Prevalence of patients with palliative needs in the wards of portuguese public hospitals

Introduction: The early referral to palliative care is one of thekeys to the success of this care, to promote the best quality oflife possible of patient and his family and to achieve the mostimportant outcomes.Aim: To determine the prevalence of patients with palliativeneed in the Portuguese public hospitals,from which how manyare referenced to palliative care and if not what are the mainreasons.Methods: 32 physicians from 11 hospitals were asked about1273 patients (≥18 years old) using the surprisedquestion(Would you be surprised if your patient dead withinthe next year,6 months, 30 and 15 days?); when the answerin at least one period was no, they were asked if the patientwas referenced to palliative care and if not, they were invitedto indicate 5 main reason from a list of 19. Exclusion criteria:patients in wards of pediatric, obstetrics, psychiatry, palliativecare units and ER.Results: The dead was expected within 1 year for 51.4%(prevalence of patients with palliative care needs), within 6months for 38.3%, within 30 days for 22.3% and within 15days for 16.1%. 67.2% of cancer patients, 48.7% of non-cancer patients and 45.5% of mixed disease have palliativecare needs. Only 6.8% of the patients whose dead wasexpected within 1 year, 7.5%, 9.9% and 9.8% of those deadwas expected within 6 months, 30 days and 15 days, werereferred to palliative care. The 5 main reasons for not referralwere: the patient is still actively treated to the disease, we stillcan treat (cure) the patient, the symptom control wasachieved, the patient is not dying and the palliative care wasnot the best for the patient.Conclusions: The general hospitals wards have a highprevalence of patients with palliative care needs but only avery few of them are referred to palliative care. Moreeducation of the physician in palliative care is needed toincrease the proportion of patients referred ant to increasethe early referral as one of the keys to success of health care.