Cuidados ao doente em agonia

Abstract

Background Providing good care in the last few days of life can be considered as a priority in order to improve patient quality of life. Palliative care provides relief from pain and other distressing problems associated with life-threatening illness, through the prevention and relief from suffering. In the last days and hours of life a team approach is required in order to address the needs of patient and their families and plan good quality care of the dying. The Liverpool Care Pathway (LCP) for the Dying Patient incorporates appropriate guidelines and empowers generic health care workers to deliver optimal care in the last days and hours of life. Methods: Retrospective routine notes review, Cross-sectional analytical study. The sample was made of 182 patients that died in the palliative care unit and 81 patients that died in an oncologic medical ward in IPO Porto. Multiprofessional routine notes of last 5 days of life were analysed using the base review formularies given by the LCP team.The variables were: gender; age; diagnosis; consciousness level in the last 24/48 hours of life; multidisciplinary team agreement that the patient is dying; patient and family´s expression of understanding of plan of care; patient and family’s opportunity to discuss religious and spiritual needs; medication written up for pain, agitation, respiratory tract secretions, nausea and vomiting and dyspnoea; team discussion about inappropriate interventions – blood tests, antibiotics, capillary glycemia, taking vital signs, oxygen therapy, not for cardiopulmonary resuscitation; review of nutricional and hydration needs. Results: In both settings there was lack of routine notes concerning the care in last days and hours of life. In the medical ward, most of the care plans were not reviewed by the health care team, while in the palliative care unit appropriate care was more often delivered and futile interventions suspended. Conclusions: Being able to prioritize care to ensure that patient and family needs are met is the way to provide the best possible care.

Date of Award	2012
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Margarida Maria Vieira (Supervisor)