MINISTRY OF HEALTH OF UKRAINE

Kharkiv National Medical University

 

Approved

on the methodical meeting Department of Oncology

Head of Department

MD, Professor VI Starikov

"30" August 2012

 

 

A methodical development For independent work of students

 

Course 6

Faculty of Medicine (specialty "General Medicine", "Pediatrics", "Prophylactic medicine")

Study Subject: Oncology

 

Topic	Number of hrs
Theme 8. Keeping of documentation in clinical oncology	2
Theme 9. Deontology in Oncology	2
Topic 10. Treatment of chronic pain syndromes	2

 

 

 

Kharkiv 2012

 

Background.

The diagnosis of cancer has a high moral and legal responsibility for health workers removing cancer diagnosis with particular disease sometimes causing irreparable psychological trauma.

Cancer patients felt symptoms of the disease, choose a specialist on your own. Therefore medechni workers in any specialty should have the knowledge that at the first examination will help him suspected cancer process. You can not neglect any of the elements of diagnosis - history of life and disease, patient examination, according to palpation and percussion. So before you apply modern aggressive diagnostic methods, we must make full use of classical methods of questioning, examination and physical examination of the patient.

It is important to determine the prognosis and planning the most effective treatment. This requires an objective assessment of the anatomical distribution of disease. It is therefore advisable to know the classification, the basic principles which can be applied in all localizations of malignant tumors. This is the TNM system.

Age tradition regarded cancer as a fatal disease. Therefore, from the doctors involved in the treatment of cancer patients requires special tact and ability to find a contact with a patient, calm him and convince him of the necessity of treatment. Medical personnel should find proper and adequate approach to the patient. Especially suitable require so-called inkurabelni sick. Famous Italian oncologist Zh.H.Hardini said incurable does not mean nekurabelnosti. Helping cancer patients in the most severe stage of the disease for them is a major deontological principles. The objective of this period is the elimination of pain, insomnia, complications caused by the growth of tumors, and other paraneoplastic conditions. More N.N.Petrov (1945) pointed out the need for such patients symptomatic therapy with careful regulation of frequency and time taking medicines explaining the importance of regular and prolonged course of treatment, even if these drugs can not make strong actions.

 

Study objective: Deepen the theoretical and practical knowledge of students from deontological aspects of working with cancer patients.

Know:

1.       Features of the physical examination for suspected malignancy.

2.       Features instrumental and laboratory examination of patients with malignant neoplasms.

3.       Anatomical classification of tumors with elements of clinical morphology.

4.       Principles of classification of tumors in stages.

5.       Work plan and examination of the patient, based on survey data, formulate clinical diagnosis.

6.       Analyze the causes of abandonment of malignant tumors.

7.       Principles of ethics in oncology.

Be able to:

Conduct review of cancer.

Absorb the history and analyze it.

Fill core samples records cancer center.

Analyze the causes of abandonment of malignant tumors.

Preparing cancer patients for instrumentation and hardware techniques research.

Medical ethics - is part of general medical ethics. The question of ethics in oncology is not fundamentally different from general medical, ethical and legal standards. On admission to the clinic doctor all the attention should be focused on the patient. Incomplete conducted the analysis and synthesis of information obtained in each case can lead to misdiagnosis. Psychological response to tumor disease depends on the type of nervous system, age, profession, family circumstances, stage, tumor, the intelligence of the patient. It is therefore very important question: whether to inform the patient about his diagnosis. American doctors always tell patients not only diagnosis, but also approximate prediction. But as a rule, the word "cancer" patient otozhnyuye with the term "death after long suffering." Therefore, in our country, most doctors recommend talking to the patient that the treatment of this disease is necessary because of "the possibility of a tumor." The doctor should have methods of psychotherapy - to be able to encourage the patient to lift his mood, inspire confidence in his recovery and subsequent continuation fulfilling life. He must convince the patient of the need to perform certain procedures and operations. Some patients suspected at the presence of malignant tumors require a doctor's frank information, assuring that they are safely to think about the possible imminent death. However, clinical experience suggests that even with no hope of cure can not violate his self-favorable end of the disease. Even if the diagnosis is clear, we should not overestimate the courage of the patient and hints about the presence of neoplastic diseases only after assessing the mental and physical condition.

Symptomatic therapy is the correction relation to specific symptoms. Distracting task of psychotherapy is a temporary distraction from the disease, weakening fixing existing symptoms. In case of refusal of the patient examination and treatment should be clarified that his condition could worsen. You must make minutes orogen "accomplice" assessment and treatment to alleviate emotional stress, stress that often accompany expectations of medical analysis, the physician should explain to the patient the purpose and objectives of the consultative examination.

Clinical rounds in cancer dispensaries have their own characteristics out how to clearly remember that perhaps what can and what can not speak in the presence of the patient. You can not conduct a detailed discussion of case histories in the wards. While traversing to be talking about each patient, his disease to the extent permitted in the presence of the patient. Almost until his death in patient remains hope for recovery. Before a doctor is a very difficult task: how to keep that hope. Sometimes even cancer advanced stage stop for a while to grow. Therefore, when asked relatives can never predict term of life of the patient. Here is inappropriate excessive, unjustified optimism. In critical condition turns doctor when sick people with cancer of the uterus asks about the volume of executed transactions. In such cases, you should answer that does not lead to a disturbance of family life. General medical doctors nets that guide the patient in oncologic dispensary must explain that this institution better diagnostic capabilities, and treat it not only cancer, but also those diseases that may eventually turn into cancer.

Should generally lead clarifications nekorys at Art and wise use of drugs and homeopathic remedies.

Materials control baseline (rising levels) of students: test questions, test items

Quiz:

Score skarzhen and history of cancer patients.

Features objective investigation for suspected malignancy.

Mandatory minimum clinical examination in the outpatient setting.

Rules students in oncology clinic. Supervision of patients. Reports on rounds.

Indications for appointment symptomatic treatment of cancer patients.

Correction inkurabelnoho psychological state of the patient.

Principles of ethics in oncology. Types of higher nervous activity and response of patients with cancer.

Tactics doctor in relation to cancer patients.

Motives failure patients on treatment. The ratio of people who recovered from cancer, with patients with long standing forms of malignant tumors.

Information relative. Kantserofobiya. Euthanasia. Calling consultant.

 

T estovi task

Physician Oncologist:

1.       must notify the relatives of the patient prognosis;

2.       from relatives cope true diagnosis;

3.       inform the patient about the presence of tumor it *;

4.       not to inform the patient and family about the true diagnosis

The oncologist should explain to the patient:

1.       purpose and methods of examination;

2.       nature of the proposed treatment;

3.       Weather for denial of treatment;

4.       All of the above *.