Symptom management and palliative care for patients dying in an Internal Medicine Department

Objective: the aim of this study was to describe the clinical characteristics of patients who died in an Internal Medicine department during 2007, including those who passed over after a phase of agony (including symptoms, symptom control, drugs used, and non-pharmacological palliative care). Materials and methods: this was an observational prospective study that analyzed medical records, excluding those who died less than 24 hours after hospital admission or after advanced cardiopulmonary resuscitation. Result: of 861 admissions 42 subjects died; 87.5% were catalogued as agonizing, and their main symptom was dyspnea (85.7%); control was inadequate for dyspnea as well as for other silent symptoms (only 7.1% died with all symptoms controlled). There were no references in their medical records to any other type of palliative non-pharmacological approach (psychosocial, spiritual, or grief care). Conclusions: there is a high percentage of patients who die in agony in conventional hospitalization wards. Symptoms collected from these patients do not differ from those seen in palliative care units, although dyspnea is most usual and uncontrolled pain is less frequent. Symptom control is difficult but improves with standard palliative drugs (morphine, midazolam and butylscopolamine). There were no systematic references to non-pharmacological palliative care in medical records.