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Advisor(s)
Abstract(s)
Introdução: A neoplasia do pulmão (NP) é considerada uma epidemia global dado o impacto em termos de incidência e mortalidade, perspectivando-se aumento nos próximos anos. A maioria dos doentes é diagnosticada em fase avançada e sintomática. A abordagem tem evoluído no sentido da referenciação precoce e integração dos Cuidados Paliativos (CP) no continuum da doença em paralelo com os Cuidados Oncológicos convencionais. O relevo desta patologia justifica uma avaliação das necessidades, análise da capacidade de resposta das equipas e o desenvolvimento de estratégias de melhoria e monitorização da qualidade.
Metodologia: Estudo descritivo e correlacional para a caracterização dos doentes com NP referenciados e admitidos nas equipas de CP a nível nacional durante o ano de 2017, e respetiva avaliação sintomática. Utilizadas medidas de estatística descritiva simples e analítica (recurso a softwares SPSS v24 e Microsoft Excel)
Resultados: Os doentes com NP constituíram 10.1% (38) do total de doentes admitidos nas equipas participantes. A idade média da amostra foi 71.37 anos, a maioria do sexo masculino (71.1%), casado (57.89%), com instrução básica (63.2%) e residente em área urbana (76.5%). Existia doença metastática em 65.8% dos doentes. A distribuição de admissão pelas tipologias de serviços foi: 60.5% em ECSCP, 34.2% em UCP e 5.3% em EIHSCP. A mediana da distância percorrida entre local de residência e serviço de admissão foi 6.6Km, com diferença significativa em função da tipologia de serviço (p<0.001). A mediana do tempo de espera para admissão foi 2 dias, também com diferença significativa consoante a tipologia de serviço (p<0.001). A mediana do tempo entre referenciação e alta nos doentes admitidos foi de 33 dias, com taxa de mortalidade de 63.2% e sobrevida (SV) mediana de 17 dias. O controlo sintomático foi motivo de referenciação em 68.4%. Em 71.11% houve registo de avaliação sintomática às 48-72h de admissão, mas apenas em 21.1% mediante o instrumento de avaliação FACIT-PAL. Não se encontrou diferença significativa na SV consoante o estadio da doença (p=0.501) e não existiu correlação significativa entre tempo de espera para admissão e o Score sintomas (p=0.217) ou a SV (p=0.668). Conclusões: Neste estudo obtivemos um retrato parcial da realidade dos doentes com NP referenciados e admitidos em equipas de CP. Apesar dos vieses inerentes à reduzida amostra, identificamos oportunidades de melhoria no aspecto da avaliação e controlo sintomático. É desejável um maior envolvimento das equipas em atividades de investigação e monitorização da qualidade.
Introduction: Lung Neoplasm (LN) is considered a global epidemic due to its impact in terms of incidence and mortality, with perspectives of increment in overcoming years. Most patients are diagnosed at advanced stage and symptomatic. LN management has evolved towards early referral and integration of Palliative Care (CP) in the continuum of the disease side-by-side with conventional Oncological Care. The relevance of this pathology justifies an assessment of needs, analysis of existing capacities and the development and improvement of quality monitoring. Methodology: Descriptive and correlational study for the characterization of patients with LN referred and admitted to national PC teams during 2017 and symptomatic evaluation. Descriptive and analytical statistical measures were used (software support: SPSS v24 and Microsoft Excel). Results: Patients with LN corresponded to 10.1% (38) of total patients admitted to the participating teams. Their mean age was 71.37 years, the majority beeing male (71.1%), married (57.89%), with basic education (63.2%) and urban residence (76.5%). Metastatic disease was present in 65.8%. Type of PC team admission was distributed as following: 60.5% in Community-team, 34.2% in Hospice and 5.3% in Hospital-team. Median distance between place of residence and admission PC service was 6.6 km, with a significant difference according to PC type of team (p <0.001). Median time to admission was 2 days, also with a significant difference depending on the type of team (p <0.001). Median time between referral and discharge in admitted patients was 33 days, with a mortality rate of 63.2% and median survival (SV) of 17 days. Symptomatic control was the main reason for referral (68.4%). In 71.11%, symptomatic evaluation was recorded at 48-72h from admission, but only in 21.1% FACIT-PAL was undertaken as the evaluation instrument. There was no significant difference in SV according to disease stage (p = 0.501) and no significant correlation was obtained between time to admission and symptom Score (p = 0.217) or SV (p = 0.668). Conclusions: In this study we obtained a partial picture of the reality of LN patients referred and admitted to PC teams. Despite the inherent biases of the small sample, we identify opportunities for improvement at the level of symptomatic assessment and control. Greater involvement of PC teams is warranted in research and monitoring activities.
Introduction: Lung Neoplasm (LN) is considered a global epidemic due to its impact in terms of incidence and mortality, with perspectives of increment in overcoming years. Most patients are diagnosed at advanced stage and symptomatic. LN management has evolved towards early referral and integration of Palliative Care (CP) in the continuum of the disease side-by-side with conventional Oncological Care. The relevance of this pathology justifies an assessment of needs, analysis of existing capacities and the development and improvement of quality monitoring. Methodology: Descriptive and correlational study for the characterization of patients with LN referred and admitted to national PC teams during 2017 and symptomatic evaluation. Descriptive and analytical statistical measures were used (software support: SPSS v24 and Microsoft Excel). Results: Patients with LN corresponded to 10.1% (38) of total patients admitted to the participating teams. Their mean age was 71.37 years, the majority beeing male (71.1%), married (57.89%), with basic education (63.2%) and urban residence (76.5%). Metastatic disease was present in 65.8%. Type of PC team admission was distributed as following: 60.5% in Community-team, 34.2% in Hospice and 5.3% in Hospital-team. Median distance between place of residence and admission PC service was 6.6 km, with a significant difference according to PC type of team (p <0.001). Median time to admission was 2 days, also with a significant difference depending on the type of team (p <0.001). Median time between referral and discharge in admitted patients was 33 days, with a mortality rate of 63.2% and median survival (SV) of 17 days. Symptomatic control was the main reason for referral (68.4%). In 71.11%, symptomatic evaluation was recorded at 48-72h from admission, but only in 21.1% FACIT-PAL was undertaken as the evaluation instrument. There was no significant difference in SV according to disease stage (p = 0.501) and no significant correlation was obtained between time to admission and symptom Score (p = 0.217) or SV (p = 0.668). Conclusions: In this study we obtained a partial picture of the reality of LN patients referred and admitted to PC teams. Despite the inherent biases of the small sample, we identify opportunities for improvement at the level of symptomatic assessment and control. Greater involvement of PC teams is warranted in research and monitoring activities.
Description
Keywords
Neoplasia do pulmão Cuidados paliativos Qualidade Referenciação Integração Lung neoplasm Palliative care Quality Referral Integration