ANAMNEZA Iva Kirac, Nikolina Šantek, Katija Ćulav

Guest Iva Kirac, Nikolina Šantek, Katija ĆulavHosted by Marijana MatkovićMay 3, 2026

Iva Kirac, Nikolina Šantek, Katija Ćulav

About this episode

What you'll hear in this conversation

Imagine a healthcare system where the focus isn't just on treating illness, but on preparing the patient's body and mind *before* treatment even begins. This is the concept of prehabilitation, a practice gaining traction globally but still largely absent in Croatia. It challenges the conventional approach to patient care, shifting the emphasis from mere survival to the patient's quality of life throughout and after their medical journey. This conversation brings together three experts who are working to embed this crucial shift into the Croatian healthcare landscape: Iva Kirac, director of a patient association; Nikolina Šantek, a physiotherapist specializing in kinesiology; and Katija Ćulav, an anesthesiologist now heading palliative medicine and care. They reveal how simple, often overlooked interventions before surgery can dramatically reduce complications, accelerate recovery, and redefine what it means to heal. You will walk away with a deeper understanding of how patient outcomes are shaped not just by medical procedures, but by holistic preparation and continuous support.

Insights from the conversation

What to take from this episode

The focus on prehabilitation, particularly for digestive tumors, has shown that delaying primary treatment by two to four weeks to improve a patient's general condition and nutritional status can significantly reduce post-operative complications over the next three months. Sometimes, slowing down the start of treatment can speed up the overall recovery.

Croatia currently lacks standardized protocols for prehabilitation, not just for adherence, but for consistent evaluation and adaptation of practices based on results. Effective protocols, especially in resource-constrained hospital settings, must be simple and iterative, not complex, to facilitate regular assessment and improvement.

Patients facing gastrointestinal tumors often present with extremely low body mass indexes, sometimes as low as 16 or 18, far below the average of 25 for a healthy person. This severe baseline depletion means prehabilitation isn't a luxury, but a necessity to ensure a patient is even fit enough to undergo primary treatment.

The team's 2019 experiment with single-session 'opera singer' breathing exercises for pre-operative patients, led by a specialist in defectology and musicology, yielded noticeable improvements in shorter intensive care stays and overall hospital duration. Simple, low-tech interventions can sometimes have a disproportionately large impact on recovery metrics.

Palliative care is frequently misunderstood, even by medical professionals, as solely end-of-life support, when in fact it serves as a continuous support system throughout a patient's treatment. Its true role is to help patients maximize their quality of life at every stage, working in conjunction with primary medical care.

Many essential patient support services, including prehabilitation and comprehensive palliative care, are technically covered by the national health insurance (HZZO) but remain largely unimplemented in practice. The challenge isn't always creating new policies, but activating and coordinating existing ones to make them accessible.

The informal 'support center' at the Clinic for Tumors, run by Ivanka Benčić—an enterostomal therapist with extensive palliative care training—demonstrates that effective patient coordination often comes from dedicated individuals and informal structures. These 'shadow' systems often bridge critical gaps that formal processes miss.

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