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Advisor(s)
Abstract(s)
Introdução: Nos últimos anos tem-se verificado um aumento crescente da prevalência
das doenças crónicas, com consequente mudança de paradigma dos cuidados de saúde. Os
Cuidados Paliativos surgem como uma necessidade a incluir nos vários níveis de prestação
de cuidados a indivíduos com doenças crónicas e potencialmente ameaçadoras de vida.
Segundo a Organização Mundial de Saúde, os mesmos constituem uma abordagem que
promove a melhoria da qualidade de vida dos doentes e familiares, através da prevenção e
alívio do sofrimento causado por problemas físicos, psicossociais e espirituais. Devem ser
introduzidos precocemente, concomitantemente, ou não, a tratamentos modificadores de
doença. Apesar destes cuidados ainda se associarem a condições oncológicas, doentes com
patologia não-oncológica experimentam iguais necessidades a nível do controlo
sintomático. Contudo, o acesso é ainda insuficiente, particularmente em doentes não-
-oncológicos, os quais são menos encaminhados aos Cuidados Paliativo e a referenciação
ocorre tardiamente, numa fase mais avançada da doença, com pior performance status e
maior probabilidade de agudizações e hospitalizações, comparativamente a doentes com
cancro.
Objetivos: Avaliar, caracterizar e estabelecer uma comparação entre doentes não-
-oncológicos e doentes oncológicos, acompanhados pela equipa de Cuidados Paliativos da
Unidade Local de Saúde da Guarda, no que concerne a dados sociodemográficos, clínicos e
de referenciação para Cuidados Paliativos.
Metodologia: Estudo observacional, descritivo bivariável e retrospetivo. Foram
consultados e selecionados manualmente os processos clínicos individuais existentes em
papel e o programa SClínico de todos os doentes referenciados ao polo da Guarda da
Equipa de Cuidados Paliativos da Unidade Local de Saúde da Guarda, falecidos no período
compreendido entre o dia 1 de abril de 2021 (inclusive) e o dia 31 de outubro de 2021
(inclusive). Procedeu-se à recolha dos dados relativos à caracterização sociodemográfica,
clínica e do processo de referenciação. Do total da amostra, foram constituídos dois
grupos com base no seu diagnóstico principal: o grupo de doentes oncológicos e o de
doentes não-oncológicos. Os dados foram registados e analisados através do Microsoft
Excel® e do SPSS® v28.0. O nível de significância utilizado foi de p<0,05.
Resultados: Foram identificados 154 doentes no período em estudo. Destes, 24 tinham
diagnóstico de patologia não-oncológica (15,6%) e 130 de patologia oncológica (84,4%). Os
doentes não-oncológicos residiam significativamente mais em instituições (65,2% vs. 24,6%), tinham sobretudo um cuidador formal (65,2% vs. 31,0%) e foram menos
acompanhados, em simultâneo, por Cuidados Paliativos e outras especialidades (62,5% vs.
81,5%), comparativamente a doentes oncológicos. As doenças relacionadas com falência
orgânica foram as patologias não-oncológicas mais frequentes (50,0%). Os principais
motivos de referenciação de doentes não-oncológicos foram “outros motivos”, “serviço
social” e “dor” enquanto dos doentes oncológicos foram o “serviço social”, “dor” e “apoio
psicológico”. A maioria dos doentes foi referenciado tardiamente, numa fase avançada da
doença, sobretudo os doentes não-oncológicos, sendo que a mediana de tempo de
sobrevivência dos doentes oncológicos foi de 32 dias, cerca do dobro dos doentes não-
-oncológicos (17,5 dias).
Independentemente do diagnóstico principal, os doentes recorreram mais ao Serviço de
Urgência em dias não-úteis, faleceram sobretudo em meio hospitalar (59,5%), e foram
referenciados aos Cuidados Paliativos maioritariamente pelo Hospital Sousa Martins
(67,5%). Deste, os principais serviços a referenciar doentes foram a Medicina Interna
(28,8%) e a Urgência (24,0%).
Conclusão: Apesar de estar preconizado que os Cuidados Paliativos devem ser
introduzidos numa fase precoce da doença, independentemente do diagnóstico, verificou-
-se que os doentes acompanhados pela equipa de Cuidados Paliativos da Unidade Local de
Saúde da Guarda foram referenciados tardiamente e tinham, maioritariamente,
diagnóstico de patologia oncológica. Perante a possibilidade de existirem algumas
barreiras à referenciação para Cuidados Paliativos, as mesmas devem ser identificadas e
poderão ser solucionadas, em parte, através da continua formação pré e pós-graduada dos
profissionais de saúde em Cuidados Paliativos, nomeadamente aqueles que contactam
proximamente com doentes com doenças graves, incuráveis e progressivas, como os
profissionais dos Cuidados de Saúde Primários. Também a desmistificação de alguns
conceitos relativos aos Cuidados Paliativos entre a população em geral poderá beneficiar o
processo de referenciação.
Introduction: In recent years, there has been a growing increase in the prevalence of chronic diseases, with a consequent change in the paradigm of health care. Palliative Care emerges as a need to be included at various levels of care for individuals with chronic and potentially life-threatening diseases. According to the World Health Organization, it constitutes an approach that promotes the improvement of the quality of life of patients and their families, through the prevention and relief of suffering caused by physical, psychosocial, and spiritual problems. It should be introduced early, with, or without simultaneous disease-modifying treatments. Although this care is still associated with oncological conditions, patients with non-oncological pathologies experience the same needs in terms of symptomatic control. However, access is still insufficient, particularly in non-oncological patients, who are less referred to Palliative Care and referral occurs late, at a more advanced stage of the disease, with worse performance status and greater likelihood of exacerbations and hospitalizations, compared to cancer patients. Objectives: To evaluate, characterize and establish a comparison between nononcological patients and oncological patients, accompanied by the Palliative Care team of the Local Health Unit of Guarda, regarding sociodemographic, clinical and referral data for Palliative Care. Methodology: Observational, descriptive, bivariate, and retrospective study. The individual clinical records on paper and the SClínico program of all patients referred to the Guarda unit of the Palliative Care Team of the Local Health Unit of Guarda, who died between 1st April 2021 (inclusive) and 31st October 2021 (inclusive), were consulted, and manually selected. Data on the sociodemographic, clinical and referral process characterization were collected. From the total sample, two groups were formed based on their main diagnosis: the group of cancer patients and the group of non-oncologic patients. Data were recorded and analyzed using Microsoft Excel® and SPSS® v28.0. The significance level used was p<0.05. Results: 154 patients were identified in the study period. From the previous, 24 were diagnosed with non-oncological pathology (15.6%) and 130 with oncological pathology (84.4%). Non-oncologic patients were significantly more institutionalized (65.2% vs. 24.6%), they mostly had one formal caregiver (65.2% vs. 31.0%) and were less accompanied by both palliative care and other specialties (62.5% vs. 81.5%) than oncologic patients. Organ failure related diseases were the most frequent non-oncological pathologies (50.0%). The main reasons for referral of non-oncologic patients were "other reasons", "social service" and "pain" while for oncologic patients it was "social service", "pain" and "psychological support". Most patients were referred late, in a more advanced stage of illness, especially non-oncologic patients, with the median survival time of cancer patients in 32 days, about twice as long of the non-oncologic patients (17.5 days). Regardless of the main diagnosis, the patients resorted more to the Emergency Service on non-working days, died mainly in the hospital (59.5%) and were referred to Palliative Care mostly by the Sousa Martins Hospital (67.5%). The main services that referred patients were Internal Medicine (28.8%) and the Emergency Department (24.0%). Conclusion: Although it is recommended that Palliative Care should be introduced at an early stage of the disease, regardless of the diagnosis, it was found that the patients accompanied by the Palliative Care team of the Local Health Unit of Guarda were referred later and had, in the majority, a diagnosis of oncological pathology. As there may be some barriers to referral to Palliative Care, these should be identified and could be solved, in part, through continued pre- and post-graduate training of health professionals in Palliative Care, namely those in close contact with patients with severe, incurable, and progressive diseases, such as Primary Health Care professionals. Also, the demystification of some concepts concerning Palliative Care among the general population could benefit the referral process.
Introduction: In recent years, there has been a growing increase in the prevalence of chronic diseases, with a consequent change in the paradigm of health care. Palliative Care emerges as a need to be included at various levels of care for individuals with chronic and potentially life-threatening diseases. According to the World Health Organization, it constitutes an approach that promotes the improvement of the quality of life of patients and their families, through the prevention and relief of suffering caused by physical, psychosocial, and spiritual problems. It should be introduced early, with, or without simultaneous disease-modifying treatments. Although this care is still associated with oncological conditions, patients with non-oncological pathologies experience the same needs in terms of symptomatic control. However, access is still insufficient, particularly in non-oncological patients, who are less referred to Palliative Care and referral occurs late, at a more advanced stage of the disease, with worse performance status and greater likelihood of exacerbations and hospitalizations, compared to cancer patients. Objectives: To evaluate, characterize and establish a comparison between nononcological patients and oncological patients, accompanied by the Palliative Care team of the Local Health Unit of Guarda, regarding sociodemographic, clinical and referral data for Palliative Care. Methodology: Observational, descriptive, bivariate, and retrospective study. The individual clinical records on paper and the SClínico program of all patients referred to the Guarda unit of the Palliative Care Team of the Local Health Unit of Guarda, who died between 1st April 2021 (inclusive) and 31st October 2021 (inclusive), were consulted, and manually selected. Data on the sociodemographic, clinical and referral process characterization were collected. From the total sample, two groups were formed based on their main diagnosis: the group of cancer patients and the group of non-oncologic patients. Data were recorded and analyzed using Microsoft Excel® and SPSS® v28.0. The significance level used was p<0.05. Results: 154 patients were identified in the study period. From the previous, 24 were diagnosed with non-oncological pathology (15.6%) and 130 with oncological pathology (84.4%). Non-oncologic patients were significantly more institutionalized (65.2% vs. 24.6%), they mostly had one formal caregiver (65.2% vs. 31.0%) and were less accompanied by both palliative care and other specialties (62.5% vs. 81.5%) than oncologic patients. Organ failure related diseases were the most frequent non-oncological pathologies (50.0%). The main reasons for referral of non-oncologic patients were "other reasons", "social service" and "pain" while for oncologic patients it was "social service", "pain" and "psychological support". Most patients were referred late, in a more advanced stage of illness, especially non-oncologic patients, with the median survival time of cancer patients in 32 days, about twice as long of the non-oncologic patients (17.5 days). Regardless of the main diagnosis, the patients resorted more to the Emergency Service on non-working days, died mainly in the hospital (59.5%) and were referred to Palliative Care mostly by the Sousa Martins Hospital (67.5%). The main services that referred patients were Internal Medicine (28.8%) and the Emergency Department (24.0%). Conclusion: Although it is recommended that Palliative Care should be introduced at an early stage of the disease, regardless of the diagnosis, it was found that the patients accompanied by the Palliative Care team of the Local Health Unit of Guarda were referred later and had, in the majority, a diagnosis of oncological pathology. As there may be some barriers to referral to Palliative Care, these should be identified and could be solved, in part, through continued pre- and post-graduate training of health professionals in Palliative Care, namely those in close contact with patients with severe, incurable, and progressive diseases, such as Primary Health Care professionals. Also, the demystification of some concepts concerning Palliative Care among the general population could benefit the referral process.
Description
Keywords
Cuidados Paliativos Doenças Crónicas Doentes Não-Oncológicos Doentes Oncológicos Referenciação