Palliative Care and the Self-Fulfilling Prophecy in Stroke Patients: is There Anything to Fear? A Retrospective Study of Patients Who Died During Hospitalization in a Quaternary Care Hospital.

Maiara Silva Tramonte, Ana Claudia Pires Carvalho, Gabriela Figueiredo Pucci, Mariana Soares Pinheiro, Ana Elisa Vayego Fornazari, Gustavo Di Lorenzo Villas Boas, Marcos Christiano Lange, Marcos Ferreira Minicucci, Rodrigo Bazan, Laura Cardia Gomes Lopes
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Abstract

Background and purpose: Primary palliative care (PC) aims to improve the quality of life for patients with acute ischemic stroke but is often misinterpreted as withdrawal of care. The self-fulfilling prophecy withdrawal bias is feared in this context of PC's early implementation. This study evaluates stroke patients who died in the hospital to determine the impact of PC evaluation.

Methods: A retrospective descriptive analysis of patients who died from acute ischemic stroke was conducted. The study included patients aged ≥18 years admitted to the Stroke Unit of a quaternary hospital in Brazil from January 2017 to December 2018. The impact of PC assessment on outcomes was analyzed, with significance set at 5%.

Results: Among the patients who died during hospitalization as a result of an ischemic stroke (n = 77), 39 (%) were assessed by the palliative care team. There was no difference in the total length of stay or duration of antibiotic therapy. Logistic regression corrected for significant variables from the univariate analysis revealed that PC evaluation was associated with a 31-fold increase in opioid use (P < 0.001), a nearly 14-fold increase in discharges to the ward, and a threefold reduction in ICU length of stay (P = 0.011).

Conclusion: PC team involvement was associated with higher rates of discharge to the floors, inferring more time spent with family and increased opioid use, suggesting better symptom control, without reducing the overall length of stay or duration of antibiotic therapy. This underscores that PC does not equate to withdrawal of care.

姑息治疗与中风患者的自我实现预言:有什么可怕的吗?对一家四级护理医院住院期间死亡患者的回顾性研究。
背景和目的:初级姑息治疗(PC)旨在改善急性缺血性脑卒中患者的生活质量,但常常被误解为撤销治疗。在 PC 早期实施的背景下,人们担心会出现自我实现预言的撤出偏差。本研究对在医院死亡的卒中患者进行评估,以确定 PC 评估的影响:方法:对急性缺血性卒中死亡患者进行回顾性描述性分析。研究纳入了 2017 年 1 月至 2018 年 12 月期间巴西一家四级医院卒中科收治的年龄≥18 岁的患者。分析了PC评估对预后的影响,显著性定为5%:在因缺血性脑卒中住院期间死亡的患者(n = 77)中,有 39 人(%)接受了姑息治疗小组的评估。总住院时间和抗生素治疗时间没有差异。对单变量分析中的重要变量进行校正后的逻辑回归显示,姑息治疗小组的评估与阿片类药物使用量增加 31 倍(P < 0.001)、病房出院人数增加近 14 倍、ICU 住院时间缩短 3 倍(P = 0.011)有关:PC团队的参与与更高的出院率有关,这意味着患者有更多的时间与家人在一起,阿片类药物的使用量也有所增加,表明症状得到了更好的控制,但总体住院时间或抗生素治疗时间并未缩短。这突出表明,PC 并不等同于放弃护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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