Palliative Care Consultation Service and Palliative Care Unit: Why Do We Need Both?

Gaertner, Jan; Frechen, Sebastian; Sladek, Markus; Ostgathe, Christoph; Voltz, Raymond

doi:10.1634/theoncologist.2011-0326

Cited by 39 publications

(53 citation statements)

References 34 publications

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“…Os principais sinais e sintomas atendidos foram náuseas e vômi-tos 40%, constipação 35%, dor em 79% dos pacientes e 94% com queixa de fraqueza. A origem inicial dos tumores foram pulmão 16%, mama 13%, hematológico 12% e gastrointestinal 12% (12).…”

Section: Discussão E Conclusãounclassified

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Perfil Dos Pacientes Oncológicos Atendidos Em Uma Unidade De Emergência

2015

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RESUMOObjetivo: Analisar o perfil dos pacientes oncológicos atendidos na Unidade de Emergência de um hospital pú-blico estadual no interior do Estado de São Paulo -Brasil. Material e método: Este é um estudo exploratório, retrospectivo. Foram utilizados os prontuários dos pacientes atendidos no departamento de emergência no ano de 2012. Resultados: Foram atendidos 172 pacientes oncológicos em um ano, 62,2% (107) do sexo masculino com média de idade de 62 anos, sendo 69,8% (120) pacientes no estágio inicial ou intermediário da doença, 97,6% (168) dos pacientes fizeram quimioterapia e 39,5% (68) radioterapia e 86% (148) destes pacientes oncológicos não apresentaram metástase, sendo 57,5% (99) tiveram alta do serviço de emergência. Quanto aos sinais e sintomas que levaram estes pacientes procurarem o serviço de emergência estão a dor 83,1% (143), náuseas e vômitos para 67,4% (116), febre 26,1% (45) e fraqueza apresentada por 11,6% (20) pacientes. Os tumores eram de origem gastrointestinal para 27,3% (47), pulmão 18,6% (32) e mama 16,9% (29), sendo utilizados analgési-cos 94,7% (163) e antieméticos 79,6% (137), por via endovenosa periférica 45% (77). Conclusão: Concluiu-se que é pequena a prevalência de pacientes oncológicos nesta unidade de emergência, e que o tratamento dos sintomas em pacientes com câncer é uma preocupação multiprofissional complexa e os serviços de emergência devem ter estrutura física e recursos humanos qualificados para atender os pacientes.Palavras chave: Enfermagem em emergência, serviços médicos de emergência, oncologia. ABSTRACTObjective: To analyze the profile of oncology patients treated at the Emergency Unit of a public hospital in the State of São Paulo -Brazil. Method: This is an exploratory, retrospective study. Medical records were used from patients seen in the emergency unit in the year 2012. Results: 172 cancer patients were treated at one year, 62.2% (107) were male with a mean age of 62 years, 69.8% (120) patients in the initial or intermediate stage of the disease, 97.6% (168) of the patients received chemotherapy and 39.5% (68) radiation and 86% (148) of these * Enfermeira, Professor Doutor

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Section: Discussão E Conclusãounclassified

“…Os pacientes oncológicos precisam de infra-estrutura de atendimentos específicas para cuidar adequadamente deste paciente gravemente doente e morrendo, não sendo os serviços de emergências locais adequados para a realização desta assistência (12).…”

Section: Discussão E Conclusãounclassified

Perfil Dos Pacientes Oncológicos Atendidos Em Uma Unidade De Emergência

2015

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“…Der Charakter eines Add-on-Angebots wird jedoch v. a. in Form palliativmedizinischer Konsildienste, palliativmedizinischer Spezialambulanzen oder in der sog. "spezialisierten ambulanten Palliativversorgung" (SAPV) unter häuslichen Bedingungen statt [8,9]. In analoger Weise zu den stationären Strukturen ergän-zen die Angebote der SAPV die hausärzt-lichen, pflegedienstlichen und familiären Unterstützungsstrukturen, ohne diese zu ersetzen.…”

Section: Spezialisierte Palliativversorgungunclassified

Frühzeitige spezialisierte palliativmedizinische Mitbehandlung

2015

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Ein herausfordernder GoldstandardBut I must go and meet with danger there, Or it will seek me in another place, And find me worse provided. W. Shakespeare, Henry IVPatienten mit inkurablen und fortschreitenden Grunderkrankungen, insbesondere malignen Tumoren, leiden unter einer Vielzahl an Symptomen und psychosozialen Belastungen -dies nicht nur in weit fortgeschrittenen oder sterbenahen Situationen, sondern bereits im frühen Erkrankungsverlauf. Insbesondere in frühen, inkurablen Erkrankungssituationen treten tumortherapiebedingte Belastungen zu den erkrankungsbedingten Belastungen hinzu.Die Belastungen von Patienten mit inkurablen und fortschreitenden Grunderkrankungen zu lindern, stellt eine der Kernaufgaben in der Behandlung von Krebspatienten dar. In aller Regel wird diese Aufgabe der "Allgemeinen Palliativversorgung" (APV) dem Onkologen in Zusammenarbeit mit dem Hausarzt zufallen, da er die Patienten durch ihren Erkrankungsverlauf hindurch betreut und im Rahmen der regelmäßigen Kontakte am ehesten in der Position ist, physische und psychosoziale Belastungen der Patienten zu erkennen, zu behandeln und weitere Unterstützung zu koordinieren. Bei einigen inkurabel erkrankten Patienten stellen sich besonders komplexe Belastungssituationen dar, die mit den Ressourcen und auch der Expertise der onkologischen und hausärztlichen Alltagsroutine nicht aufzulösen sind. Diese komplexen Belastungssituationen stellen eine Domä-ne der sog. "Spezialisierten Palliativversorgung" (SPV) dar, die durch einen breiten, multiprofessionellen und interdisziplinären, sowohl akut-interventionellen als auch dauerhaften Unterstützungsan-satz -zusätzlich zu den Strukturen der Regelversorgung -gekennzeichnet ist.Dieser Beitrag stellt die Grundzüge des interdisziplinären palliativmedizinischen Behandlungsansatzes dar, diskutiert gängige Definitionen, beschreibt die in Deutschland etablierten stationären, konsiliarischen, ambulanten und häus-lichen spezialisierten palliativmedizinischen Versorgungsstrukturen und fasst die wissenschaftliche Evidenz sowie die Empfehlungen der onkologische Fachgesellschaften für einen frühzeitigen Einbezug spezialisierter palliativmedizinischer Handlungsansätze in die Behandlung von Krebspatienten zusammen.

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“…The palliative care infrastructure differs by region, with some countries supporting palliative home care services and others preferring that services be delivered at palliative care units or hospices. 17,18 Finally, the team should determine who has primary responsibility for treatment based on the disease course. As long as patients remain on an oncology treatment structure, the palliative care physicians serve a consulting role and do not make disease-specific treatment decisions.…”

Section: S-20mentioning

confidence: 99%

Provision of Palliative Care and Pain Management Services for Oncology Patients

Marchetti¹,

Voltz²,

Rubio³

et al. 2013

J Natl Compr Canc Netw

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Early initiation of palliative care to address pain and other symptoms offers the potential to improve quality of life for patients with cancer. The approaches to implementing and delivering palliative care and pain management services vary depending on patient needs, available resources, provider training, and clinical setting. This article describes the experiences in developing programs in which the need for early palliative care or pain management services for patients with cancer was recognized. In each case, collaborative efforts, careful planning, administrative support, and ample time were needed to implement such services. To tailor services based on the available resources, different approaches were taken, including structuring of services within oncology units; creation of an integrated partnership between oncology and palliative care departments; establishment of a multidisciplinary comprehensive service; and incorporation of nurse-based pain services to address acute, chronic, and cancer pain. These examples offer insights into how to optimize delivery of services in a variety of settings with varying resources. (JNCCN 2013;11(Suppl 1): S17-S27) recommends that combined standard oncology and palliative care should be considered early in the disease process for patients with metastatic cancer and/or a high symptom burden. Meanwhile, the European Society for Medical Oncology (ESMO) formalized the relationship between medical oncology and palliative care in a series of policy statements published in 2003. 4 These policies recognize that alleviation of pain and other symptoms should be given a high priority, that medical oncologists must be experts in evaluating and managing these symptoms, and that cancer centers should provide supportive and palliative care as part of their basic services. Provision of Palliative Care and Pain Management Services for Oncology PatientsAlthough agreement exists on the need for early palliative care services for patients with cancer, less guidance is available on optimal ways to develop successful programs. The availability of palliative care and pain management services varies by country and geographic location, and across medical centers. Programs incorporating palliative care services must base their design on the needs of the patients, the training and availability of health care providers, and the resources available.

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Palliative Care Consultation Service and Palliative Care Unit: Why Do We Need Both?

Cited by 39 publications

References 34 publications

Perfil Dos Pacientes Oncológicos Atendidos Em Uma Unidade De Emergência

Perfil Dos Pacientes Oncológicos Atendidos Em Uma Unidade De Emergência

Frühzeitige spezialisierte palliativmedizinische Mitbehandlung

Provision of Palliative Care and Pain Management Services for Oncology Patients

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