Palliative Prognostic Index accuracy of survival prediction in an inpatient palliative care service at a Brazilian tertiary hospital.

PURPOSE: The Palliative Prognostic Index (PPI) was developed to improve survival prediction for advanced cancer patients. However, there is limited data about the PPI application in a real-world scenario. This study aimed to assess the accuracy of PPI > 6 in predicting survival of cancer inpatients. METHODS: A prospective observational cohort in an inpatient palliative care service at a tertiary hospital in São Paulo-SP, Brazil, between May 2011 and December 2018. RESULTS: We included 1,376 critically ill cancer inpatients. Patients were divided into three PPI subgroups: PPI ≤ 4, PPI 4-6, and PPI ≥ 6. Their respective medium overall survival values were 44 days (95% confidence interval [CI] 35.52-52.47), 20 days (95% CI 15.40-24.59), and 8 days (95% CI 7.02-8.98), (p < 0.001). PPI ≥ 6 predicted survival of <3 weeks with a positive predictive value (PPV) of 72% and an negative predictive value (NPV) of 68% (sensitivity 67%, specificity 72%). PPI > 4 predicted survival of <6 weeks with a PPV of 88% and an NPV of 36% (sensitivity 74%, specificity 59%). When PPI was <4, the mortality rate over 3 weeks was 39% with a relative risk (RR) of 0.15 (95% CI 0.11-0.20; p < 0.001), and the 6-week mortality rate was 63% with a RR of 0.18 (95% CI 0.13-0.25; p < 0.001) compared to PPI ≥ 4. CONCLUSIONS: PPI was a good discriminator of survival among critically ill cancer inpatients and could assist in hospital discharge decision. PPI may help healthcare policymakers and professionals in offering high-quality palliative care to patients.

Profissionais Paliativistas e suas Contribuições na Prevenção de Luto Complicado / Palliative care professionals and their contribution to the prevention of complicated grief / Profesionales paliativistas y sus contribuciones en la prevención del duelo complicado

Resumo Os cuidados paliativos buscam qualidade de vida baseada principalmente na prevenção e alívio do sofrimento de pacientes que possuem doenças ameaçadoras de vida, englobando as esferas de ordem física, psicossocial e espiritual. Além disso, estende-se ao pós-morte do paciente, oferecendo suporte à família no processo de luto. Esta pesquisa qualitativa teve como objetivo compreender e analisar a formação dos profissionais em relação ao processo de morrer do paciente e as percepções daqueles em relação às suas contribuições para a prevenção de luto complicado da unidade de cuidado. A Teoria do Apego fundamentou teoricamente este estudo. Participaram voluntariamente profissionais de saúde que integram formalmente equipes de cuidados paliativos. Foi utilizado um questionário autoaplicativo para obtenção de dados acadêmicos, profissionais e de cursos realizados, e uma entrevista semiestruturada. A análise das informações colhidas nas entrevistas foi realizada através de transcrição e categorização das mesmas, seguida de análise de conteúdo. Os resultados confirmaram que a formação dos profissionais em relação ao processo de morrer é escassa. Ademais, observou-se que os profissionais de saúde que trabalham em cuidados paliativos possuem comportamentos de apego, os quais são identificados como naturais nesse contexto, o que acaba por dificultar a percepção de que são importantes contribuições para a prevenção de luto complicado da unidade de cuidado. Diante desses resultados, a presente pesquisa trouxe a relevância sobre a necessidade da inserção das temáticas morte e morrer na educação dos profissionais de saúde, o que pode contribuir para melhor assistência à unidade de cuidado nos seus processos de luto....(AU)

Abstract Palliative care seeks quality of life based primarily on prevention and relief of suffering of patients who have life threatening diseases, encompassing physical, psychosocial and spiritual areas. Furthermore, extending the post-mortem patient, it offers support to the family in the grieving process. This qualitative study aimed to understand and analyze the training of professionals in relation to dying patients and their perceptions regarding their contribution to the prevention of complicated grief in the care unit. The Attachment Theory grounded this research theoretically. Volunteer professionals of the palliative care teams participated in this study. A self-administered questionnaire was used to obtain academic and professional data, besides their courses taken, and a semi-structured interview. The analysis of the collected data was done through transcription and categorization, followed by the content analysis. The results confirmed that the training of professionals in relation to the dying process is scarce. Moreover, it was observed that health professionals working in palliative care have attachment behaviors, identified as natural in this context, and that that ends up making it harder to realize that is an important contribution to prevent grief from becoming complicated in the care unit. The results of this research brought out the relevance of the need of inserting themes such as death and dying in the education of the professionals of this field, which can contribute to a better assistance in the care unit in the grieving process....(AU)

Resumen Los cuidados paliativos buscan la calidad de vida basada principalmente en la prevención y el alivio del sufrimiento de pacientes que poseen enfermedades amenazadoras de la vida, incluyendo las esferas de orden físico, psicosocial y espiritual. Además, se extienden más allá de la muerte del paciente y ofrecen apoyo a la familia en el proceso de luto. Esta investigación cualitativa tuvo como objetivo comprender y analizar la formación de los profesionales con relación al proceso de muerte del paciente y las percepciones de aquellos a propósito de sus contribuciones a la prevención del duelo complicado en la unidad de cuidado. La Teoría del Apego fundamentó teóricamente este estudio. Participaron voluntariamente profesionales de salud que integran formalmente equipos de cuidados paliativos. Se utilizó un cuestionario autoaplicativo para obtener datos académicos, profesionales y de cursos realizados y una entrevista semiestructurada. El análisis de las informaciones recogidas en las entrevistas se llevó a cabo a través de su transcripción, categorización y posterior análisis de contenido. Los resultados confirmaron que la formación de los profesionales con relación al proceso de muerte es escasa. Además, se ha observado que los profesionales de salud que trabajan en cuidados paliativos poseen comportamientos de apego que se identifican como naturales en ese contexto, lo que acaba dificultando la percepción de que suponen importantes contribuciones para la prevención del duelo complicado en la unidad de cuidado. Ante estos resultados, la presente investigación destacó la relevancia de la necesidad de incluir las temáticas muerte y morir en la educación de los profesionales de salud, lo que puede contribuir a una mejor asistencia a la unidad de cuidado en sus procesos de luto....(AU)

Implementing a patient-centred outcome measure in daily routine in a specialist palliative care inpatient hospital unit: An observational study.

BACKGROUND: Gathering clinical evidence data on patients' palliative care needs is paramount to identify changes in outcomes over time and maintaining on-going quality improvement. Implementation of patient-centred outcome measures has been widely recommended. The routine use of these instruments in daily practice is challenging and not widespread. AIM: To implement a patient-centred outcome measure in daily practice and fulfil one quality indicator: improve pain during the 72 h after admission, in at least 75% of patients. DESIGN: An observational prospective study. The Palliative care Outcome Scale was used at admission (T0), third day (T1) and weekly. SETTING/PARTICIPANTS: Hospital palliative care unit with 17 individual rooms. All patients admitted to the unit were included in the study. RESULTS: Preliminary results ( N = 84) revealed inconsistent and missing data (14%). Symptoms were sub-optimally controlled by T1. Processes changed, and only a team member could apply Palliative care Outcome Scale. Doctors were encouraged to grasp the meaning of Palliative care Outcome Scale results for each patient. The post-pilot included 317 patients. No missing data occurred. There was an improvement in most items between T0 and T1: 'pain' and 'other symptoms' presented statistical significant differences ( p < 0.05). CONCLUSION: Implementing a patient-centred outcome measure in a hospital palliative care service is feasible and improves quality of care. Controlling high pain at T0 improved (>80%) by T1. Results became more consistent and symptom control was improved overall. Patients are evaluated based on holistic domains by an interdisciplinary team and we have added a much needed measure to help guide improvement of the quality of care provided.