37 PRIPOROčILA zA OBRAvNA v O SIMPTOMOv v PALIATIvNI OSKRBI BOLNIKA Z NAPREDOv ALNIM RAKOM Maja Ebert Moltara Obvadovanje simptomov v paliativni oskrbi predstavlja eno od ključnih, osnovnih veščin, ki jih mora izvajati zdravstveno osebje. Znanj s področja paliativne oskrbe in obvladovanja simptomov napredovale bolezni v slovenskem prostoru tekom redne- ga šolanja dobimo malo. Pri pridobivanju teh znanj in veščin so zato potrebne izkuš- nje in tudi strokovna literatura. Priporočila (angl. recommendation) predstavljajo mnenje lokalnega ali nacionalne- ga uporabnika, ki se opirajo na strokovna priporočila posameznih ustanov, strokov- nega medicinskega združenja ali zdravniških stanovskih organizacij in praviloma te- meljijo na smernicah, vendar niso pripravljena po standardnih uveljavljenih merilih za smernice (primer: nacionalna priporočila). V Sloveniji smo imeli dosedaj na pod- ročju obvadlovanja simptomov v paliativni oskrbi izdelana le posamezna priporočila (npr. priporočila za zdravljenje bolečine) oziroma mnenja, ki pa nikakor ne zadostu- jejo potrebam. V želji da zapolnimo to vrzel se je zato skupina strokovnjakov, ki se v svojem vsakodnevnem delu srečujejo z obvladovanjem simptomov napredovalega raka, odločila da pristopi k temu projektu. Priporočila so dokument, ki naj pomagajo pri vsakodnevnih odločitvah in naj pa se ne uporabljajo togo ali brez razmisleka. Če kje je ravno v paliativni oskrbi v ospredje potrebno postaviti človeka, našega bolnika, njegove vrednote in želje ter vedno znova pretehtati, najustreznejše odločitve. Priporočila so živ dokument in se bodo s časom prilagajala novim ugotovitvam stro- ke. Začeli smo z temeljnimi, najpogosteje izraženimi motečimi simptomi, že sedaj pa načrtujemo tudi nova poglavja. Vsa priporočila bodo na voljo v razpravo širši skupini strokovnjakov, po dokončni uskaditvi pa bodo predstavljena tudi ustrenim RSK. 38 REc OMMENDATIONS IN SyMPTOM MANAGEMENT IN ADv ANcED cANcER Symptom management in palliative care is one of the essential healthcare skills in palliative care. During official school education in Slovenia we do not learn a lot about palliative care and management of advanced disease symptoms. The acquisi- tion of this knowledge and skills therefore requires experience and professional literature. Recommendations represent the opinion of a local or national user who relies on the professional recommendations of a particular institution, professional medical association, or physician-affiliated organization and, as a rule, is guideline-based, but not prepared according to standard established guidelines (eg. national recom- mendations). In Slovenia, so far, only individual recommendations (eg. recommen- dations for pain management) or opinions have been made in the field of managing symptoms in palliative care, which in no way meet the needs. In order to fill this gap, a group of experts, who are struggling with the symptoms of advanced cancer in their daily work, decided to join this project. Recommendations are a document that should help with everyday decisions and should not be used rigidly or without consideration. In palliative care it is necessary to put a person, our patient, in forefront, his or her values and desires and reconsid- ers the most appropriate decisions. The recommendations are a living document and will adapt over time to the new findings of the profession. We started with the most common, most commonly re- ported disturbing symptoms, and are already planning new chapters. All recom- mendations will be made available for discussion to a wider group of experts and will be presented to the relevant RSCs once finalized.