Validação do escore palliative prognistic index em pacientes internados em uma unidade de cuidados paliativos oncológicos

Abstract

Introduction: Malignant neoplasms are currently the second leading cause of mortality in the adult population. The implementation of palliative care is indicated from the moment of diagnosis, concomitant with curative practices. In the most advanced stage of the disease, the correct prognosis is fundamental for the implementation of therapies and resource use, as well as supporting decisions of the patient and their families. The use of prognostic scores and survival estimates help the clinical staff to establish this prognosis more assertively. Objectives: 1. To validate the Palliative Prognostic Index (PPI) score, symptom-based score, to predict mortality in patients admitted to a palliative care unit; 2. Develop an educational folder on symptom control with non-pharmacological measures, aimed at patients and families. Method: 1. Quantitative, prospective, observational, analytical study conducted with 211 patients admitted to the Exclusive Oncologic Palliative Care Unit. The PPI score was applied the morning after admission and every 7 days using a structured questionnaire. A ROC curve was used to determine the best PPI cutoff point to predict death at 3 weeks and at 6 weeks. 2. The booklet was developed based on literature review and with appropriate language for patients and families. Results: 2 products were developed. Developed Products: Product 1 - Original scientific article with the main results of the research, submitted to the international journal Journal of Pain and Symptom Management - JPSM, Qualis A1. A total of 211 patients were included in the study. Mean age was 63.77 years, female gender at 55.9%, and mean PPI of 5.83 points. PPI> 5 points predicted death at 3 weeks (ROC curve area 0.736, sensitivity 60.1%, specificity 76.5%); and PPI> 4 points showed a prediction of death at 6 weeks (ROC curve area of 0.754, sensitivity of 69.2%, and specificity of 69.4%). Thus, it will be discussed with the palliative care service the adoption of PPI with the cutoff points validated in the present study. Product 2 - Construction of guidance booklet for patients and families, addressing non-pharmacological strategies in symptom control in Palliative Oncology Care. This Folder will also be discussed with the palliative care service for its implementation. Conclusions: The results showed that the PPI score showed good accuracy in predicting mortality at 3 weeks and 6 weeks.