Evaluation of the symptoms and treatment prescribed to hospitalized patients

Abstract

Objective: Evaluation of the presence of symptoms and suitability in the treatment of patients admitted to medical wards at HU-UFSC. Identification of patients eligible for palliative care (PC). Method: A prospective cohort study, which evaluated patients in the first 48 hours of hospitalization (D1) and after 48 hours (D2). On D1, palliative performance and symptom assessment scales were applied (PPS/ESAS). The treatment established for the control of detected symptoms was also identified. On D2, the ESAS scale was applied again, and the medical prescription reviewed. When the presence of severe symptoms was found, the attending physician was informed. Patients who presented PPS≤60 were eligible for PC prioritization. For statistical analysis Student's t and χ² tests were used. Results: 168 patients were studied. Of these, 26.8% had PPS≤60. PC was described in one medical chart. Patients with mild symptoms reported significant worsening in the second evaluation, especially worsening in pain (32.3%) and well-being (49.3%). Symptoms considered severe showed significant improvement. There was no control of pain reported as moderate. Prescriptions for pain control were predominantly "if necessary", prevailing the use of non-opioid analgesics and weak opioids. The attending physician was informed of 116 (69%) patients with ESAS score≥4. Conclusion:The control of symptoms, especially those considered mild, was unsatisfactory. Drug prescription was inadequate to control pain, and non-existent for some reported symptoms. There was no adequate prioritization of PC. There is a need for optimization and dissemination of PC among health professionals.

Cognition, functionality and symptoms in patients under home palliative care

“…The prescriptions for pain control were predominantly "if necessary", prevailing the use of non-opioid analgesics and weak opioids. In the same study, anxiety was not treated in over 75% of the patients 16 .…”

“…The multicentre study Support 15 , conducted in 1995 with 10,000 patients with terminal disease, showed that half of them died with moderate or severe pain, without any analgesic prescription. A recent study with hospitalized patients, not on PC, showed patients with various non-medicated symptoms, including pain 16 . On the other hand, studies with chronic patients under PC demonstrate a good control of symptoms and improvement of the quality of life of these patients 17, 18 .…”

Knowledge of Resident Doctors Regarding Palliative Care: A Systematic Review

“…The study by Roldi and Moritz [33] concluded that due importance is not given to palliative care and that there is a need for optimization and dissemination of this topic among health professionals, mainly due to the growth of aging population and the consequent increase in the prevalence of non-communicable chronic diseases.…”

Percepção dos familiares sobre a atuação da equipe de cuidados paliativos durante internação hospitalar

“…Para se garantir assistência efetiva em cuidados paliativos, já existem ferramentas que podem ser utilizadas pelos profissionais, a exemplo da Escala de Avaliação Sintomas de Edmonton (ESAS), que avalia e mensura sinais e sintomas de sofrimento e desconforto como: dor, fadiga, náuseas, depressão, ansiedade, sonolência, apetite, desconforto respiratório e mal-estar geral. Esta avaliação deve ser aplicada diariamente, por meio de perguntas simples e direcionadas para os pacientes ou familiares (16) . Porém, após na análise das entrevistas foi observado que esta ferramenta não era usada pela equipe de cuidados paliativos ou, se era, não se explicava sua função aos familiares.…”