Prevalencia del estreñimiento en una población de pacientes oncológicos, en seguimiento por el equipo de cuidados paliativos / Prevalence of constipation in a cancer patient population followed up by a palliative care team

Objetivos: Determinar la prevalencia del estreñimiento en una población de pacientes oncológicos en seguimiento por el equipo de cuidados paliativos. Describir los tratamientos utilizados para el estreñimiento; comparar la frecuencia de estreñimiento según el tratamiento opioide.Material y métodos: Estudio epidemiológico, observacional y transversal. Realizado íntegramente en el Hospital Universitario Arnau de Vilanova (HUAV) de Lleida. Se utilizó un cuestionario heteroadministrado para entrevistar a pacientes en régimen ambulatorio y hospitalario, con diagnóstico de enfermedad oncológica avanzada, y en seguimiento por el equipo de cuidados paliativos durante un mínimo de 5 días.Variables: La prevalencia de estreñimiento se valoró mediante la aplicación de los criterios Roma IV. Por otra parte, se registraron variables correspondientes a las características basales de los pacientes y a su enfermedad, así como los distintos tratamientos utilizados para combatir el estreñimiento y los fármacos opioides. Para la descripción de variables cualitativas, se utilizaron las frecuencias absoluta y relativa, y para las cuantitativas la media y la desviación típica; para la comparación de las mismas se utilizó el test de Chi cuadrado y la t de Student cuando procedía, con un nivel de significación de 0,05.Resultados: De los 100 pacientes incluidos, 98 fueron aptos para el análisis. Un 19,4 % cumplía los criterios Roma IV de estreñimiento en el momento de la valoración. La proporción de pacientes con diagnóstico de estreñimiento fue mayor en régimen hospitalario sin que esta variable alcanzara la significación estadística. No se detectaron diferencias estadísticamente significativas en la prevalencia de estreñimiento entre los distintos tratamientos opioides. El 53,1 % de los pacientes seguía tratamiento habitual con algún laxante, siendo el más frecuente el hidróxido de magnesio (48,1 %), y solo un 11,5 % recibía tratamiento con más de un laxante...(AU)

Objectives: To determine the prevalence of constipation in oncological patients under follow-up by a palliative care team. To describe the treatments used for constipation, comparing the frequency of constipation according to opioid therapy status.Material and methods: An epidemiological, observational, cross-sectional study. It was completely carried out at the Arnau de Vilanova University Hospital (HUAV) in Lleida. A researcher-administered questionnaire was used to interview outpatients and inpatients diagnosed with advanced cancer disease, and followed up by a palliative care team for a minimum of 5 days.Variables: The prevalence of constipation was assessed by applying the Rome IV criteria. On the other hand, variables corresponding to the baseline characteristics of the patients and their disease were recorded, as were the different treatments used to combat constipation and the use of opioid drugs. Concerning qualitative variables, the absolute and relative frequencies were used; for quantitative variables, the mean and standard deviation were used. For comparisons, the chi-square test and Student’s t-test were used when appropriate, with a significance level of 0.05.Results: Of all 100 patients included, 98 were eligible for the analysis; 19.4 % met the Roma IV criteria for constipation at the time of assessment. No statistically significant differences were detected in the prevalence of constipation between different opioid treatments. Even though the proportion of constipated patients was higher among inpatients, this was not statistically significant. In all, 53.1 % of patients were on regular treatment with some laxative, the most frequent being magnesium hydroxide (48.1 %), and only 11.5 % received treatment with more than one laxative.Conclusions: Taking into consideration all the previous information, constipation continues to be a symptom with a non-negligible prevalence among patients with advanced cancer disease..(AU)

Sedación paliativa: situación actual y áreas de mejora / Palliative sedation: current situation and areas of improvement

Objetivo. Conocer la prevalencia, las características epidemiológicas y la calidad del registro relativos a la sedación paliativa (SP) en un hospital universitario. Establecer áreas de mejora. Material y método. nálisis descriptivo retrospectivo de los registros clínicos de pacientes oncológicos fallecidos en nuestro centro entre octubre y diciembre de 2010. Las variables analizadas incluyeron: datos epidemiológicos y ubicación de los pacientes, presencia de SP, síntoma que la motivó, grado de participación del paciente y la familia en la toma de decisiones, fármacos y dosis utilizados. El análisis cualitativo se desarrolló mediante 2 rondas Delphi en las que cada participante recibió los resultados globales del grupo. Fueron seleccionados aquellos ítems en los que existía un consenso completo o elevado. Resultados. Identificamos 53 defunciones por cáncer, el 51% recibieron SP. La edad media fue de 67 años, y el 64% fueron varones. El cáncer de pulmón supuso el 32%. Quince pacientes dependían de Oncología, 7 de Hematología y 4 del Servicio de Urgencias. En el 53,85% existió intervención de cuidados paliativos. Los síntomas que motivaron la SP fueron: disnea en 11 casos y delirium en 5. El tiempo medio ingreso-SP fue de 9,5 días (duración media, 1,2 días). La media de fármacos utilizados fue de 2,6, con empleo de morfina en el 100% y midazolam en el 98%. En 20 casos constatamos el registro de consentimiento para su inicio (100% verbal). Doce profesionales participaron en el análisis cualitativo fruto del cual consensuamos una plantilla para mejorar los registros de selección, toma de decisiones y evolución en los casos de SP. Conclusiones. La SP fue motivada por disnea o delirium y se aplicó en la mitad de los pacientes fallecidos. Las áreas de mejora detectadas afectaban al registro de los criterios de selección, al tipo de sedación y a la participación del paciente en la toma de decisiones. Por ello hemos consensuado un conjunto mínimo de datos que facilitará la recogida de información de los profesionales (AU)

Objective. To determine the prevalence, epidemiology and registration status of palliative sedation (PS) prevalence in a teaching hospital, and to establish areas for improvement. Methods. A descriptive retrospective analysis was designed using the records from cancer patients who died between October and December 2010. The variables included were: epidemiological, inpatient unit, refractory symptom, drugs and dosages, and patient participation in the decision making process. The qualitative analysis followed a Delphi process: each participant received the overall performance of the group referred to as mean, median, 25th and 75th percentile. Items selected were those in which there was total or a high consensus. Results. A total of 53 deaths were identified. Just over half (51.92%) received PS. The mean age was 67.46 and 64% were males. The most frequent diagnosis was lung cancer (32.14%). Fifteen of the patient patients were in the Oncology ward, 7 in Hematology, and 4 at the Emergency Department. The PC team took part in 14 of the sedations performed. A refractory symptom was identified in 20. There were 11 cases of dyspnea and 5 cases of delirium. The mean time between admission and PS was 9.5 days. The mean duration of PS was 1.2 days, with a mean number of 2.6 drugs used. There were 20 informed consents which were all verbal. The mean time from last chemotherapy to death was 82 days. For the Delphi process, 12 oncology or palliative care health professionals were included. A consensus was reached on the minimum data to be recorded in case of PS. This list includes: selection criteria, decision-making process and the sedation evolution. Conclusions. PS was applied in half of the patients who died due to dyspnea or delirium. Selection criteria were identified, as well as the type of PS and patient involvement in decision making process. A consensus was also reached on a minimum dataset that would help the clinician to record relevant information in PS (AU)

[Palliative sedation: Current situation and areas of improvement]. / Sedación paliativa: situación actual y áreas de mejora.

OBJECTIVE: To determine the prevalence, epidemiology and registration status of palliative sedation (PS) prevalence in a teaching hospital, and to establish areas for improvement. METHODS: A descriptive retrospective analysis was designed using the records from cancer patients who died between October and December 2010. The variables included were: epidemiological, inpatient unit, refractory symptom, drugs and dosages, and patient participation in the decision making process. The qualitative analysis followed a Delphi process: each participant received the overall performance of the group referred to as mean, median, 25th and 75th percentile. Items selected were those in which there was total or a high consensus. RESULTS: A total of 53 deaths were identified. Just over half (51.92%) received PS. The mean age was 67.46 and 64% were males. The most frequent diagnosis was lung cancer (32.14%). Fifteen of the patient patients were in the Oncology ward, 7 in Hematology, and 4 at the Emergency Department. The PC team took part in 14 of the sedations performed. A refractory symptom was identified in 20. There were 11 cases of dyspnea and 5 cases of delirium. The mean time between admission and PS was 9.5 days. The mean duration of PS was 1.2 days, with a mean number of 2.6 drugs used. There were 20 informed consents which were all verbal. The mean time from last chemotherapy to death was 82 days. For the Delphi process, 12 oncology or palliative care health professionals were included. A consensus was reached on the minimum data to be recorded in case of PS. This list includes: selection criteria, decision-making process and the sedation evolution. CONCLUSIONS: PS was applied in half of the patients who died due to dyspnea or delirium. Selection criteria were identified, as well as the type of PS and patient involvement in decision making process. A consensus was also reached on a minimum dataset that would help the clinician to record relevant information in PS.