Avaliação das necessidades paliativas e impacto na qualidade de vida dos doentes após hospitalização por infeção a SARS-COV-2

: proposta de uma melhoria em cuidados paliativos para o Alentejo central

Abstract

Introduction: COVID-19 (Coronavirus disease 2019) is a highly infectious disease caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2; WHO 2020). On March 22, 2020, the World Health Organization (WHO) declared the current outbreak of COVID-19 a pandemic. Despite intense international efforts to contain its spread, it has resulted in millions of confirmed cases, many of which have medium and long-term sequelae, and more than six million deaths worldwide, at least until March 2021. It is therefore necessary to understand the role that palliative care services play in the provision of end-of-life care in this context, and identify the impact on the quality of life of patients and the associated sequelae of those who survived the disease and which variables are most related to the risk of death and/or future addictions. Methodology: Quantitative retrospective study. A scoping review was initially carried out, with the objective of a preliminary evaluation of the potential scope and scope of the available literature on the subject. Then a retrospective observational analysis of patients with SARS-CoV2 infection during their hospitalization period and follow-up in an outpatient consultation at the Local Health Unit of Central Alentejo was carried out. Results: Of the 85 individuals in the sample, almost two thirds underwent hospital treatment with admission to the ICU (Intensive Care Unit) with a higher incidence of infection severity in men than in women. Age appears as a predominant factor in the severity of the infection. In 96% of cases there was increased use of health resources in the context of unscheduled urgent admissions. Of the cumulative distribution of symptoms, more than 70% present a minimum of 5 symptoms out of the 9 flagged. It should also be noted that insomnia, fatigue and pain are systematically prevalent. Regarding the number of comorbidities, there is a strong positive correlation with the number of persistent symptoms, with approximately 38% of the variation in the number of symptoms can be explained by the variation in the number of comorbidities. It should also be noted that patients with obesity, respiratory failure, asthma and diabetes present, compared to those without these comorbidities, statistically significant differences in the number of persistent symptoms. The identification of future palliative needs by health professionals, who accompanied patients post-discharge and in the follow-up consultation or in other consultations in the institution, is minimal. There was, therefore, a negative impact on the quality of life of the patients in the sample. Conclusions: The pandemic provided an opportunity to rethink the planning of advanced care health services in which the starting point for any discussion should always be the values and priorities of the patients themselves, with particular emphasis on patients who may present palliative needs in the future. There may also be specific challenges, in particular in the approach to patients with SARS-Cov-2 infection, which may introduce new debates on the follow-up of these patients. Finally, a final reflection is presented that incorporates a proposal for a palliative care action plan structured in three sequential phases.

Date of Award	17 Dec 2024
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Amélia Feliciano (Supervisor)