Пацієнт орієнтований підхід в лікуванні пухлин шкіри

Abstract

Сучасні системи охорони здоров’я все більше спрямовані на пацієнт орієнтовану стратегію. На наш погляд, дана стратегія є перспективною і для вирішення проблем хворих на передрак і рак шкіри, зростання захворюваності якими відзначається не тільки у всьому світі, а і на Україні. Відповідно до цієї стратегії, задоволеність пацієнтів є важливим компонентом вибору медичної технології. Ми дослідили ефективність хірургічних методів лікування актинічного кератозу, неінвазивної та інвазивної форм плоскоклітинного раку шкіри шляхом вивчення короткострокової та довгострокової задоволеності пацієнтів.

Современные системы здравоохранения все больше направлены на пациент ориентированную стратегию. На наш взгляд, данная стратегия является перспективной и для решения проблем больных предраком и раком кожи, рост заболеваемости которыми отмечается не только во всем мире, а и в Украине. Согласно этой стратегии, удовлетворенность пациентов является важным компонентом выбора медицинской технологии. Мы исследовали эффективность хирургических методов лечения актинического кератоза, неинвазивной и инвазивной форм плоскоклеточного рака кожи путем изучения краткосрочной и долгосрочной удовлетворенности пациентов.

Modern health systems increasingly focus on patient-centered strategies. In our opinion, this strategy promising and for solving the problems of patients with preeclampsia and skin cancer, an increase in morbidity of which is noted not only in the whole world, but also in Ukraine. According to this strategy, patient satisfaction is an important component of the process of making decisions about medical technology. We investigated the efficacy of surgical treatment of actinic keratosis, non-invasive and invasive forms of squamous cell carcinoma by examining the short-term and long-term satisfaction of the patients. Methods. To achieve this goal, we used personalized data from patients with actinic keratosis (АК), non-invasive аnd invasive forms of squamous cell carcinoma (SCCіs аnd сSCC), which were under the dynamic supervision of the State Scientific Institution “Scientific and Practical Centre of Preventive and Clinical Medicine” of the State Administration doctors, and survey data on the quality of life of patients at the time of diagnosis and after 3 months and 1 year after treatment with using the dermatological quality of life index. Results. During 2015-2016 129 patients were under our supervision, among them 37 patients with cSCC, 67 patients with AK and 25 patients with SCCis. During the process of making decisions about medical technology the duration of the disease before treatment and the size of the tumor were took into account by doctors. All patients who participated in the study, received treatment. Surgical medical technologies have predominated from 97.7% in men with acne to 45.4% in women with SCCis. The evaluation of the effectiveness of the proposed medical technology has been conducted, taking into consideration the complications during treatment and relapse of the disease. The shortterm level of patient satisfaction with the applied medical technology was studied three months after the treatment. Thus, the average DLQI score in patients with AK, SCCis and cSCC is 0.06 ± 0.01 points, 0.12 ± 0.03 points and 0.75 ± 0.04 points respectively, which indicates satisfaction of the patients with the result of the proposed treatment method. One year after treatment, the DLQI score is 0 in all patients with AK, SCCis and cSCC, who were offered surgical and radiosurgical treatments, which indicates long-term patient satisfaction with therapy. Conclusions. Research on short-term and long-term satisfaction of the patients found that short-term satisfaction is more likely to be related to the patient-doctor relationships, while long-term satisfaction is a reflection of the effectiveness of medical technology. Therefore, the concept of a patient focused on treating tumors of the skin is a key element of the quality of the provision of medical care.