The need for Palliative Care in an Internal Medicine Department
Keywords:
palliative care, symptom control, futile therapyAbstract
Introduction: Palliative care should be a fundamental part of any Health System. In Portugal no studies have objectively analysed
the prevalence of such patients in Internal Medicine wards. This study aimed to characterize palliative care needs in Internal
Medicine wards of a Central/University Hospital, to define the profile of patients, determining their needs and assessing the
adequacy of care.
Material and Methods: Prospective and observational study including 670 patients admitted to an Internal Medicine ward of
a Central/University Hospital in a period of 9 consecutive weeks. Selection of patients in need of Palliative Care who answered a
questionnaire and a review of clinical files aiming to assess several variables, namely, disease leading to the need of palliative care,
reason for admission, performance status, symptoms/symptom control measures and special care in agony.
Results: The study determined palliative care needs in 15% of the hospitalized patients (54 cancer patients and 48 non cancer
patients), that presented multiple and intense symptoms, requiring complex therapy and extensive nursing care. Although most
symptoms have improved there was insufficient symptomatic control, especially of anorexia, fatigue, depression and anxiety.
There was also difficulty in the recognition of agony (achieved in only 1/3 of patients) and institution of the appropriate attitudes
and therapeutic measures, with maintenance of futile therapy.
Mortality was 31.3%. Of the patients discharged from the hospital only 3 were admitted in palliative care units.
Conclusion: This study illustrates in an objective way the need for palliative care in Internal Medicine wards and points to the
importance of specific training of Internists in this particular area.
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