Palliative care patients: ‘Need anesthesia’

between 20 percent and 50 percent of patients who are dying Under the care of health professionals from Palliative care units in Spain Need sedatives, regardless of where the care is provided (hospital, home or other centers), as will be revealed in the meeting with the expert ‘Aging and multidiseases: the palliative view. Difficulty in making a decision under prognostic uncertainty”, in the framework of the 42nd National Congress of the Spanish Society of Internal Medicine (SEMI) and the 37th Congress of the Galician Society of Internal Medicine (Sogami).

In this session, key aspects in this field will be addressed, such as reduction of therapeutic effort, As well as the need to implement a Advance care planning To adapt measures to the patient’s presumed survival, as well as all clinical, social or spiritual aspects to be considered when providing this type of care and the primary role of the internist in this field as a specialist with an integrated vision in the management of a fragile, complex and/or multi-disease patient. Most of these anaesthesia are performed in Palliative care units in acute hospitals.

The course is shared by Christina Vicente Martin, from the Palliative Care Unit of the Internal Medicine Service of the Hospital Rey Juan Carlos de Mostolz (Madrid) and will manage it Susanna Square, Coordinator of the Palliative Care Group of the Spanish Society of Internal Medicine (SEMI) and Head of the Department of Internal Medicine at the University Hospital Severo Ochoa in Leganes (Madrid) and Head of the Palliative Care Unit of the said hospital.

When is palliative sedation usually used?

In Plaza’s words: “Palliative care must be understood within the framework of a comprehensive approach to patient care from the moment of diagnosis of a disease in which there is no possibility of recovery with a current, proactive and rehabilitative vision. The goal isAchieving the highest possible level of well-being and quality of life to the patient and his family.

It’s a care that includes tActive and complementary therapies To treat the underlying disease it requires specific knowledge that includes pain control, symptom relief, special care in various ailments, spiritual support, communication skills, social support, recreational activities or physical therapy. In many cases, according to Plaza, Painkillers may be the ultimate cure for these diseases, when a patient’s symptoms are resistant to the treatments used and represent a significant burden of suffering.”

For his part, Vicente emphasized that “between 1 and 3 percent of patients with chronic diseases will be in advanced disease and clinical complexity.” In 2030, the annual number of deaths in the world is expected to rise from 58 to 74 million, with causes related to organ failure and cognitive and physical fragility being responsible for most of this increase. It is known that these diseases cause Symptomatic burden and impoverishment of quality of life similar to that of patients with end-stage cancer.” Vicente summarizes. However, “the extension of palliative care to these operations is hampered by uncertainty in the prognosis, which is frequently repeated, and treated with a stubbornness disproportionate to their true potential for improvement, and diminishes the relief of their symptoms and suffering.” Clinical assessment of survival together with prognostic measures and patient care values ​​and desires are useful tools for knowing where we are and how to act.

Profile of the patient who could benefit the most from palliative care

Palliative care was understood in its infancy to manage the end of life of cancer patients with a large burden of symptoms (pain, shortness of breath, delirium, agony…), but “little by little it became clear that many patients with diseases did “Cancer patients also do not have a very limited life expectancy, and they also present symptoms with a burden of suffering that were not given the same response in terms of control as cancer patients,” Plaza explains.

Therefore, the development of palliative care programs for non-cancer patients has begun Chronic kidney failure, heart failure, chronic obstructive pulmonary disease or neurodegenerative diseases (amyotrophic lateral sclerosis, dementia), among many others. All of these ailments are routinely managed in internal medicine services, particularly in cases of advanced disease and at the end of life, “it is in the full competence of the internist to have knowledge in this type of care,” says Plaza, who confirms this palliative sedation will be applied. As another treatment in any of the above diseases, when there are refractory symptoms (which cannot be adequately controlled despite therapeutic efforts) with conventional treatments.

SEMI, together with the Portuguese Society of Internal Medicine (SPMI), has promoted and developed a “Consensus guide to good practice in end-of-life care With the participation of 150 experts and 37 recommendations in seven main areas. Among the many aspects, they include: Guidelines for action in the last days of a patient’s life and support in the family grieving process

Covid-19 epidemiological care and palliatives

It should also be noted during the session that during the pandemic, and especially in the first wave, health care practically shifted to the care of infected patients. Health centers have closed and more than 90 percent of hospitals have been designated for Covid. “The rest of the patients were missing, including patients with palliative needs.” Regarding the turning point that occurred in the care of these patients.

In short, “Palliative care should be configured as an effective treatment from the diagnosis of a terminal illness and applied to the patient to cover his clinical, social or spiritual needs and to ensure a good quality of life and end of life.”