Subreferenciação de doentes com DPOC a cuidados paliativos: Aplicação do Edmonton Symptom Assessment System (ESAS), COPD Assessment Test (CAT) e St. George Respiratory Questionnaire (SGRQ)

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a progressive, irreversible respiratory condition associated with significant morbidity and a substantial impact on the quality of life of affected individuals. Despite its high symptomatic burden and the marked functional limitation observed in advanced stages, referral of these patients to palliative care services remains scarce, highlighting a gap between identified clinical needs and the care effectively provided. The present study aimed to evaluate the under-referral of patients with COPD to palliative care, through the application of validated clinical assessment tools, namely the Edmonton Symptom Assessment System (ESAS), the COPD Assessment Test (CAT), and the St. George's Respiratory Questionnaire (SGRQ). This was an observational, cross-sectional, and descriptive study conducted in a sample of 195 patients with confirmed COPD, followed at the Freamunde Family Health Unit (USF Freamunde). The study included an etiological, sociodemographic, and occupational characterization of the population, complemented by a detailed clinical assessment. This included evaluation of symptom burden, spirometric parameters, prescribed therapy, and vaccination status. The aforementioned assessment tools were applied to a subgroup of patients with a forced expiratory volume in one second (FEV₁) below 50%. Potential associations were explored between assessment outcomes and relevant clinical variables, such as age, GOLD classification, and therapeutic regimen. The objective was to identify clinical profiles potentially eligible for referral to palliative care. The findings revealed that none of the evaluated patients had been referred to palliative care, even in cases where the assessment tools indicated a high symptom burden and, consequently, a likely need for such care. These results reinforce the existence of a systematic under-representation of COPD patients within palliative care settings. They underscore the urgent need to raise awareness among healthcare professionals regarding this issue and to implement integrated care models that systematically incorporate objective criteria, based on symptom scales, for the timely identification and referral of candidates for palliative care.