Doentes paliativos nos hospitais públicos portugueses

Introduction: Early identification and referral of patients with palliative needs is essential so they can benefit from the effectiveness of early intervention of palliative care. Referral for palliative care is an important, growing and complex challenge and process for the practice of health professionals, particularly for physicians. Lack of information and training may prevent proactivity in the process of early referral. Currently, some multidimensional instruments help to identify the population with palliative needs. The surprise question, validated for Portugal, "Would you be surprised if this patient died during the next year?" is an important, useful and reliable tool for this identification. Aim: to determine the prevalence of adult patients with palliative needs hospitalized in public hospitals; to determine who were referenced for palliative care and to identify the reasons for non-referral of these patients. Materials and Methods: an analytical, observational and cross-sectional study was performed in the first quarter of 2015 in 11 hospitals of the Portuguese Health System. The data collection instrument consisted of a questionnaire with demographic and clinical characterization, the surprise question regarding 1 year, 6 and 1 month and, 15 days, and 19 possible reasons for non-referral of patients. The collected data were analyzed using descriptive and analytical statistics, considering statistical significance if p <0.05. Results: From a total of 1273 patients, 51.4% were patients with palliative needs, the majority coming from the oncology (79.3%) and medicine services (62.3%), and mainly with oncological disease (67.2%). Only 6.8 to 9.9% of the patients were referred, mainly oncological (15.1%) or with 15 days or less of life (9.8%). The five main reasons for non-referral were: still being under active treatment (61.5%), “still able to do something from a curative point of view” (40.9%), the patient being symptomatically controlled (33.2%), not considered to be actively dying (27.6%) and not being an added value to the patient (15.4%). Conclusion: High prevalence of patients with palliative care need, low referral rate. The training and qualification of health professionals is necessary and imperative for an adequate identification and referral in a useful time of patients with palliative needs.