Abstract
Introduction: Chronic respiratory diseases lead to a limited life expectancy and poor quality of life, which amounts to considerable suffering for patients and their families. Providing high quality end-of-life care should be a main concern in any respiratory ward.
Aims: To identify interventions (pharmacological, non-pharmacological, invasive or palliative) provided to terminal respiratory patients in their last 72 hours of life.
Methods: Retrospective, descriptive analysis of patients with chronic respiratory disease deceased in our unit over the last 2 years.
Results: During this period, 54 patients were assessed. The most common primary diagnosis were cancer (39%) and chronic obstructive pulmonary disease (26%). The most frequent cause of admission was dyspnoea (67%). More than 50% of patients underwent noninvasive ventilation, only 3 of which with a clearly palliative intent. 37% (n=20) of patients were referred to the hospital Palliative Care Team; in 9 cases this was done in the last 72 hours of life. The numeric pain scale was applied daily and most of them registered some relief: 29 patients were treated with strong opioids, 16 had breakthrough analgesic and in 9 patients was used palliative sedation. Dyspnoea was still not routinely assessed by standardized measurement scale. Few patients had clearly stated an advanced care plan treatment, namely concerning decisions not-to intubate.
Conclusions: There are still difficulties in recognising proximity to end-of-life, mainly in a non-oncologic setting. While focused on a curative-restorative medicine, we miss opportunities for Palliative Care integration. We need to improve our competences in such matters to alleviate the suffering of our patients and their families.
- Copyright ©the authors 2016