Equipo interconsultor en cuidados paliativos: alivio de síntomas en las primeras 48 horas de hospitalización

Silva, Magda Aparecida dos Santos; Diniz, Marcio Augusto; Carvalho, Ricardo Tavares de; Chiba, Toshio; Mattos-Pimenta, Cibele Andrucioli de

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (6) • 2020 • https://doi.org/10.1590/0034-7167-2019-0391 copiar

Equipo interconsultor en cuidados paliativos: alivio de síntomas en las primeras 48 horas de hospitalización

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Comparar el alivio de síntomas obtenido por equipo interconsultor en cuidados paliativos (ICP) al obtenido por equipo de cuidado tradicional (CT), en enfermos con cáncer avanzado en las primeras 48 horas de hospitalización.

Método:

Alocados en los Equipos ICP y Equipo CT, 290 pacientes han sido evaluados por la Escala de Síntomas de Edmonton (ESAS) en las primeras 48 horas de la hospitalización. El desenlace principal ha sido la reducción mínima de 2 puntos en la intensidad de síntomas.

Resultados:

En 48 horas, el Equipo ICP tuvo reducción de 2 puntos en las medias de las diferencias (p < 0,001) del dolor, náusea, disnea y depresión; y el Equipo CT, en la náusea y perjuicio del sueño (p < 0,001). Regresión Logística Múltiple mostró para el Equipo ICP mayor oportunidad de alivio del dolor (RC 2,34; CI 1,01-5,43; p = 0,049).

Conclusión:

Hubo superioridad del Equipo ICP para alivio del dolor, disnea y depresión. Estudios que amplíen la comprensión acerca de las modalidades de equipo son necesarios.

Descriptores:
Cuidados Paliativos; Cuidados Paliativos al Final de la Vida; Evaluación de Síntomas; Manejo del Dolor; Eficacia del Tratamiento

Variables	PCCT = 127* n(%)	TC = 163^† n(%)	p value
Gender			0.52^‡
Male	68(53.5)	74(45.4)
Female	59(46.5)	89(54.6)
Marital situation			0.65^‡
With partner	79(62.2)	96(58.9)
Without partner	48(37.8)	67(41.1)
Age			0.34^§
Mean(SD)	59.6(1.3)	57.2(1.5)
Median (minimum - maximum)	60(24-87)	59(19-84)
Schooling (years)			0.77 ^§
Mean(SD)	5.9(0.4)	7.7(0.5)
Median (minimum - maximum)	4.0(1-16)	8.0(1-19)
Monthly income^¶			0.22^§
Mean(SD)	3.1(0.2)	3.5(0.4)
Median (minimum - maximum)	3.0(0-15)	3.0(0-20)
Religious Practice			0.80^‡
No	52(40.9)	78(47.9)
Yes	75(59.1)	85(52.1)
Setting			< 0.001^{‡ \|\|}
Emergency Room	56(44.1)	119(73.0)
First aid room	71(55.9)	44(27.0)
Tumor location			0.10^‡
Gastrointestinal	75(59.0)	82(50.3)
Genitourinary	11(08.7)	14(08.6)
Lungs	18(14.2)	23(14.1)
Others**	23(18.1)	44(27.0)
KPS^§			0.86^§
Mean(SD)	43(1.5)	52(1.4)
Median (minimum - maximum)	40(20-70)	50(20-70)
Number of deaths			0.20
Up to 30 days	44(34.6)	42(25.8)
30-90 days	14(11.0)	24(14.7)
Symptoms on admission
Pain	7.1(0.2);7.5	7.9(0.2);8.0	0.59
Tiredness	6.9(0.2);7.0	7.1(0.3);7.0	0.92
Nausea	6.3(0.3);7.0	6.7(0.3);7.0	0.86
Anxiety	7.2(0.3);8.0	7.3(0.3);8.0	0.10
Drowsiness	7.0(0.3);7.0	7.7(0.2);8.0	0.13
Appetite	7.6(0.3);8.0	8.1(0.3);9.0	0.19
Wellbeing	6.6(0.3);6.5	6.2(0.3);6.0	0.25
Dyspnea	6.1(0.3);6.0	6.7(0.3);7.0	0.02^{\| §}
Depression	5.6(0.4);5.5	4.6(0.4);5.0	0.59
Sleep	7.3(0.3);8.0	7.4(0.3);8.0	0.70
Symptom Burden	47(1.6);47	48(1.4);46	0.30

Symptoms	0-24 hours n = 100	0-48 hours n = 83
Pain
n(%)	75(75)	58(70)
Mean(SD);Median	4.9(0.5);6.0	5.1(0.6);5.0
Differences Mean	-2.1(0.4);-1.0	-2.5(0.5);-2.0
p value	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**
Tiredness
n(%)	77(77)	60(84)
Mean (SD); Median	5.3(0.6);6.5	5.3(0.6);6.0
Differences Mean	-1.0(0.3);0.0	-1.3(0.5);-0.5
p value	0.015*	0.013*
Nausea
n(%)	46(46)	36(43)
Mean (SD); Median	2.6(0.5);0.0	3.1(0.6);0.0
Differences Mean	-2.3(0.6);-2.0	-3.2(0.7);-3.0
p value	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**
Anxiety
n(%)	60(60)	46(55)
Mean (SD); Median	5.8(0.6);6.0	6.1(0.6);6.0
Differences Mean	-1.0(0.4);0.0	-1.6(0.5);-0.5
p value	0.025*	0.02*
Drowsiness
n(%)	78(78)	60(72)
Mean (SD); Median	5.9(0.5);7.0	6.5(0.5);7.0
Differences Mean	-1.0(0.5);0.0	-0.7(0.5);0.0
p value	0.074	0.118
Appetite
n(%)	65(65)	48(56)
Mean (SD); Median	7.2(0.5);9.5	7.1(0.6);10
Differences Mean	-0.6(0.4);0.0	-1.2(0.5);0.0
p value	0.001*	0.022*
Wellbeing
n(%)	86(86)	67(81)
Mean (SD); Median	6.1(0.5);7.0	6.4(0.5);6.0
Differences Mean	-0.6(0.3);0.0	-0.8(0.3);0.0
p value	0.031	0.022*
Dyspnea
n(%)	51(51)	41(49)
Mean (SD); Median	1.4(0.4);0.0	1.4(0.4);0.0
Differences Mean	-1.5(0.4);0.0	-2.0(0.5);-2.0
p value	0.002*	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**
Depression
n(%)	43(43)	32(38)
Mean (SD); Median	3.1(0.6);0.0	3.7(0.7);0.0
Differences Mean	-0.7(0.6);0.0	-2.4(0.6);-1.0
p value	0.001*	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**
Sleep
n(%)	69(69)	52(63)
Mean (SD); Median	5.7(0.6);7.0	4.9(0.6);5.0
Differences Mean	-1.8(0.5);0.0	-1.6(0.5);0.0
p value	<0.001*	0.005*
Symptom Burden
Mean (SD); Median	48.0(2.7);45.5	49.5(3.4);46
Differences Mean	-5.0(1.3);-4.0	-5.6(1.7);-5.5
p value	< 0.001*	0.001*

Symptoms	0-24 hours n = 96	0-48 hours n = 75
Pain
n(%)	76(79)	62(83)
Mean(SD);Median	4.1(0.5);5.0	3.3(0.5);3.0
Differences Mean	-3.1(0.5);-2.0	-1.3(0.6);1.5
p value	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.	0.10
Tiredness
n(%)	73(76)	57(93)
Mean (SD); Median	5.9(0.4);6.0	5.8(0.5);7.0
Differences Mean	-1.7(0.4);0.0	-1.2(0.5);0.0
p value	0.001^* * p <0.05 (Statistically significant). Wilcoxon Test	0.054
Nausea
n(%)	52(54)	40(53)
Mean (SD); Median	2.6(0.4);0.0	2.6(0.5);1.0
Differences Mean	-3.4(0.6);-3.0	-3.4(0.6);-4.0
p value	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.
Anxiety
n(%)	66(69)	53(71)
Mean (SD); Median	4.9(0.5);5.0	5.1(0.6);6.0
Differences Mean	-1.7(0.4);0.0	-1.5(0.5);0.0
p value	*< 0.001^ * p <0.05 (Statistically significant). Wilcoxon Test**	0.001^* * p <0.05 (Statistically significant). Wilcoxon Test
Drowsiness
n(%)	68(71)	56(75)
Mean (SD); Median	5.5(0.4);6.0	5.6(0.5);6.0
Differences Mean	-1.7(0.4);0.0	-1.1(0.4);0.0
p value	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test	0.025^* * p <0.05 (Statistically significant). Wilcoxon Test
Appetite
n(%)	74(77)	59(79)
Mean (SD); Median	4.8(0.5);5.0	4.8(0.6);5.0
Differences Mean	-1.1(0.4);0.0	-1.3(0.5);0.0
p value	0.018^* * p <0.05 (Statistically significant). Wilcoxon Test	0.009^* * p <0.05 (Statistically significant). Wilcoxon Test
Wellbeing
n(%)	77(80)	62(83)
Mean (SD); Median	5.5(0.4);5.0	5.7(0.5);5.0
Differences Mean	-0.2(0.3);0.0	-0.3(0.4);0.0
p value	0.635	0.564
Dyspnea
n(%)	34(35)	30(40)
Mean (SD); Median	2.7(0.5);0.0	-2.7(0.7);-2.0
Differences Mean	-1.7(0.5);-1.5	-1.8(0.5);-1.0
p value	0.003^* * p <0.05 (Statistically significant). Wilcoxon Test	0.001^* * p <0.05 (Statistically significant). Wilcoxon Test
Depression
n(%)	41(43)	31(41)
Mean (SD); Median	2.3(0.4);0.0	2.4(0.5);0.0
Differences Mean	-1.5(0.6);0.0	-1.3(0.6);0.0
p value	0.039	0.057
Sleep
n(%)	77(80)	63(84)
Mean (SD); Median	4.3(0.4);5.0	4.5(0.6);5.0
Differences Mean	-2.2(0.4);0.0	-2.3(0.5);-2.0
p value	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.
Symptom Burden
Mean (SD); Median	42.9(2.3);42	42.5(2.6);40
Differences Mean	-6.9(1.6);-5.0	-5.3(1.9);-7.0
p value	*< 0.001^ * p <0.05 (Statistically significant). Wilcoxon Test**	0.008^* * p <0.05 (Statistically significant). Wilcoxon Test

Symptoms	0-24 hours		0-48 hours
Symptoms	OR (95% CI)	p value	OR (95% CI)	p value
Pain	1.42 (0.67-2.99)	0.360	2.34 (1.01-5.43)	0.049^* * p <0.05 (Statistically significant) ^† † Possibility in reducing 2 points in the intensity of the symptoms or 20 points in the burden of symptoms
Tiredness	0.84 (0.40-1.76)	0.645	0.97 (0.43-2.21)	0.948
Nausea	0.96 (0.37-2.51)	0.940	1.27 (0.42-3.81)	0.668
Anxiety	0.87 (0.40-1.90)	0.722	1.02 (0.41-2.51)	0.959
Drowsiness	0.72 (0.34-1.51)	0.382	0.95 (0.40-2.25)	0.909
Appetite	1.72 (0.75-3.91)	0.197	1.39 (0.59-3.29)	0.449
Wellbeing	1.68 (0.72-3.91)	0.222	1.52 (0.63-3.68)	0.350
Dyspnea	0.60 (0.20-1.80)	0.361	0.55 (0.16-1.92)	0.350
Depression	0.90 (0.33-2.51)	0.850	1.31 (0.39-4.42)	0.664
Sleep	0.78 (0.37-1.64)	0.510	0.55 (0.24-1.25)	0.146
Symptom Burden	0.63 (0.31-1.24)	0.174	0.93 (0.45-1.93)	0.845

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Magda Aparecida dos Santos Silva E-mail: magda_mass@yahoo.com.br