Análise clínica-nutricional e a relação com o desfecho clínico dos pacientes atendidos pela equipe interconsultora de cuidados paliativos de um hospital público da redião de saúde oeste do Distrito Federal e desenvolvimento de materiais didático e pedagógico sobre a temática

Abstract

Introduction: Globalization and the technological advances achieved from the second half of the 20th century caused a process of demographic and epidemiological transition that led to changes in the health-disease process, and boosted the aging of the population and increasing prevalence of chronic diseases. -degenerative Clinical and nutritional screening processes, as well as timely, coordinated and effectively communicated care, can reduce the nutritional risks and clinical complications associated with the patient's evolutionary process. When dealing with patients with chronic-degenerative diseases, especially when there is no expectation of cure, PC should be considered. Objectives: to analyze the clinical and nutritional status and the relationship with clinical outcome of patients treated by the Interconsultant Team for Palliative Care (EICP) of a Public Hospital in the Western Health Region of the Federal District. Develop didactic and pedagogical materials, based on the results found in the research, which can be used by other institutions and disseminated among health professionals who assist individuals in Palliative Care. Method: A retrospective longitudinal study was carried out. Adults and elderly people, of both sexes, attended by the Palliative Care Interconsultant Team, from January 2017 to December 2018, in a public hospital in the Federal District, were included in the study. The sample was obtained from the attendance sheet of this hospital team. Patients' sociodemographic, clinical and nutritional data were obtained from the hospital spreadsheet and electronic medical records accessed by InterSystems TrakCare®. Patients treated by the hospital's IECP not found in the SES/DF InterSystems TrakCare® electronic medical record were excluded. Statistical analyzes performed in the Stata program, version 13.0, included descriptive statistical analysis, bivariate analyzes to assess the association between the variables of interest, and survival analysis using the Kaplan-Meier estimator and the survival curve graph, in addition to of the log-rank test to assess the difference in survival time between the groups analyzed. Tests that presented a p-value lower than 0.05 were considered significant. Results: of the 121 patients identified in the hospital spreadsheet, 117 were analyzed in this study. The results showed that most patients treated by the EICP were elderly, hospitalized for an acute event in the emergency room, at risk of malnutrition or malnutrition and who had low functionality and chronic non-communicable diseases. Most of the patients who presented clinical and nutritional complications, in both evaluated moments, had reached the caloric intake and were using the artificial route of administration of the diet. Patients with low functionality were mostly using the artificial route of administration of the diet, both at the time of the opinion and at the time of the clinical outcome. The nutritional status of patients was not associated with their functionality. The clinical diagnosis of patients was associated with exacerbations, functionality of patients, use of artificial route of administration of the diet and protein intake offered. Evaluating the factors associated with the clinical outcome of the patients, it was observed that a higher percentage of patients who died had low functionality and a lower supply of caloric intake both at the time of the opinion and in the clinical outcome. Despite a longer survival time among patients without a diagnosis of neoplasia, the long-rank test showed no significant difference in survival time between patients with or without a diagnosis of neoplasia. Products developed: Submission of an article on the topic of palliative care, Publication of an article on the topic of Covid, development of didactic and pedagogical materials (folder, Postr and Continuing Training Course in Palliative Care) and review of the Booklet on Hydration and Nutrition in Dementia published in 2020. Conclusions: According to the findings, it is evident the importance of PC and the evaluation, monitoring and early clinical and nutritional treatment, and the adoption of approaches that allow a better quality of life and survival of patients. The present study contributes to reinforce the importance of encouraging constant training of professionals involved in PC care, and of expanding the access and recommendation of PC in a timely, comprehensive and individualized way, in order to provide dignity in the process of terminality of life. A continuous training course in Palliative Care and didactic and pedagogical materials were developed to be disseminated among health professionals and institutions that assist individuals in Palliative Care. A review of the Primer on Hydration and Nutrition in Dementia, published in 2020, was also carried out.