Cuidados paliativos e cuidados hospice em pacientes portadores de doenças infecciosas graves no estado do Ceará

Abstract

Introduction: Palliative care (PC) is the approach that promotes quality of life for patients and their families in the face of diseases that threaten the continuity of life, through prevention and relief of suffering. Since the beginning of the development of this care approach, it is understood that patients living with serious infectious diseases are candidates for receiving these specialized treatments, from diagnosis to the advanced stage of the disease. However, there is a lack of studies in the scientific literature on PC for this profile of patients. Objectives: To describe the characteristics of patients who died at the São José Hospital for Infectious Diseases, a reference institution in the State of Ceará; and to compare the end-of-life care provided to patients monitored by the specialized palliative care service (SECP) in relation to patients who were not assisted by a specialized service. Methodology: This is a cross-sectional, retrospective study, covering all patients who died during hospitalization in the period from January 2017 to March 2018 and had as a basic cause of death an advanced serious disease. We also analyzed comparatively the data of patients who, in the period from January 2019 to September 2019, died in this same hospital under the assistance of the SECP, identifying general information and which therapies were adopted at the end of these patients' lives. Results: There was no significant difference between the two groups when comparing age and sex (p = 0.643 vs p = 0.566, respectively). The prevalence of the use of invasive mechanical ventilation was almost 10 times higher in the group of patients without specialized support (63.6% vs 6.7%, respectively; p <0.001) and the number of patients undergoing hemodialysis at the end of life occurred at an 8-fold higher incidence in this group (22.1% vs 3.3% respectively; p = 0.002). The use of central venous catheter (55, 71.4% vs 6, 10%; p <0.001), bladder catheterization (55, 71.4% vs 7, 11.7%; p <0.001) and enteral diet for nasoenteric tube (59, 76.6% vs 1, 1.7%; p <0.001) also had a much higher prevalence among patients who were not followed up by the SECP on the last day of life. The occupation of intensive care beds during the active process of death occurred with a prevalence 8 times higher (27.3% vs 3.3%; p <0.001) and with regard to the use of antibiotic therapy on the last day of life, we also identified a higher incidence among patients in this group (74% vs 8.3%, respectively; p <0.001). Among HIV patients in both groups, the use of TAARV on the last day of life comparatively also showed a statistically significant difference (54.1% vs 2.3%, respectively; p <0.001), the same occurred when analyzing the dispensing of antituberculin drugs among patients with active tuberculosis in the active process of death (9.1% vs 91.7%, respectively; p <0.001). Regarding symptom control at the end of life, we found that all patients followed by the SECP received opioids on their last day of life, while only 13% of patients who died without specialized assistance received opioids at the time of death (p <0.001) . Conclusions: Patients with serious infectious diseases when assisted by a specialized PC service during the end of life and the death process have several aspects of positive impact from the care and managerial point of view of care, enabling a better practice in health and management of public resources.