dar adev\u0103rata provocare este transformarea acestei nevoi \u00eentr-un acces efectiv, echitabil \u0219i la momentul potrivit. Urm\u0103torul pas trebuie s\u0103 fie integrarea palia\u021biei \u00een parcursul obi\u0219nuit al pacientului, al\u0103turi de medicina de familie \u0219i de specialit\u0103\u021bile care trateaz\u0103 boala de baz\u0103.<\/p>\n<p style=\"text-align: justify;\">Programul conferin\u021bei urm\u0103re\u0219te tocmai aceast\u0103 trecere de la principii la solu\u021bii aplicabile. Vom discuta despre situa\u021bia actual\u0103 a \u00eengrijirilor paliative din Rom\u00e2nia, evaluarea \u00een dinamic\u0103 a nevoilor pacientului, palia\u021bia bolilor non-oncologice, \u00eengrijirea la domiciliu, telemedicin\u0103 \u0219i reducerea barierelor care \u00eent\u00e2rzie accesul. O aten\u021bie important\u0103 este acordat\u0103 \u00eengrijirilor paliative pediatrice \u0219i v\u00e2rstnicului cu patologie non-oncologic\u0103, dou\u0103 domenii care necesit\u0103 o dezvoltare mai consistent\u0103.<\/p>\n<p style=\"text-align: justify;\">Componenta clinic\u0103 este foarte bine reprezentat\u0103: managementul durerii \u0219i al simptomelor rare, utilizarea ra\u021bional\u0103 \u0219i deprescrierea medica\u021biei, nutri\u021bia, radioterapia paliativ\u0103, urgen\u021bele neobi\u0219nuite \u0219i situa\u021biile clinice complexe de la sf\u00e2r\u0219itul vie\u021bii. \u00cen acela\u0219i timp, programul reflect\u0103 caracterul holistic al palia\u021biei prin sesiuni dedicate comunic\u0103rii empatice, suportului psihosocial \u0219i spiritual, sprijinului \u00een doliu, planific\u0103rii anticipate a \u00eengrijirii \u0219i sus\u021binerii profesioni\u0219tilor din echip\u0103.<\/p>\n<p style=\"text-align: justify;\">Abord\u0103m \u0219i teme de mare actualitate, precum aspectele etice ale inteligen\u021bei artificiale, limitele tehnologiei, deciziile de tip DNR \u0219i dilemele etice de la sf\u00e2r\u0219itul vie\u021bii. Cred c\u0103 tocmai aceast\u0103 \u00eembinare \u00eentre practica medical\u0103, organizarea serviciilor, comunicare, etic\u0103 \u0219i dimensiunea uman\u0103 reprezint\u0103 valoarea edi\u021biei din acest an. Mesajul central este c\u0103 nu este suficient s\u0103 \u0219tim c\u0103 pacientul are nevoie de palia\u021bie; trebuie s\u0103 construim mecanismele prin care el s\u0103 ajung\u0103 efectiv la serviciul potrivit, \u00een locul potrivit \u0219i la momentul potrivit.<\/p>\n<p style=\"text-align: justify;\"><strong>\u00cen ultimul interviu ne-a\u021bi vorbit despre necesitatea unei dezvolt\u0103ri coordonate \u0219i sustenabile a \u00eengrijirilor paliative \u00een Rom\u00e2nia. Ce s-a schimbat \u00een acest interval \u0219i care sunt ast\u0103zi cele mai importante evolu\u021bii pe care le observa\u021bi \u00een domeniu?<\/strong><\/p>\n<p style=\"text-align: justify;\">Observ\u0103m unele evolu\u021bii importante. \u00cen primul r\u00e2nd, \u00eengrijirea paliativ\u0103 este mai prezent\u0103 \u00een dezbaterea medical\u0103 \u0219i institu\u021bional\u0103, iar necesitatea unui Program Na\u021bional de \u00cengrijiri Paliative (PNIP) este recunoscut\u0103 tot mai clar. A fost creat cadrul legislativ pentru dezvoltarea acestui program \u0219i s-au f\u0103cut pa\u0219i pentru definirea serviciilor de baz\u0103 \u0219i specializate \u0219i a modalit\u0103\u021bilor de finan\u021bare.<\/p>\n<p style=\"text-align: justify;\">\u00cen al doilea r\u00e2nd, exist\u0103 o preocupare mai mare pentru diversificarea serviciilor. Nu mai putem construi palia\u021bia aproape exclusiv \u00een jurul unit\u0103\u021bilor cu paturi. Avem nevoie de servicii la domiciliu, ambulatorii, echipe mobile de spital, centre de zi \u0219i de o implicare mai consistent\u0103 a medicinei de familie.<\/p>\n<p style=\"text-align: justify;\">Exist\u0103 \u0219i o mai bun\u0103 \u00een\u021belegere a faptului c\u0103 palia\u021bia nu se adreseaz\u0103 doar pacientului oncologic \u0219i nici numai ultimelor zile de via\u021b\u0103. Beneficiarii sunt \u0219i pacien\u021bii cu insuficien\u021be cronice de organ, boli neurologice progresive, demen\u021be, insuficien\u021b\u0103 cardiac\u0103, boala cronic\u0103 de rinichi \u0219i alte afec\u021biuni amenin\u021b\u0103toare de via\u021b\u0103.<\/p>\n<p style=\"text-align: justify;\">Totu\u0219i, trebuie s\u0103 facem diferen\u021ba \u00eentre existen\u021ba unui cadru normativ \u0219i func\u021bionarea efectiv\u0103 a unei re\u021bele na\u021bionale. Evolu\u021bia este real\u0103, dar \u00eenc\u0103 insuficient\u0103. Implementarea, finan\u021barea sustenabil\u0103, resursele umane \u0219i reducerea diferen\u021belor teritoriale r\u0103m\u00e2n marile provoc\u0103ri.<\/p>\n<p style=\"text-align: justify;\"><strong>Pentru perioada urm\u0103toare, care sunt principalele obiective ale ANIP \u0219i ce considera\u021bi c\u0103 ar trebui s\u0103 se schimbe \u00een urm\u0103torii ani pentru ca \u00eengrijirea paliativ\u0103 s\u0103 fie mai bine integrat\u0103 \u00een sistemul de s\u0103n\u0103tate din Rom\u00e2nia?<\/strong><\/p>\n<p style=\"text-align: justify;\">Un obiectiv major al ANIP este s\u0103 contribuie la transformarea cadrului strategic \u0219i legislativ \u00eentr-o re\u021bea func\u021bional\u0103 de servicii, accesibil\u0103 pacien\u021bilor din toate regiunile \u021b\u0103rii. Dorim s\u0103 r\u0103m\u00e2nem un partener activ al Ministerului S\u0103n\u0103t\u0103\u021bii, al Casei Na\u021bionale de Asigur\u0103ri de S\u0103n\u0103tate, al organiza\u021biilor profesionale, universit\u0103\u021bilor \u0219i furnizorilor publici, priva\u021bi \u0219i neguvernamentali.<\/p>\n<p style=\"text-align: justify;\">O alt\u0103 prioritate este dezvoltarea resursei umane. Avem nevoie at\u00e2t de mai mul\u021bi profesioni\u0219ti specializa\u021bi, c\u00e2t \u0219i de competen\u021be de baz\u0103 \u00een palia\u021bie pentru medicii de familie \u0219i speciali\u0219tii care \u00eengrijesc pacien\u021bi cu boli cronice progresive \u00een unit\u0103\u021bi sanitare care nu au structuri specializate de palia\u021bie . Educa\u021bia \u00een \u00eengrijirea paliativ\u0103 trebuie consolidat\u0103 \u00een preg\u0103tirea universitar\u0103, postuniversitar\u0103 \u0219i \u00een formarea profesional\u0103 continu\u0103.<\/p>\n<p style=\"text-align: justify;\">ANIP va continua s\u0103 sus\u021bin\u0103 standardele de calitate, ghidurile de practic\u0103, cercetarea, colectarea de date relevante \u0219i schimbul de experien\u021b\u0103 \u00eentre servicii. \u00cen acela\u0219i timp, avem responsabilitatea de a informa corect publicul \u0219i profesioni\u0219tii despre ceea ce este \u0219i ceea ce nu este \u00eengrijirea paliativ\u0103.<\/p>\n<p style=\"text-align: justify;\">\u00cen urm\u0103torii ani, ar trebui s\u0103 trecem de la ini\u021biative fragmentate la un parcurs coerent al pacientului, \u00een care palia\u021bia s\u0103 fie integrat\u0103 \u00een oncologie, cardiologie, neurologie, pneumologie, nefrologie, geriatrie, pediatrie \u0219i medicina de familie, psihiatrie etc. Pacientul nu trebuie s\u0103 fie obligat s\u0103 aleag\u0103 \u00eentre tratamentul bolii \u0219i tratamentul suferin\u021bei sale sau a experien\u021bei pe care o tr\u0103ie\u0219te odat\u0103 cu parcurgere traiectoriei bolii.<\/p>\n<p><strong>Accesul la \u00eengrijiri paliative este \u00eenc\u0103 inegal la nivel na\u021bional. Ce ar trebui schimbat pentru ca pacientul s\u0103 poat\u0103 beneficia de astfel de servicii la momentul potrivit, indiferent de domiciliu sau de tipul bolii?<\/strong><\/p>\n<p style=\"text-align: justify;\">Un obiectiv major al ANIP este s\u0103 contribuie la transformarea cadrului strategic \u0219i legislativ \u00eentr-o re\u021bea func\u021bional\u0103 de servicii, accesibil\u0103 pacien\u021bilor din toate regiunile \u021b\u0103rii. Dorim s\u0103 r\u0103m\u00e2nem un partener activ al Ministerului S\u0103n\u0103t\u0103\u021bii, al Casei Na\u021bionale de Asigur\u0103ri de S\u0103n\u0103tate, al organiza\u021biilor profesionale, universit\u0103\u021bilor \u0219i furnizorilor publici, priva\u021bi \u0219i neguvernamentali.<\/p>\n<p style=\"text-align: justify;\">O alt\u0103 prioritate este dezvoltarea resursei umane. Avem nevoie at\u00e2t de mai mul\u021bi profesioni\u0219ti specializa\u021bi, c\u00e2t \u0219i de competen\u021be de baz\u0103 \u00een palia\u021bie pentru medicii de familie \u0219i speciali\u0219tii care \u00eengrijesc pacien\u021bi cu boli cronice progresive \u00een unit\u0103\u021bi sanitare care nu au structuri specializate de palia\u021bie. Educa\u021bia \u00een \u00eengrijirea paliativ\u0103 trebuie consolidat\u0103 \u00een preg\u0103tirea universitar\u0103, postuniversitar\u0103 \u0219i \u00een formarea profesional\u0103 continu\u0103.<\/p>\n<p style=\"text-align: justify;\">ANIP va continua s\u0103 sus\u021bin\u0103 standardele de calitate, ghidurile de practic\u0103, cercetarea, colectarea de date relevante \u0219i schimbul de experien\u021b\u0103 \u00eentre servicii. \u00cen acela\u0219i timp, avem responsabilitatea de a informa corect publicul \u0219i profesioni\u0219tii despre ceea ce este \u0219i ceea ce nu este \u00eengrijirea paliativ\u0103.<\/p>\n<p style=\"text-align: justify;\">\u00cen urm\u0103torii ani, ar trebui s\u0103 trecem de la ini\u021biative fragmentate la un parcurs coerent al pacientului, \u00een care palia\u021bia s\u0103 fie integrat\u0103 \u00een oncologie, cardiologie, neurologie, pneumologie, nefrologie, geriatrie, pediatrie \u0219i medicina de familie, psihiatrie etc. Pacientul nu trebuie s\u0103 fie obligat s\u0103 aleag\u0103 \u00eentre tratamentul bolii \u0219i tratamentul suferin\u021bei sale sau a experien\u021bei pe care o tr\u0103ie\u0219te odat\u0103 cu parcurgere traiectoriei bolii.<\/p>\n<p><strong>Una dintre direc\u021biile importante pentru dezvoltarea palia\u021biei este integrarea ei mai timpurie \u00een \u00eengrijirea pacien\u021bilor cu boli cronice progresive. C\u00e2t de departe suntem \u00een Rom\u00e2nia de momentul \u00een care \u00eengrijirea paliativ\u0103 va fi privit\u0103 ca parte a parcursului terapeutic \u0219i nu doar ca o interven\u021bie pentru stadiile terminale ale bolii?<\/strong><\/p>\n<p style=\"text-align: justify;\">La nivel de principii profesionale, \u0219tim foarte clar \u00een ce direc\u021bie trebuie s\u0103 mergem: \u00eengrijirea paliativ\u0103 trebuie integrat\u0103 precoce \u0219i oferit\u0103 concomitent cu tratamentele adresate bolii. La nivelul practicii cotidiene, \u00eens\u0103, suntem \u00eenc\u0103 \u00eentr-o perioad\u0103 de tranzi\u021bie.<\/p>\n<p style=\"text-align: justify;\">Persist\u0103 asocierea palia\u021biei cu abandonarea tratamentului sau cu apropierea iminent\u0103 a mor\u021bii. Aceast\u0103 percep\u021bie exist\u0103 uneori nu doar \u00een r\u00e2ndul pacien\u021bilor \u0219i familiilor, ci \u0219i al profesioni\u0219tilor. Din acest motiv, trimiterea c\u0103tre serviciile de palia\u021bie se face adesea foarte t\u00e2rziu, c\u00e2nd suferin\u021ba este deja sever\u0103, iar posibilitatea unei interven\u021bii complexe \u0219i eficiente este redus\u0103.<\/p>\n<p style=\"text-align: justify;\">Pentru a schimba aceast\u0103 situa\u021bie avem nevoie de criterii de screening al nevoilor paliative, trasee clinice integrate \u0219i colaborare real\u0103 \u00eentre echipa care trateaz\u0103 boala de baz\u0103 \u0219i echipa de palia\u021bie. Integrarea trebuie prev\u0103zut\u0103 \u00een protocoalele clinice, nu l\u0103sat\u0103 exclusiv la ini\u021biativa individual\u0103.<\/p>\n<p style=\"text-align: justify;\">A\u0219adar, direc\u021bia este corect\u0103 \u0219i exist\u0103 centre \u00een care acest model func\u021bioneaz\u0103, dar el nu este \u00eenc\u0103 aplicat uniform. Vom putea vorbi despre o integrare real\u0103 atunci c\u00e2nd accesul la palia\u021bie va fi declan\u0219at de complexitatea nevoilor pacientului, nu de ideea c\u0103 \u201enu se mai poate face nimic\u201d.<\/p>\n<p><strong>\u00cen ultimii ani, s-a discutat tot mai mult despre integrarea \u00eengrijirilor paliative precoce, inclusiv al\u0103turi de tratamentele oncologice sau pentru alte boli cronice progresive. C\u00e2t de important este ca pacientul s\u0103 ajung\u0103 la palia\u021bie \u00eenaintea stadiilor terminale ale bolii?<\/strong><\/p>\n<p style=\"text-align: justify;\">Este esen\u021bial. \u00cengrijirea paliativ\u0103 precoce nu \u00eenseamn\u0103 renun\u021barea la tratamentul oncologic sau la alte terapii active. \u00censeamn\u0103 ad\u0103ugarea unui nivel de \u00eengrijire care controleaz\u0103 simptomele, previne suferin\u021ba evitabil\u0103 \u0219i ajut\u0103 pacientul \u0219i familia s\u0103 fac\u0103 fa\u021b\u0103 mai bine bolii.<\/p>\n<p style=\"text-align: justify;\">Dac\u0103 intervenim devreme, putem trata durerea, dispneea, grea\u021ba, oboseala, insomnia, anxietatea sau depresia \u0219i alte suferin\u021be \u00eenainte ca acestea s\u0103 devin\u0103 cople\u0219itoare. Putem sprijini men\u021binerea autonomiei \u0219i a capacit\u0103\u021bii func\u021bionale, putem facilita comunicarea privind obiectivele \u00eengrijirii \u0219i putem preveni investiga\u021bii, intern\u0103ri sau interven\u021bii care nu aduc un beneficiu real pacientului (inclusiv s\u0103 evit\u0103m \u00eencr\u00e2ncenarea terapeutic\u0103).<\/p>\n<p style=\"text-align: justify;\">Exist\u0103 \u0219i un avantaj important pentru familie. Aceasta prime\u0219te informa\u021bie, sprijin emo\u021bional \u0219i social, preg\u0103tire pentru \u00eengrijirea la domiciliu \u0219i, atunci c\u00e2nd este necesar, suport \u00een perioada de doliu.<\/p>\n<p style=\"text-align: justify;\">Mesajul pe care trebuie s\u0103 \u00eel transmitem este c\u0103 palia\u021bia nu \u00eencepe atunci c\u00e2nd medicina activ\u0103 se opre\u0219te. Ea poate \u0219i trebuie s\u0103 \u00eenso\u021beasc\u0103 tratamentul bolii. Cu c\u00e2t este introdus\u0103 mai devreme, cu at\u00e2t poate contribui mai mult la calitatea vie\u021bii \u0219i la p\u0103strarea demnit\u0103\u021bii \u0219i autonomiei pacientului.<\/p>\n<p><strong>Tehnologia \u0219i inteligen\u021ba artificial\u0103 intr\u0103 tot mai mult \u00een practica medical\u0103. Unde pot aduce valoare real\u0103 \u00een \u00eengrijirea paliativ\u0103 \u0219i unde trebuie p\u0103strat\u0103 cu prioritate componenta uman\u0103 a rela\u021biei cu pacientul?<\/strong><\/p>\n<p style=\"text-align: justify;\">Tehnologia poate aduce valoare real\u0103 acolo unde ne ajut\u0103 s\u0103 identific\u0103m mai repede nevoile pacientului \u0219i s\u0103 folosim mai bine timpul profesioni\u0219tilor. Instrumentele digitale pot facilita evaluarea repetat\u0103 a simptomelor, monitorizarea la domiciliu, colectarea rezultatelor raportate de pacient, comunicarea \u00eentre membrii echipei \u0219i continuitatea \u00eengrijirii.<\/p>\n<p style=\"text-align: justify;\">Inteligen\u021ba artificial\u0103 poate sprijini analiza unor volume mari de date, identificarea pacien\u021bilor cu risc crescut de deteriorare, recunoa\u0219terea unor tipare de simptome \u0219i semnalarea situa\u021biilor care necesit\u0103 reevaluare. Poate fi util\u0103 \u0219i pentru documentare, educa\u021bie, cercetare \u0219i verificarea siguran\u021bei unor scheme terapeutice. Dar aceste instrumente trebuie validate clinic, utilizate transparent \u0219i supravegheate de profesioni\u0219ti. Protec\u021bia datelor, riscul de eroare sau de bias \u0219i responsabilitatea deciziei medicale nu pot fi ignorate.<\/p>\n<p style=\"text-align: justify;\">Exist\u0103 \u00eens\u0103 domenii \u00een care componenta uman\u0103 r\u0103m\u00e2ne de ne\u00eenlocuit: comunicarea unui prognostic dificil, \u00een\u021belegerea valorilor \u0219i temerilor pacientului, negocierea obiectivelor \u00eengrijirii, sprijinul spiritual \u0219i existen\u021bial, \u00eenso\u021birea familiei \u0219i prezen\u021ba la sf\u00e2r\u0219itul vie\u021bii.<\/p>\n<p style=\"text-align: justify;\">Tehnologia poate m\u0103sura intensitatea durerii, dar nu poate \u00een\u021belege singur\u0103 ce \u00eenseamn\u0103 acea durere \u00een via\u021ba pacientului. \u00cen palia\u021bie, trebuie s\u0103 folosim tehnologia pentru a avea mai mult timp pentru pacient, nu pentru a ne \u00eendep\u0103rta de el.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prof. dr. Vladimir Poroch Medic primar chirurgie general\u0103, atestat \u00eengrijiri paliative Pre\u0219edinte Asocia\u021bia Na\u021bional\u0103 de \u00cengrijiri Paliative \u2013 ANIP \u00cengrijirea paliativ\u0103 \u00eenseamn\u0103 mai mult dec\u00e2t controlul simptomelor \u00een stadiile avansate [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":19255,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[276],"tags":[],"class_list":["post-19254","post","type-post","status-publish","format-standard","has-post-thumbnail","category-interviu"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Palia\u021bia trebuie integrat\u0103 \u00een parcursul obi\u0219nuit al pacientului - 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