RESUMO
Introducción La atención domiciliaria es una modalidad asistencial cada vez más demandada por los pacientes en situación terminal. Conocer el tiempo de supervivencia permitiría a los equipos asistenciales elaborar planes de cuidados adecuados y afrontar mejor dilemas éticos. No existen suficientes herramientas predictivas de supervivencia en estos pacientes en su atención domiciliaria. Objetivo Comprobar la validez y aplicación de una herramienta pronóstica diseñada en medio hospitalario con parámetros biológicos para su aplicación en domicilio. Material y método Estudio analítico, observacional y prospectivo en pacientes oncológicos terminales atendidos por un Equipo de Soporte de Atención Domiciliaria desde 1/10/03 a 7/11/05. A quienes cumplieron criterios de inclusión, previo consentimiento informado, se les extrajo sangre para la determinación de unos parámetros analíticos. Se analizó el significado pronóstico de las variables obtenidas para supervivencia igual o inferior a 30 días. El modelo predictivo a validar está representado por una ecuación logística. Se (..) (AU)
Introduction Home care is a health care service that is in increasing demand for terminally ill patients. Knowing survival time would help health care teams to develop appropriate care plans, and to deal with ethical dilemmas. There are not sufficient predictive tools for survival prognosis in those patients. Objective To verify the validity and application of a prognostic tool designed for a hospital, with analytical parameters for its application in the home setting. Materials and methods Prospective, observational and analytical study on patients with terminal cancer cared by a home care support team from 10/1/03 to 7/11/05. A blood sample was taken for the analysis of laboratory tests on those patients with, inclusion criteria and prior informed consent. Prognostic significance of the variables obtained for a survival equal to or less than 30 days was analysed. The predictive model to validate was represented by a logistic equation. Its predictive capacity was analysed by calculating the ROC and its corresponding AUC with a 95% confidence interval (CI).ResultsThe model and the prognostic equation of Nabal and col. were applied in 80 patients. This collect information associated with cachexia-anorexia syndrome and the organs involved. Only leukocytes and neutrophils showed a statistically significant difference for survival equal to or less than 30 days. Conclusions The sample size was small due to the difficulty of working in the home. The results do not agree with other models, questioning the validity of this tool in our environment. More studies that adjust the methodology developed in the field of home care are required (AU)
