Doentes com necessidades paliativas em serviços de internamento hospitalar da região autónoma dos Açores

: número de doentes e adequação dos cuidados nos últimos dias de vida

Abstract

Introduction: Despite the undeniable benefits of palliative care (most effective when integrated early), late or absent referral is frequent. The Gold Standards Framework Prognostic Indicator Guidance includes the surprise question (validated for Portugal) and facilitates the identification of patients in their last year of life. The Liverpool Care Pathway is a multiprofessional tool designed to guide the care of dying patients. The absence of data on the prevalence of palliative care needs in Azores motivated this investigation. The main objectives were: to determine the number of adult inpatients with palliative care needs in Azorean hospitals; how many are referred and reasons for non-referral. Methods: Quantitative, descriptive, cross-sectional, observational study, carried out in three Azorean hospitals. Non-probabilistic sample. Data collection through professionals, by questionnaire. RESULTS 86 professionals participated (69.8% physicians, 30.2% nurses). 282 evaluations by physicians and 358 by nurses were collected. 40.4% of patients evaluated by physicians and 35.3% by nurses presented palliative care needs (prognosis estimated by surprise question ≤1 year), with higher prevalence in oncology and medicine wards and also in those with mixed or cancer diagnosis. 11.4% of patients evaluated by physicians and 10.6% by nurses (mostly with cancer or an estimated prognosis ≤1 month) were referred. The main reasons for nin-referral were: patient in active treatment, symptomatically controlled, curative potential, non-imminent death, palliative care without added value and resources for other alternatives. 6.7% of physicians and 7.7% of nurses were familiar with the LCP. Conclusions: In spite of the high prevalence of inpatients with palliative care needs in Azorean hospitals, referrals fall short, with late and inequitable accessibility (preferential in cancer patients and those with limited life expectancy). The reasons given for non-referral demonstrate unawareness of the principles and philosophy of palliative care. Education and training is crucial to ensure the timely identification, treatment and/or referral of these patients.

Date of Award	22 Mar 2019
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Manuel Luís Capelas (Supervisor)