Může paliativní nemocniční tým přinést něco nového do terminální fáze nemoci?

Abstract

Good communication and documentation of patients‘ preferences in the dying phase can help to provide patient-centered care in hospitals. We aimed to explore whether the support of the palliative team can make any difference in the dying phase.

Methods: This was a mixed-method retrospective case-control study with content analysis of medical records. We included all in-hospital cases who died in the  Faculty hospital Kralovske Vinohrady with the support of the palliative care team between January 2019 and April 2020. Big data from registries of routine visits were used for propensity score matching to controls not supported by the palliative care team. Groups were compared over the documentation of the dying phase, prognosis, limitation of life-sustaining treatments, patients’ preferences, family support, and days spent in the intensive care unit. The statistical significance of differences between the case and control groups was tested by Fisher’s exact test and Mann-Whitney U-test.

Results: We identified 213 dyads. The dying phase, prognosis, limitation of life-sustaining treatments, patients‘ preferences, and family support significantly differed between the groups and were more often documented in the palliative care group.  (p<0.001) This was associated with fewer days spent in the intensive care unit. (16% vs 33% of hospital days)

Conclusions: The study revealed that integration of the palliative care team makes a considerable difference in the dying phase documentation, promotes advance care planning, and can help to provide less aggressive patient-centered care based on their preferences.