Comparative study of end-of-life care in an internal medicine ward and a palliative care unit.

Rui Carneiro, Isabel Barbedo, Isabel Costa, Ernestina Reis, Nelson Rocha, Edna Gonçalves

Abstract


Dued to ageing population and growing of chronic advanced illnesses, nowadays, the majority of deaths take place in hospitals. Terminal patients with cancer and other non-malignant diseases share the same type of problems which, once correctly accessed, may have similar approach. Inappropriate terminal care can lead to unnecessary suffering of patients and their families.A retrospective chart review was done for the first 96 patients who died in 2005 due to advanced chronic illnesses in a Internal Medicine ward (48 patients) and in a Palliative Care unit (48 patients). The main outcome was the documentation of the presence/absence of a group of symptoms, the ability of the medical staff to perceive the patients as dying and the adjustments made in the comfort care plans.There were no demographic differences between the two sets of populations. In the Internal medicine ward it was seen an acute pattern of treatment even though the situation was clearly chronic and advanced. In the Palliative Care Unit there was a systematic surveillance and assessment of symptoms and other problems, like psycho-spiritual needs. In both environments, pain, dyspnoea and gastrointestinal problems were the symptoms most frequently recorded in clinical charts. The number of symptom recordings entered diminished in the agonic phase.These data highlight the need for a better assessment of patients' needs in order to promote impeccable end-of-life care.

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