Intervenção da Equipa Intra-Hospitalar de Suporte em Cuidados Paliativos nos doentes internados em serviços hospitalares do Centro Hospitalar Trás-os-Montes e Alto Douro - Unidade de Vila Real

Abstract

Introduction: Palliative Medicine encompasses the study and holistic approach to patients with severe and/or progressive, advanced, life-threatening illnesses, for which the prognosis is limited, and the primary focus of care is the promotion of well-being and quality of life. Clinical intervention for these patients, by a multidisciplinary team, goes beyond the rigorous treatment of symptoms and the physical manifestations of the disease causing suffering, extending to psychological, social, and spiritual support for both the patient and their caregivers/family, continuing through the bereavement period. This intervention should occur early in the course of the disease and not just in the final stages, following a model of cooperative and shared care with other specialties that can offer disease-directed interventions. In order to understand, acquire, and cement specialized skills and knowledge in this area, a technical-scientific internship with the Palliative Care Team at the Trás-os-Montes and Alto Douro Hospital Center was proposed. During the internship, it became opportune to develop a scientific component through a study focused on the activity of the Palliative Care Team (PCT) Consultation, considering its dimension of providing quality care, explicitly defined and measurable. Objectives: Objectives of the internship component: - Acquire practical skills in the field of Palliative Care; - Observe and analyze contexts, projects, and procedures in Palliative Care; - Apply theoretical knowledge acquired during the first year of the Master's in clinical practice in Palliative Care; - Identify strategies and areas of intervention in Palliative Care according to appropriate instruments and methodologies; - Contribute to personal and social development and professional qualification in Palliative Care. Objectives of the scientific component: - Characterize in demographic, social, and clinical terms the patients observed by the PCT admitted to the Trás-os-Montes and Alto Douro Hospital Center - Vila Real Unit (CHTMAD-VR); - Evaluate the impact of opioid use in pain control for patients observed by the PCT, admitted to CHTMAD-VR. Methods: The technical-scientific professional internship with the palliative care team of the Trás-os-Montes and Alto Douro Hospital Center took place from September to November 2022, covering intra-hospital, outpatient, and inpatient aspects, totaling 405 contact hours. Data collection for both the internship and scientific components was obtained using clinical information from: the SClinico and GHAF software programs; the "EIHSCP-Visit Log" document, complemented by personal records. A Microsoft Excel® sheet was created to fill in and catalog data relevant to the study. Statistical analysis will be performed using IBM Statistical Package for the Social Sciences (SPSS®) and Microsoft Excel®. Results: The practical component of the internship covered crucial areas of palliative care, including symptom assessment and control, communication techniques, family support strategies, and working in a multidisciplinary team, emphasizing personalized care that requires understanding the context and impact of the disease on the patient's life. For the scientific component, a sample of 104 patients admitted to CHTMAD-VR services, who requested PCT collaboration from January 1, 2022, to December 31, 2022, was considered. All presented with uncontrolled pain (associated or not with other symptoms), requiring adjustment of opioid analgesic therapy. The average age of the patients was 74 years (min: 39 years, max: 98 years) and the majority (58.7%) were male. Most of the referred patients (73%) had oncological disease. Regarding the use of opioids for pain control in the observed patients, morphine was the most commonly used drug. All patients showed a statistically significant reduction in the median pain intensity before (median = 4) and after (median = 0) PCT intervention, z = -8.90, p < 0.0005. Conclusion: The skills and knowledge acquired during the internship with a specialized palliative care team, combined with full integration into their care activities with all team members, solidified my conviction about the added value of this path in my training. The scientific component developed corroborated the added value of PCT intervention in the quality of life of its patients, demonstrating a statistically significant reduction in pain intensity. In summary, the intervention of PCT at CHTMAD-UVR has had and continues to have an extremely positive impact on the lives of hospitalized patients and on my professional and personal life.