[Palliative care in a department of internal medicine].

Abstract

Introduction: Palliative care improves the quality of life of seriously ill patients suffering from chronic, progressive disease. Objective: We assessed the need for palliative care and the characteristics of patients in serious condition treated in internal medicine department suffering from a chronic progressive disease. Method: Our retrospective study of patients admitted to our clinic from the Emergency Department between January 1, 2020 and January 31, 2024 assessed the following data: characteristics of diseases, the dates of diagnosis and palliative care, the indication for admission, their condition, symptoms and the place and the date of their possible death. Results: The average age of the 197 patients was 71 years, 45% were men. Among them, 95% suffered from cancer and 5% from other chronic progressive diseases. Locations of the primary cancer were lung, colon and breast. The others suffered from organ failure and neurological disease. Only 4% of cancer patients underwent early palliative care. The average of the functional stage was ECOG 3.4 or Karnofsky index 24%. The leading symptoms were pain, loss of appetite and bloating. In patients with cancer, the average of the interval between the diagnosis and palliative care was 110 weeks, by 17% of the patients these two dates were the same. The average time between the date of palliative care and palliative consultation in our department was 26 days and by 71% of patients with cancer these two dates were the same as well. Family discussions were completed by 33% of the patients, which low rate can be partly attributed to restrictions on visiting patients during the COVID–19 pandemic. By the end of the study, 88% of the patients died, only 27% was discharged home. The average time between the beginning of palliative care and the date of death was 82 days. Discussion: Our study revealed that the patients in palliative care have a significant symptom burden. The diagnosis and the beginning of palliative care in patients with cancer are often delayed, early palliative care is rare. They often do not die in their homes where they would like. We rarely think about the palliative care in the case of patients suffering from non-cancerous, chronic progressive disease. Conclusion: Early palliative care of patients with chronic progressive diseases improves their quality of life. Orv Hetil. 2024; 165(26): 1010–1016.