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Title: Palliative inpatient care in the Palliative Medical Unit of the Therapeutic and Nursing Institution in Cracow


INTRODUCTION. Advances in medical science, prolonged life expectancy, projected rise in morbidity and mortality due to neoplastic and other than neoplastic chronic diseases result in a bigger need for specialist palliative care. Recognition of the factors conditioning occurrence of pain in hospitalized patients may help in taking care of them in a more effective way and alleviate suffering of the ill staying in palliative care units. AIM. The aim of this study was the assessment of some selected factors determining the degree of pain intensity felt by the ill receiving inpatient palliative care in the Palliative Medical Unit of the Therapeutic and Nursing Institution in Cracow. MATERIALS AND METHODS. In the conducted study the analysis of medical report documentation of 779 randomly selected patients out of 5193 of the admitted to the Inpatient Palliative Medical Unit of the Therapeutic and Nursing Institution in Cracow from 01 March 1997 to 31 December 2013 was done. The study comprised 15% of all hospitalized patients each year, from 1997 to 2013. Among the researched, two groups of patients were identified: those with diagnosed neoplastic disease (CHN) numbered 685 persons and a group of patients with non neoplastic disease (CHNN) consisting of 94 ones. The study analysed: triple assessment of pain severity and other pathological symptoms, the dependencies between pain and ; demographic data, the duration and length of hospitalization, the kind of concomitant diseases, and severity of other somatic and psychological health complaints. In order to measure the intensity of pain the numerical rating scale was used (NRS), whereas other pathological symptoms were assessed by ESAS scale (Edmonton Symptom Assessment System). Additionally, pharmacological management was analysed. The following tests were used for data analysis: ch2 Pearson; Fisher; Fisher-Freeman-Halton; t-Student; Kolmogorow-Smirnow; U Man-Whitney, Friedman, analysis of variance (ANOVA), and generalized estimating equations model (GEE). Effects which had value p < 0,05 were statistically significant. RESULTS: The author’s own study showed that during hospitalization in both groups the intensity of pain decreased. The assessment of pain intensity correlated with the stage of hospitalization. Patients reported the highest intensity of pain on the day of admission to the inpatient palliative care unit. In the second measurement the degree of pain intensity was lower than in the first one and in the third measurement it was the lowest. In both researched groups the differences were substantial (p < 0,001). The differences were similarly substantial in the length of hospitalization: the persons with the CHNN group were, on average, hospitalized longer than from CHN group. The study found tha ; t previous palliative treatment before hospitalization conditioned pain intensity but only in CHN group and only on the day of admission to the inpatient care unit. In the first stage of the treatment, the persons who had been under palliative care before reported bigger intensity of pain. Pain intensity also correlated with patients’ sex and age. The older the patients with the CHN group were, the lower the pain intensity was, whereas in patients in the CHNN group the pain was increasing. The studied women in both groups assessed their level of pain intensity as higher in comparison with the pain of the researched men. The author’s own study showed that there is a substantial dependency between physical and mental suffering. In the CHN group the pain, at least in one measurement, correlated positively with despondency, drowsiness, anxiety and dyspnoea, and in the CHNN group with anxiety, appetite, activity and nausea. Patients in the CHN group who developed a decubitus ulcer had significantly higher pain severity at the third examination stage than those without decubitus ulcers. In the CHN group, furthermore, significant relationships were found between pain severity and pain location: if the pain was localised within the neoplastic area, in all three measurements patients rated the severity of their pain as higher compared to those whose pain was localised elsewhere. In con ; trast, patients who described their pain as 'generalised' rated their pain severity significantly higher than patients with an indicated pain location. The study also showed notable differences between the groups in assessing the severity of other associated complaints. Such symptoms as despondency, anxiety, nausea, decreased appetite and mood were more intensified in the group of neoplastic patients rather than in the group of patients without the disease. However, in the group of patients without neoplastic disease activity limitation and drowsiness were more noticeable. It was observed that during the hospitalization the severity of dyspnoea decreased, especially in patients with neoplasms, but appetite did not increase and nausea and anxiety did not decrease in severity. In the last period of life in CHN patients lower activity was noticed but despondency and drowsiness increased whereas in CHNN patients mood problems became more aggravated. The risk of decubitus ulcers was much bigger in the CHNN rather than the CHN group. Similarly, the number of patients with decubitus ulcers on admission significantly prevailed among the CHNN group. Decubitis ulcers more often occurred in CHNN patients rather than the second group. The reason for hospitalization discharge in palliative unit differed greatly between CHN and CHNN (p < 0,001). In the CHN group death of a patient occured m ; ore often whereas in the CHNN group a patient was more often directed to other medical unit. CONCLUSIONS: The author’s own study demonstrated the effectiveness of palliative care in relieving pain in persons undergoing inpatient palliative care at the Palliative Medical Unit of the Therapeutic and Nursing Institution in Cracow. Factors determining the degree of pain intensity among the studied patients include age, gender, stage of hospitalization, location of pain and its treatment, concomitant diseases, decubitus ulcers and the risk of their formation. Equally important as pain treatment is the alleviation of other concomitant pathological symptoms, as they are determinants of pain severity. Similarly, the emotional state of patients influences the assessment of pain intensity. On the other hand, marital status, place of residence, duration of illness, length of hospitalisation and recognition of clinical diagnosis do not affect the degree of pain among the studied patients receiving inpatient palliative care. The author’s own study showed significant differences between the studied groups both in the course of hospitalization and in the frequency and severity of physical and psychological concomitant symptoms. These results may help to better understand the suffering of patients, not only with neoplastic, but also with other chronic diseases, and consequently contribute to ; even more effective palliative management.

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2 - studia doktoranckie

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Rada Dyscypliny Nauki o zdrowiu


Wordliczek, Jerzy

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Apr 29, 2024

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ZB-137395 Apr 29, 2024


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