Need for palliative care in patients admitted to emergency departments of three tertiary hospitals: evidence from a Latin-American city

Abstract

Background: Emergency departments (ED) serve as a contact point for critically ill patients. According to experience, a fraction of patients visiting ED present with symptoms and require palliative care; however, the prevalence of these patients has not been determined in Peru so far. Objectives: To estimate the prevalence of advanced disease in patients admitted to ED and identify among them the need for palliative care. Patients and methods: In the ED of 3 tertiary hospitals in Lima all adult patients had an evaluation of the medical history and an interview with patients or caregivers. The presence of multiple metastases was considered advanced cancer, and dementia, neurological, respiratory, hepatic or cardiac disease with functional dependence or severe deterioration for non-oncological illness. The screening tool was a validated and adapted palliative care questionnaire. Results: The prevalence of advanced illness was 7.5% (60 of 797 admissions). The age of patients was 19-96 (median 73.1) years of which 48.3% were females, 23 (39%) patients had oncological and 37 (61%) patients non-oncological diagnoses. The most frequent symptoms upon admission were dyspnoea, drowsiness, and pain. A total of 13 (21.7%) of patients with advanced disease were already receiving palliative care and 8 (13.3%) had controlled symptoms. Conclusions: Nearly 1 in 13 patients attending ED of tertiary hospitals has advanced disease, of which 80% reported the need for palliative care with less than a quarter of them having received it.

Screening tools to identify patients with unmet palliative care needs in the emergency department: A systematic review

“…The quality of 22 studies were assessed using the NOS (see Appendix 5) 12,16,17,18,20‐26,30‐36,38‐40,46 . The majority of these studies included a representative cohort of participants and sufficient follow‐up.…”

“…43 Another study reported that the SQ had moderate to strong correlation with the Caregiver Burden Score and Risk Instrument for Screening in the Community, but a poor correlation between the Clinical Frailty scale and the EQ-5D. 44 While Tineo et al 40 did not assess the psychometric properties of their screening tool, their study reported that an unpublished pilot study found that their screening tool had acceptable internal consistency (Cronbach coefficient = 0.699).…”

“…[15][16][17][18][19][20][21][22][23][24][25][26] The majority of studies reported screening unmet PC needs in ED patients with specific EOL conditions or patients requiring admission (see Table 1). 12,13,[15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Across the 35 included studies, a total of 14 unique screening tools were assessed (see Table 1 and Appendix 2). The majority of studies did not utilize another screening tool as a reference standard, except for three studies that used screening tools that had been previously used to identify unmet PC needs in patients in other clinical settings.…”

Quality of life in patients with advanced cancer according to place of care in a referral hospital

“…Los cuidados paliativos son una alternativa terapéutica obligatoria para mejorar la calidad de vida en los pacientes con enfermedades avanzadas, sobre todo en la etapa del final de la vida (5) . En Perú, en agosto de 2018 se promulga la ley de plan nacional de cuidados paliativos para enfermedades oncológicas y no oncológicas, sin embargo actualmente los cuidados paliativos todavía no son accesibles para todos, concentrándose en las principales ciudades y con mayor aplicación para enfermedades oncológicas; pero son pocos los estudios que evalúan calidad de vida estos pacientes (6) .…”

“…Por dificultades para acceder a una atención oportuna, muchos de los pacientes con enfermedades oncológicas son atendidos en hospitales de referencia y acuden a los servicios de emergencia con posterior hospitalización, incluso cuando ya pertenecen a programas de cuidados paliativos (6) . El objetivo del presente estudio es comparar la calidad de vida percibida por pacientes con cáncer avanzado en etapas finales de vida en un hospital de referencia, con pacientes de un programa de cuidados paliativos domiciliario.…”