The XVI International Conference of the “Palliative Medicine in Practice” Journal took place in Gdańsk on June 23–24, 2023. The conference was chaired by the National Consultant in the field of palliative medicine and Head of the Department of Palliative Medicine at the Institute of Medical Sciences of the University of Zielona Góra, Professor Wojciech Leppert. The event was held under the honorary patronage of Professor Marcin Gruchała, the Rector of the Medical University of Gdańsk and under the substantive patronage of the Polish Association of Palliative Care.
The participants were welcomed during the opening panel of the conference, which included the Editor-in-Chief of the journal “Palliative Medicine in Practice”, Professor Wojciech Leppert, Dr Kamil Chwojnicki — the Vice-Dean of the Faculty of Medicine at the Medical University of Gdańsk, and Dr Aleksandra Modlińska — the Provincial Consultant in Palliative Medicine in the Pomeranian Voivodeship.
The inaugural lecture titled Opioids in chronic pain management was delivered by Professor Sebastiano Mercadante, a world expert in the field of pain and palliative care. During this lecture, Professor Mercadante discussed recent recommendations of the American Society of Clinical Oncology (ASCO) on pain management in cancer patients [1]. A systematic review of the literature identified systematic reviews and randomized controlled trials on the efficacy and safety of opioid analgesics in people with cancer, approaches to opioid initiation and titration, and the prevention and management of opioid adverse events. PubMed and the Cochrane Library were searched from January 1, 2010, to February 17, 2022.
During this lecture, Professor Mercadante drew attention to the concept that opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Opioids should be initiated PRN (pro re nata, as needed) at the lowest possible dose to achieve acceptable analgesia and patient goals, with early assessment and frequent titration. For patients with a substance use disorder, clinicians should collaborate with a palliative care, pain and/or substance use disorder specialist to determine the optimal approach to pain management. Opioid adverse effects should be monitored, and strategies are provided for prevention and management. Professor Mercadante also indicated a possibility of using methadone as the first opioid (typically this opioid is given as a second or third line of treatment of pain as an opioid switch or at a low dose as an addition to concurrently used another opioid). Professor Mercadante also suggested that fentanyl products administered through the transmucosal route in the treatment of breakthrough pain episodes at doses proportional to baseline opioids are effective and safe [according to SPC (Summary of Product Characteristics), it is necessary to titrate the dose from the lowest available dose of a given fentanyl product]. After the inaugural lecture, the thematic sessions began.
The first session of the conference, chaired by Professor Jerzy Wordliczek and Professor Małgorzata Malec-Milewska, focused on pain in cancer patients. It was initiated by Professor Jerzy Wordliczek from the Clinic of Interdisciplinary Intensive Care at the Collegium Medicum of the Jagiellonian University in Kraków, who discussed the diagnosis and current treatment options for neuropathic and nociplastic pain. The lecture emphasized the complexity of the pathophysiology contributing to the development of these types of pain and the necessity for administering multimodal therapy. Next, Dr Magdalena Kocot-Kępska, from the Department of Pain Research and Therapy and the Department of Anesthesiology and Intensive Care at the Collegium Medicum of the Jagiellonian University in Kraków, discussed new treatment options for visceral pain, including neuromodulatory procedures indicated in cancer patients, such as spinal cord stimulation or celiac plexus radio ablation.
In the following presentation, Assistant Professor Renata Zajączkowska, from the Clinic of Interdisciplinary Intensive Care at the Collegium Medicum of the Jagiellonian University in Kraków, presented the pathophysiology and treatment of bone pain in cancer patients. The lecture highlighted the need to adjust the treatment of bone pain to the stage of underlying cancer, as well as the possibility of using drugs that improve bone metabolism and adjuvant analgesics. The topic of co-analgesics in the treatment of cancer pain was further elaborated in the lecture by Professor Małgorzata Malec-Milewska from the Department of Anesthesiology and Intensive Care at the Medical Center of Postgraduate Education in Warsaw. That lecture also addressed the risk of adverse effects associated with the use of co-analgesics, cannabinoids, and steroid therapy.
The second session of the conference focused on the use of cannabinoids in the symptomatic treatment of cancer patients. The session was initiated by Professor Małgorzata Łukowicz from the Rehabilitation Clinic at the Medical Center of Postgraduate Education in Warsaw, who gave a lecture titled Theoretical foundations and examples from clinical practice of cannabinoid use. The lecture presented the current state of knowledge about the localization and functions of cannabinoid receptors, as well as clinical situations in which the use of cannabinoids should be considered. Attention was also drawn to the high therapeutic index of cannabinoids (1000:1), which is associated with a relatively low risk of adverse effects.
During the third session of the conference, participants had the opportunity to participate in case-based interactive workshops on the treatment of cancer pain. The workshops were conducted by Professor Małgorzata Malec-Milewska and Assistant Professor Jarosław Woroń.
The fourth session of the conference focused on the possibilities of spiritual care development in medicine. It was led by Professor Małgorzata Krajnik from the Department of Palliative Care at the Collegium Medicum of the Nicolaus Copernicus University in Toruń, who inaugurated the session with a lecture titled Education in spiritual care. Among other things, the Professor discussed the zones of human spirituality according to the Polish Association for Spiritual Care in Medicine, as well as the benefits of educating healthcare workers and chaplains about spiritual care for patients. Then, Dr Beata Brożek from the Department of Palliative Care at the Collegium Medicum of the Nicolaus Copernicus University in Toruń presented the topic of dignity therapy. This intervention involves a conversation, during which memories are elicited from patients’ memory, aimed at providing support in the advanced stage of the disease. The speaker presented evidence of the positive impact of this therapy, including results from her own research, in which dignity therapy provided support to patients with severe chronic obstructive pulmonary disease (COPD). The session was concluded with a lecture by Dr Martyna Janicka, from the Dr Józef Bednarz Provincial Hospital for the Nervously and Mentally Ill in Świecie, titled Attentive listening and the search for the meaning of suffering. She emphasized the role of healthcare professionals in supporting patients who need to find meaning in their new reality, which is accompanied by the suffering caused by advanced-stage disease.
The fifth session of the conference focused on the integration of palliative care and psycho-oncology. The session was chaired by Professor Monika Lichodziejewska-Niemierko from the Department of Palliative Medicine at the Medical University of Gdańsk and Professor Mikołaj Majkowicz from the Institute of Health Sciences at the University of Szczecin. The session was opened by a lecture from Professor Krystyna de Walden-Gałuszko, from the University of Warmia and Mazury in Olsztyn, titled The role of artificial intelligence in medicine, in which the potential risks associated with the increasing role of artificial intelligence in medical care were presented, including the potential deterioration of empathic communication in clinical practice. Next, Professor Mikołaj Majkowicz delivered a lecture on the significance of immune power personality in the work of a psycho-oncologist. He presented the presence of immune power personality traits (healthy helping, love-based relationships, the ability to confide, assertiveness, strength of character, sensitivity to internal signals, and the complexity of self-structure) as a factor potentially protecting against burnout in individuals working with critically ill cancer patients.
Then, Professor Monika Lichodziejewska-Niemierko gave a lecture titled How to implement advance care planning in clinical practice? During the presentation, she discussed how palliative care should be tailored to the preferences of patients. She emphasized that advanced care planning (ACP) should be based on honest and thorough discussions about the possibilities and limitations of proposed treatment. These discussions should involve the patient, their family members, as well as the medical staff. Professor Lichodziejewska-Niemierko emphasized that effective implementation of ACP should enable shared decision-making (SDM) at every stage of the disease.
In the fourth presentation of the session, Professor Marzena Samardakiewicz from the Department of Psychology, Chair of Psychosocial Aspects of Medicine at the Medical University of Lublin, presented new directions in the development of psycho-oncology. Professor Samardakiewicz discussed the history and activities of the Polish Psycho-Oncology Society. Furthermore, considering the increasing demand for psycho-oncological care, she emphasized the need to expand its accessibility and improve its quality through continuous training for the entire medical staff, including highly specialized personnel such as psychologists and psychiatrists.
The closing lecture of the session titled The role of narrative medicine in palliative care education was delivered by Dr Agata Rudnik from the Department of Clinical Psychology and Health at the Institute of Psychology and Academic Psychological Support Center at the University of Gdańsk. The speaker introduced the definition of narrative medicine as a clinical practice enhanced with narrative competencies, which involve, inter alia, the ability to interpret and understand another person’s story. The lecture presented the potential use of narrative medicine techniques in education, such as interviews, descriptions of observations and feelings related to the illness situation, and creative writing workshops, in order to enhance students’ communication skills, which are particularly important in effective palliative care.
The sixth session, titled Education in palliative care and medicine, was conducted by Dr Leszek Pawłowski from the Department of Palliative Medicine at the Medical University of Gdańsk and Dr Izabela Kaptacz from the Department of Palliative Medicine and Care at the Medical University of Silesia in Katowice. The session began with a lecture by Dr Andreas Stähli from Johannes-Hospiz Münster in Germany, titled Postgraduate education in palliative care and curricular issues in Central, Eastern, and South-Eastern Europe. The speaker presented the results of an international survey in which national leaders of palliative care described the development and challenges of postgraduate education in palliative medicine [2]. Over 90% of the respondents indicated that the interdisciplinary curriculum recommended by the WHO would help promote palliative medicine in their countries, which could be achieved through further research and international cooperation.
In the following lecture, Dr Grzegorz Loroch from the Department of Palliative Medicine at the University of Zielona Góra presented the palliative medicine curriculum for medical students at the University of Zielona Góra. The work was carried out in collaboration with a team of researchers from the Department of Palliative Medicine, including Dr Grzegorz Loroch, Maria Forycka BSc, Dr Emilia Pucek, and Professor Wojciech Leppert. The curriculum combines theoretical classes, practical lessons, and communication workshops at the Medical Simulation Center, where students learn how to deliver difficult information in clinical scenarios. Subsequently, the scenarios are discussed with the teacher during debriefing sessions. During the sixth year, students consolidate their knowledge by participating in clinical work with a physician for 90 hours.
Next, Dr Izabela Kaptacz from the Department of Palliative Medicine and Care at the Medical University of Silesia in Katowice discussed undergraduate education in palliative care nursing. The speaker presented the principles of implementing a palliative medicine education program for first and second-degree nursing students, including practical classes, internships, as well as education in pain assessment and treatment.
To conclude the sixth session, Dr Leszek Pawłowski delivered a lecture titled Volunteering as a form of social education. He emphasized the significant role of volunteering in palliative care and discussed the activities of the European Association for Palliative Care (EAPC) Volunteering Task Force. Dr Leszek Pawłowski presented the results of the work of the EAPC Task Force, which included among other activities promoting and spreading the idea of hospice volunteering and analysis of the impact of the COVID-19 pandemic on the involvement of volunteers in palliative care worldwide [3]. The speaker also discussed important local initiatives undertaken by the Hospice Foundation in Gdańsk.
The seventh session consisted of short presentations of submitted papers and was moderated by Dr Grzegorz Loroch. The session began with the presentation of a paper titled Assessment of neuropathic pain in patients diagnosed with multiple myeloma, which was authored by Dr Eleonora Mess from The University of Medical Sciences in Legnica and Wroclaw Medical University, Dr Marzena Wichlińska from the Higher Medical School in Legnica and the Karol Marcinkowski University Hospital in Zielona Góra, and Dr Agata Zdun-Ryżewska from the Division of Quality of Life Research at the Medical University of Gdańsk. The study assessed neuropathic pain using an author-developed questionnaire in 79 patients with multiple myeloma treated at the Haematology Department of the Karol Marcinkowski University Hospital in Zielona Góra. The study found a relatively low frequency and moderate intensity of pain. It also demonstrated a relationship between increased pain intensity and a decline in physical functioning.
The third presentation provided the results of a review titled Medicines use review in palliative care in the light of available literature by Dr Iga Pawłowska and Professor Ivan Kocić from the Department of Pharmacology at the Medical University of Gdańsk. During the lecture, Dr Iga Pawłowska presented data on medicine use reviews — services where pharmacists consult and identify patients’ medication-related problems. The research findings indicated an increasing number of medicine use reviews, and patients were receptive to the idea of medication consultations with pharmacists. The speaker also highlighted the need to establish common positions regarding therapy due to the potential risk of conflict between pharmacy services and other elements of palliative care.
In the subsequent lecture, Dr Karol Budzeń from the St. Pio Hospice in Puck discussed the off-label use of drugs in palliative care, based on his own experience from clinical practice. The presented cases included the use of atropine drops in the symptomatic treatment of sialorrhea in a patient with laryngeal cancer, subcutaneous morphine and furosemide in the treatment of resting dyspnea in a patient with lung cancer, as well as local administration of tranexamic acid to reduce bleeding from malignant ulceration in a patient with tongue cancer with metastases.
As part of the fifth lecture of the session, researchers from the Medical University of Gdańsk — Dr Agnieszka Gorzewska, Dr Magdalena Osowicka from the Department of Palliative Medicine, and Dr Tomasz Nadolny from the Department of Pneumonology and Allergology, presented a case titled Patient with misdiagnosed disseminated cancer, qualified for palliative care while awaiting histopathological results. The lecture discussed the management of a patient who, during hospitalization, was in a moderate to severe general condition and cachectic, with radiographic images suggesting secondary cancerous lesions that needed to be differentiated with pleural mesothelioma. The patient was disqualified from curative treatment and palliative care was recommended. Only after histopathological verification of the pleural infiltration, the diagnosis of cancer was excluded, and further diagnostic workup revealed vasculitis.
In the next presentation, Dr Agnieszka Chojnacka from the University of Lower Silesia in Wrocław discussed grief counselling for women experiencing reproductive loss. The lecture focused on how the loss of an unborn child can impact the mental state of women. The speaker emphasized the significant role of grief counselling in the process of accepting miscarriage and described the tasks performed within counselling, such as helping in expressing emotions related to reproductive loss and accompanying the process of acceptance.
The session of submitted papers concluded with a lecture by Kacper Wilczkowski, who presented the results of an analysis of data regarding agreements with the National Health Fund in Poland in the field of palliative and hospice care. The analysis was conducted by a team of students, doctoral candidates, and graduates from the Faculty of Medicine at the Medical University of Gdańsk, in collaboration with the Department of Palliative Medicine: Julia Doskocz, Jan Getek, Bartosz Kaniowski, Katarzyna Korzeniewska, Filip Lebiedziński, Maciej Pancewicz, Szymon Rydzewski, Kacper Wilczkowski. The presentation provided a quantitative summary of guaranteed services provided by healthcare facilities, categorized by types of services (home hospice, inpatient care, outpatient clinic) and the populations served (adults, children). The contracted amounts were also summarized. The data collected during the study will serve as a basis for further analysis of patients’ access to palliative care and the needs of healthcare units.
The Conference concluded with the eighth session, which took the form of a panel discussion. Experts deliberated on the directions of development in palliative, supportive, and hospice care in Poland and worldwide. The discussion was moderated by Professor Wojciech Leppert, and the panel included Professor Monika Lichodziejewska-Niemierko, Dr Izabela Kaptacz, Dr Leszek Pawłowski, Dr Iwona Sitarska, and Dr Grzegorz Loroch.
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