Continuous Sedation in Palliative Care in Portugal: A Prospective Multicentric Study.

Objective: This study aimed to survey the practice of palliative sedation in Portugal, where data on this subject were lacking. Methods: This was a prospective multicentric study that included all patients admitted to each team that agreed to participate. Patients were followed until death, discharge, or after 3 months of follow-up. Results: The study included 8 teams: 4 as palliative care units (PCU), 1 as a hospital palliative care team (HPCT), 2 as home care (HC), and 1 as HPCT and HC. Of the 361 patients enrolled, 52% were male, the median age was 76 years, and 285 (79%) had cancer. Continuous sedation was undergone by 49 (14%) patients: 26 (53%) were male, and the median age was 76. Most patients, 46 (94%), had an oncological diagnosis. Only in a minority of cases, the family, 16 (33%), or the patient, 5 (10%), participated in the decision to sedate. Delirium was the most frequent symptom leading to sedation. The medication most used was midazolam (65%). In the multivariable analysis, only age and the combined score were independently associated with sedation; patients <76 years and those with higher levels of suffering had a higher probability of being sedated. Conclusions: The practice of continuous palliative sedation in Portugal is within the range reported in other studies. One particularly relevant point was the low participation of patients and their families in the decision-making process. Each team must have a deep discussion on this aspect.

Do spirituality and emotional intelligence improve the perception of the ability to provide care at the end of life? The role of knowledge and self-efficacy.

OBJECTIVES: Spirituality, emotional intelligence, and palliative care (PC) knowledge have a positive and direct influence on self-efficacy and on perception of preparation and ability to provide end-of-life (EOL) care. The aim of this work is to propose a conceptual model that relates spirituality, emotional intelligence, PC knowledge, self-efficacy, and the preparation and ability to provide EOL care by doctors and nurses. METHODS: Quantitative, exploratory, descriptive, and inferential study applied to doctors and nurses in a hospital in the north of Portugal, between May and July 2022. The data collection instrument includes a questionnaire. The relationships between latent variables were evaluated using structural equation models by the partial least squares method using the Smart PLS 3.0 software. It was obtained the previous authorization of the ethics committee. RESULTS: The results (n = 380) indicate that self-efficacy, spirituality, and PC knowledge have a positive influence on the ability to provide EOL care. Emotional intelligence and spirituality have a direct and positive effect on self-efficacy. There is no direct influence of emotional intelligence on the ability to provide EOL care, but emotional intelligence has an indirect effect mediated by self-efficacy. SIGNIFICANCE OF RESULTS: Spirituality, self-efficacy, and emotional intelligence are very important for the ability of doctors and nurses to provide EOL care. The identification of predictive factors of the ability to provide EOL care and the determination of the relationship between them can improve the provision of EOL care, reduction of health costs, timely and early referral of people to PC, and increase life quality.

Analysis of a telephone hotline for palliative care patients at home and their families.

BACKGROUND: To describe the use of a telephone consultation (TC) hotline for palliative care (PC) patients and their families at home provided by a PC service, during the COVID-19 lockdown. METHODS: Observational and cross-sectional study of a TC hotline performed by a PC service from 1 January to 31 December 2020. Data was collected through a record sheet completed during the call. Descriptive analyses were performed using the SPSS software (V.21 for Windows). RESULTS: A total of 494 calls were retrieved (n=187 patients; 6500 minutes recorded). Compared to 2019, incoming calls increased 33.8%. Most callers were a family member (n=419) or a community health worker (n= 60). The peak of calls was registered in April (13.5%), May (13.2%) and October (15.0%). Main problems included uncontrolled symptoms (81.9%), need for medication (8.6%), information (4.8%) and consultation rescheduling (2.6%). In 81.9% of the cases, the call occurred during a crisis. The PC team solved 92.9% of the problems. Only 20 patients were admitted in the emergency department (this was 30.5% less compared to 2019). CONCLUSIONS: The TC is a feasible alternative to traditional in-person follow-ups. Callers considered it very useful, especially during the COVID-19 lockdown. Communication was improved and admissions to emergency services were reduced.

(No) Oral Health in Palliative Care Patients: Predisposing Factors and Treatment.

OBJECTIVE: To describe mouth disorders in patients undergoing palliative care (PC); to identify predisposing factors for oral disorders and pharmacological and nonpharmacological strategies. METHODS: Observational, exploratory, correlational, and descriptive study about mouth disorders of patients admitted to a hospital specializing in PC in Portugal, between November 6, 2019, and July 31, 2020. The data collection instrument was a questionnaire and the consultation of the patient's clinical file. It was obtained the previous authorization of the ethics committee and the patient's informed consent. Data were analyzed using the SPSS® software (V.26). RESULTS: The sample was 46, 56.52% were over 71 years old, and the male sex ratio of 63.04%. Most of the patients had an advanced oncological disease, were polymedicated, had missing teeth, and no regular hygiene habits. Xerostomia and oral candidiasis were the most identified problems. Patients with oncological diseases have more probability to suffer from mouth disorders (P = .047), compared to noncancer patients. Patients with frequent oral hygiene have fewer mouth disorders (rp = -0.304; P = .040). There is a considerable improvement in the tongue coating with an increase in oral hygiene (P = .005). Mouth care plays is important in patient comfort (n = 45; 97.83%) and nonpharmacological strategies are effective for the relief of xerostomia (n = 35; 94.59%). CONCLUSIONS: Nonpharmacological strategies are effective in the treatment of xerostomia and tongue coating. More information to determine the effectiveness of the strategies in the treatment of mouth disorders is necessary.

Telesalud en cuidados paliativos durante la pandemia de COVID-19: resultados de un estudio correlacional / Telehealth in palliative care during the COVID-19 pandemic: results of a correlational study

Introducción y objetivo: La prestación de asistencia sanitaria mediante telemedicina ha cobrado especial importancia durante la pandemia de COVID-19 debido a la cancelación de consultas presenciales y visitas domiciliarias. Sin embargo, se necesita más investigación para determinar su validez y evidencia de aplicabilidad en cuidados paliativos. El objetivo de este estudio es describir la satisfacción del paciente y las características de la atención telefónica realizada por un equipo de cuidados paliativos a raíz de la pandemia por SARS-CoV-2. Material y métodos: Estudio retrospectivo, descriptivo-correlacional del servicio de consulta telefónica realizado por un equipo de cuidados paliativos. Los registros de llamadas telefónicas realizadas entre el 01-01-2020 y el 31-12-2020 se analizaron mediante un formulario que combinaba el análisis de la hoja de registro telefónico utilizada en el servicio y la consulta del expediente clínico del paciente. Los datos también incluían información sobre el usuario, el paciente y el motivo del contacto. También se investigó la relación entre la consulta telefónica y las variables número de días de ingreso y visitas al servicio de urgencias. Resultados: En 2020 se atendieron 494 llamadas telefónicas. La mayoría de los contactos fueron realizados por familiares (n = 419; 84,8 %) y atendidos por enfermeras (n = 225; 45,6 %). El principal motivo de contacto fue el control de síntomas (n = 380; 76,9 %). La asesoría telefónica resolvió el 92,9 % (n = 459) de los problemas, permitiendo que el paciente permanezca en su domicilio. Sin embargo, un 4,0 % fueron derivados al servicio de urgencias y un 3,0 % al hospital para cuidados paliativos. La consulta telefónica se asocia a una disminución del número de días de hospitalización (rp = −0,52; p = 0,0001) y de episodios de urgencia (rp = −0,62; p = 9,10 × 10-8). (AU)

Introduction and objective: The provision of health services using telemedicine has gained particular importance during the COVID-19 pandemic, due to the cancellation of physical consultations and home visits. However, more studies are needed to determine its validity and proof of applicability in palliative care. The aim of this study is to describe patient satisfaction and characteristics of the telephone care provided by a palliative care team due to SARS-CoV-2 pandemic. Material and methods: A retrospective, descriptive-correlational study of the telephone consulting service provided by a palliative care team. The records of telephone calls made between 01.01.20 and 31.12.2020 were analyzed using a form that combined the analysis of the telephone record sheet and the consultation of the patient’s clinical file. The data also included information about the user, the patient, and the reason for the contact. The relationship between telephone consultation and the variables number of days of admission and visits to the emergency service was also investigated. Results: In 2020, 494 telephone calls were answered. Most contacts were made by family (n = 419; 85.3 %) and attended by nurses (45.6 %; n = 225). The main reason for contact was symptom control (n = 380; 76.92 %). The telephone consultancy resolved 92.9 % (n = 459) of the problems, allowing the user to remain at home. However, 4.0 % were referred to the emergency department and 3.0 % to inpatient palliative care. Telephone consultation is associated with a decrease in the number of days of hospitalization (rp = −0.52; P = .0001) and episodes of urgency (rp = −0.62; P = 9.10 × 10-8). (AU)

Manifestaciones bucales en cuidados paliativos: importancia, estrategias terapéuticas y su eficacia / Oral manifestations in palliative care: importance, therapeutic strategies and their effectiveness

Introducción y objetivo: En los cuidados paliativos, las afecciones de la boca son muy frecuentes e interfieren con la calidad de vida del paciente. La boca es un lugar que aún merece poca atención por parte de los profesionales de la salud. El objetivo del presente estudio es caracterizar los trastornos bucales en pacientes de cuidados paliativos, investigar estrategias farmacológicas y no farmacológicas y analizar su eficacia. Material y métodos: Estudio exploratorio, observacional y correlacional sobre trastornos bucales en pacientes hospitalizados en un servicio de cuidados paliativos en Portugal, entre el 6 de noviembre de 2019 y el 31 de julio de 2020. El instrumento de recolección de datos incluyó un cuestionario y consulta del expediente clínico de los enfermos. Resultados: En este estudio (n = 46), el grupo de edad más representativo fue el de 71-90 años (56,52 %). La mayoría presentaba enfermedad oncológica (84,78 %) y estaban polimedicados. De estos, el 95,65 % presentaba dentición incompleta, y el 41,30 % asumía que rara vez realizaba cuidados de higiene bucal. La xerostomía fue reportada por el 89,13 % de la muestra, se observó candidiasis bucal en el 76,09 %, lengua saburral en el 23,91 % y mucositis bucal en el 10,87 %. Los pacientes con patología oncológica están más predispuestos a las alteraciones bucales (p = 0,047) en comparación con los pacientes no oncológicos. Los pacientes con hábitos de higiene bucal frecuentes tienen menos trastornos bucales (rS = –0,54; p = 0,028). Hubo una mejora considerable en la lengua saburral con el aumento en la frecuencia del cuidado de la higiene bucal (p = 0,004). Conclusiones: La implementación de estrategias farmacológicas y no farmacológicas desempeña un papel central en el bienestar y calidad de vida de la persona. Es fundamental que los profesionales de la salud conozcan las afecciones bucales y sus síntomas, lo cual es fundamental para la promoción de su bienestar. (AU)

Introduction and objectives: In palliative care, there are many mouth disorders that arise, interfering with the patient’s quality of life. The mouth is a place that still deserves little attention by health professionals. The present study aimed to characterize mouth disorders in palliative care patients; to identify the etiology of mouth disorders; to investigate pharmacological and non-pharmacological strategies, and to analyse its efficacy. Materials and methods: an exploratory, observational and correlational study on the mouth disorders of patients hospitalized in a palliative care service in Portugal between November 6, 2019 and July 31, 2020. The data collection instrument included a questionnaire and the consultation of the patient’s clinical file. Results: In this study (n = 46), the most representative age group was from 71 to 90 years (56.52 %). Most of them had oncological disease (84.78 %) and were polymedicated. Of these, 95.65 % had incomplete dentition and 41.30 % rarely performed oral hygiene care. Xerostomia was reported by 89.13 % of the sample; oral candidiasis was found in 76.09 %; tongue coating in 23.91 %, and oral mucositis in 10.87 %. Patients with oncological pathology were more predisposed to mouth disorders (p = 0.047) when compared to non-cancer patients. Patients with frequent oral hygiene habits had fewer mouth disorders (rS = –0.54; p = 0.028). There was considerable improvement in tongue coating with increased frequency of oral hygiene care (p = 0.004). Conclusions: The implementation of pharmacological and non-pharmacological strategies plays a central role in patient comfort and quality of life. It is essential that health professionals are aware of mouth conditions and their symptoms, this being essential for the promotion of well-being. (AU)