Acil Servise Başvuran İleri Evre Kanser Hastalarının Palyatif Bakım Gereksinimlerinin Değerlendirilmesi

Yıl 2024, Cilt: 9 Sayı: 2, 243 - 250, 02.06.2024

Ezgi Ayar , Özlem Uğur

https://doi.org/10.61399/ikcusbfd.1283943

Öz

Amaç: Bu çalışmada acil servise başvuran ileri evre kanser hastalarının palyatif bakım gereksinimlerinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Araştırma tanımlayıcı tipte olup İstanbul ilinde bulunan üç kamu hastanesinde 159 hasta ile gerçekleştirilmiştir. Çalışmada veriler Hasta Bilgilendirme Formu, Palyatif Performans Skalası ve Palyatif Bakım Alan Kanser Hastasının Yaşam Kalitesi (EORTC QLQ C15-PAL) skalası kullanılarak toplanmıştır.

Bulgular: Hastaların acil servise en sık başvuru nedeni ağrı (%31,7), dispne (%16,2) ve bulantı kusmaydı (%15,8). Başvuruların %88,7'sinden konsültasyon istenmiş; %49,8 dahiliye, %25,1’i anestezi, %6,5 cerrahi ve %6 oranında göğüs hastalıklarına danışılmıştır. Hastaların %38,4’üne klinik yatış yapılmış, %32,1’i taburcu olurken, %23,3’üne yoğun bakım yatışı gerçekleştirilmiş ve %6,3’ü ise ölmüştür. Hastaların %67,2'sinin Palyatif Performans Skalası puanı 70 veya altındaydı. Hastaların acil servisteki izlemleri minimum yarım ya da bir saat, maksimum 5 saat, ortalama 1,9±1,2 saat sürmüştür.

Sonuç: Araştırmada hastaların %93'ünün palyatif bakım bakım desteği almadığı saptanmıştır. Bu temelde ele alındığında acil servislere başvuran kanser hastalarının palyatif bakım desteği alması için gerekli yönlendirmelerin yapılması ve sağlık sistemi içine bu basamağın yapılandırılması önerilebilir. Böyle bir yapılanma palyatif bakım desteğine gereksinimi olan hastalarında tanılanmasına da katkıda bulunabilir.

Anahtar Kelimeler

Acil servis, onkolojik aciller, palyatif bakım.

Proje Numarası

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Evaluation of Palliative Care Needs of Advanced Stage Cancer Patients Admitting to the Emergency Department

Öz

Objective: This study aimed to evaluate the palliative care needs of advanced stage cancer patients who applied to the emergency department.

Material and Method: The research is descriptive and was conducted with 159 patients who met the selection criteria in the emergency departments of three public hospitals in Istanbul. The data for the study was collected using three tools: the Patient Information Questionnaire Form, the Palliative Performance Scale (PPS), and the Quality of Life in Palliative Cancer Care Patients (EORTC-QLQ C15-PAL) Scale.

Results: Patients frequently applied to the emergency department for pain (31.7%), dyspnea (16.2%), and nausea- vomiting (15.8%). In general, consultation was requested from 88.7% of the patients, and the most frequently consulted clinics were 49.8% internal medicine, 25.1% anaesthesia, 6.5% surgery and 6% chest diseases. The patients' emergency service visits resulted in 38.4% clinical admission, 32.1% discharge, 23.3% intensive care unit and 6.3% exitus. 67.2% of the patients had a PPS score of 70 or less. The patients' follow-up time in the emergency department was also determined to be a minimum of half an hour, a maximum of 5 hours, and an average of 1.9±1.2 hours.

Conclusion: The study found that 93% of the patients did not receive palliative care support. Considering this basis, it can be recommended to provide the necessary guidance for cancer patients who apply to emergency departments to receive palliative care support and to structure this step within the health system. Such a structure may contribute to the diagnosis of patients who need palliative care support.

Anahtar Kelimeler

Emergency deparment, Oncological emergency, Palliative care

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

• World Health Organization. Definition of palliative care (homepage on the Internet) 2020 [updated 2021, May 11]. Available from https:// www.who.int/cancer/palliative/definition/en
• Rondeau DF, Schmidt TA. Treating cancer patients who are near the end of life in the emergency department. Emerg Med Clin. North Am. 2009, 27(2):341-54. doi:10.1007/s00520-019-04906-x
• Isikber C. Onkolojik acillerin acil servise başvuru sıklığının değerlendirilmesi [master’s thesis]. [Adana]: Sağlık Bilimleri Üniversitesi 2019. 71 p.
• Yaylaci S, Topuzoglu A, Karcioglu O. Acil servise başvuran kanser hastalarının klinik karakteristikleri ve bir yıllık sağkalımları. Uluslararası Hematoloji-Onkoloji Der. 2009; 19(4), 213-222.
• George N, Phillips E, Zaurova M, Song C, Lamba S, Grudzen CR. Palliative care screening and assessment in the emergency department: A systematic review. J Pain Symptom Manage. 2016; 51(1):108-119. doi: 10.1016/j.jpainsymman.2015.07.017
• Tokocin O, Cakmak F, Ipekci A, Tihan DN, Ceylan D, Sutasir MN, et al. Factors affecting the morbidity and mortality of malignancy patients admitted to the emergency department. Phoenix Med. J. 2019; 1(1), 8-14. doi:10.38175/phnx.620036
• Canfeda S. (Mendel NM, Ece T. [Edt.]). Bulantı ve kusma. In: Mendel NM, Ece T editors. Ulusal akciğer kanseri kongre kitabı. 2013. p.188-189.
• Lamba S, Desandre PL, Todd KH, Bryant EN, Chan GK, Grudzen CR., et al. Integration of palliative care into emergency medicine: the ımproving palliative care in emergency medicine (IPAL-EM) collaboration. J Emerg Med. 2014; 46(2), 264-670.
• Richards CT, Gisondi MA, Chih-Hung C, Courtney M, Engel KG, Emanuel L, et al. Palliative care symptom assessment for patients with cancer in the emergency department: validation of the screen for palliative and end-of-life care needs in the emergency department ınstrument. J Palliat Med. 2011; 14(6), 757-764. doi:10.1089/jpm.2010.0456
• Vandyk AD, Harrison MB, Macartney G, Ross-White A, Stacey D. Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer 2012; 20 (8): 1589– 1599. doi:10.1007/s00520-012-1459-y
• Guney H. Acil servise başvuran ve palyatif bakım ihtiyacı olan hastaların yeni bir tarama metodu ile belirlenmesi, ihtiyaçlarının ve semptom şiddetlerinin speed, edmonton ve karnofsky skalaları ile incelenmesi [master’s thesis]. [Tokat]: Gaziosmanpaşa Üniversitesi, 2017. p.90
• Dincer M, Kahveci K, Doger C, Gokcinar D, Yarici KA, Tas H. Factors affecting the duration of admission and discharge ın a palliative care center for geriatric patients. Turk J Geriatr. 2016; 19(2), 74-80.
• Anderson F, Downing GM, Hill J. Palliative performance scale (pps): a new tool. J Palliat. Care 1996; 12(1):5-11.
• Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. Use of palliative performance scale in end-of-life prognostication. J Palliat. Med. 2009; 9(5): 1066-1075. doi:10.1089/jpm.2006.9.1066
• Yavuzsen T, Guc SZ, Ugur O, Bektas M, Oztop I. Retesting the psychometric characteristics of the european cancer research and treatment organization’s quality of life questionnaire palliative care 15 turkish version (Eqrtc Qlq C15-Pal) and evaluating the influencing factors. J Oncol. Scien. 2018; 4(1):35-39. doi:10.1016/j.jons.2017.08.002
• Ozcelik H, Guzel Y, Sonmez E, Aksoy F, Uslu R. Reliability and validity of the Turkish version of the eqrtc Qlq-C15-Pal for patients with advanced cancer. Palliat Support Care. 2016; 14(6): 628-634. doi:10.1017/S1478951516000195
• Caterino JM, Adler D, Durham DD, Sai-Ching JY, Hudson MF, Bastani A, et al. Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to emergency departments. JAMA 2019; 2(3): 1-3. doi:10.1001/jamanetworkopen.2019.0979
• Patel PM, Goodman LF, Knepel SA, Miller CC, Azimi A, Phillips G, et al. Evaluation of emergency department management of opioid-tolerant cancer patients with acute pain. J Pain Symptom Manage. 2017; 54(4):501-507. doi:10.1016/j.jpainsymman.2017.07.013
• Verhoef JM, Nijs E, Horeweg N, Fogteloo J, Heringhaus C, Jochems A, et al. Palliative care needs of advanced cancer patients in the emergency department at the end of life: an observational cohort study. Support Care Cancer. 2019; 28(3):1097–1107. DOI:10.1007/s00520-019-04906-x
• Kandarian B, Morrison SR, Richardson LD, Ortiz J, Grudzen CR. Emergency department-initiated palliative care for advanced cancer patients: Protocol for a pilot randomized controlled trial. Trials. 2014; 15(251):1-7. doi:10.1186/1745-6215-15-251
• Kistler EA, Morrison SR, Richardson LD, Ortiz J, Grudzen CR. Emergency department–triggered palliative care in advanced cancer. Acad Emergency Med. 2015; 22(2):237–239. doi:10.1111/acem.12573
• Wong J, Gott M, Frey R, Jull A. What is the incidence of patients with palliative care needs presenting to the emergency department? A critical review. Palliat Med. 2014; 28(10):1197-1205. doi:10.1177/0269216314543318
• Brown J, Grudzen CR, Kyriacou DN, Obermeyer Z, Quest T, Rivera D, et al. The emergency care of patients with cancer: Setting the research agenda. Emerg Cancer Care. 2016; 14(6):757-764. doi:10.1016/j. annemergmed.2016.01.021
• Grudzen CR, Shim DJ, Schmucker AM, Cho J, Goldfeld KS. Emergency Medicine Palliative Care Access (EMPallA): protocol for a multicentre randomized controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness. BMJ Open. 2019; 9(1):256-292. doi:10.1136/ bmjopen-2018-025692
• European Association for Palliative Care. Report of the eapc task force on the development of palliative care in europe: Turkey. (homepage on the Internet) 2021 [updated 2021, December 18]. Available from http:// www.eolc-observatory.net/global_analysis/turkey.htm.
• Kocak S, Ertekin B, Polat M, Girisgin S, Kara H. Onkolojik hastaların acil servise başvuru nedenleri. Sakarya Med J. 2012; 2(1):16-20. doi:10.5505/ sakaryamj.2012.96268
• Can N, Yolcu S, Beceren NG, Tomruk O. Acil servisimize başvuran kanser hastalarının sosyodemografik özelliklerinin ve acil başvuruları arasındaki ilişkinin belirlenmesi. Bozok Tıp Der. 2013; 3(2):6-11.
• Uysal N, Senel G, Karaca S, Kadiogullari N, Kocak N, Oguz G. Palyatif bakım kliniğinde yatan hastalarda görülen semptomlar ve palyatif bakımın semptom kontrolüne etkisi. Ağrı Der. 2015; 27(2):104-110. doi:10.5505/agri.2015.26214
• Groenvold M, Morten AP, Aaronson KN, Arraras IJ, Blazeby MJ, Bottomley A, Fayers MP, Graeff A, Hammerlid E, Kaasa S, Sprangers AGM, Bjorner BJ. The devolepment of the EORTC QLQ-C15-PAL: A shortened questionnaire for cancer patients in palliative care. Eur J Cancer 2006; 42(1):55- 64. doi: 10.1016/j.ejca.2005.06.022.