End-of-life care of advanced chronic non-cancer patients in a medium and long term hospital

Objectives: To describe the characteristics and evolution of advanced chronic non-cancer patients (ACNCP) with a need of end of life care (EofLC) identified and evaluated through an Exhaustive Multidimensional Assessment (EMA) and Interdisciplinary Teamwork (IT). Methods: A retrospective descriptive study, evaluating patients admitted to the Integral Medical Area (IMA) of the Pare Jofre Hospital that changed the care process from Convalescence (CON) or Long Stay (LS) to Palliative Care (PC) during the period from 2008/04/01 to 2009/03/31. General data were analysed (age, comorbidity, functional, cognitive, nutritional, social and family, status symptoms and interventions by the IT, number of drugs, complications, stay, mortality), as well as specific data (terminal criteria of the National Hospice Organization, diagnostic and prognostic information, development of the Comprehensive Care Plan, advance directives, limiting levels of effort care, times from admission to identify need of palliative care and the start of symptomatic treatment and pure palliative treatment and risk of complicated bereavement). The data analysis was performed with SPSS 15.0. Results: A total of 138 patients were studied, 55% female, and a mean age of 81 +/- 9.5; Charlson Index 3.4 +/- 1.9; Barthel at admission 5.3 +/- 15.2; cognitive impairment 89%; Mini Nutritional Assessment (MNA) (median) 12, and albumin 2.6 g/dl; intervention of more than one component by the IT 35%; predominant symptoms: dysphagia, pain, constipation and dyspnoea; complications occurred in 80% of cases; average stay was 23.5 days and mortality 93%. In the origin care recourse: Prognostic information (PI) to the family, 65%; Advance directives (AD), 25%. During hospitalization: PI to family, 92%; Adequacy level of care effort, 80%; AD 96%; Zarit score decreased to 17 points; times in days (median) from admission to identify need for palliative management; 7 days, and starting pure palliative treatment, 15 days, and risk of a complicated bereavement, 5%. Conclusions: The predominance of ACNCP in end of life situations is characterised by advanced age, high comorbidity, significant overall impairment on admission, increased symptomatic burden, and a high prevalence of complications during the stay, and high mortality. There is a lack of approach to PI and AD in the original care resources. Our EMA methodology in IT allows us identify ACNCP with indication for palliative care soon after admission and while assessing their needs and those of their families with the aim of ensuring an appropriate end-of-life -care during the most for most of their stay. (C) 2011 Sociedad Espanola de Cuidados Paliativos. Published by Elsevier Espana, S.L. All rights reserved.