Abstract
Traditionally, palliative care (PC) systems focused on the needs of advanced cancer patients, but most patients needing PC have end-stage organ diseases. Similarly, PC models focus on the needs of patients in hospices or at home; however, in most cases PC is provided in acute hospitals. Indeed, the symptom burden that these patients experience in the last year of life frequently forces them to seek care in emergency departments. The majority of them are admitted to the hospital and many die. This issue poses important concerns. Despite the efforts of attending healthcare professionals, in-hospital patients do not receive optimal care near the end-of-life. Also, evidence is emerging that delay in identifying patients needing PC have a detrimental impact on their quality of life (QoL). Therefore, there is an urgent need to identify, early and properly, these patients among those hospitalized. Several trials reported the efficacy of PC in improving the QoL in these patients. Each hospital should ensure that a multidisciplinary PC team is available to support attending physicians to achieve the best QoL for both PC patients and their families. This review discusses the role and the impact of in-hospital PC in patients with end-stage disease or advanced cancer.
Highlights
Palliative care (PC) systems focused on the needs of advanced cancer patients, but most patients needing palliative care (PC) have end-stage organ diseases
The World Health Organization defines palliative care as: “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” [1]
We found that more than one-third of people affected by these chronic diseases awaiting to be hospitalized after an emergency department (ED) visit should be identified as in need of PC
Summary
The World Health Organization defines palliative care as: “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” [1]. During the last 6–12 months of life, most patients with end-stage disease or advanced cancer experience an increase in symptom burden which forces them to seek care in acute hospitals. These patients are usually admitted to the emergency department (ED) in order to administer them urgent care for the relief of uncontrolled symptoms [6]. Patients with end-stage disease or advanced cancer need (in the ED) of procedures such as intravenous fluids infusion for dehydration, placement of a urinary catheter for acute urinary retention, paracentesis for symptomatic intractable ascites or thoracentesis for symptomatic severe pleural effusion
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