Descriptive cohort trial of terminal patients in medical home care in Bogotá – 2008–2012
Keywords:
Palliative Care, Ambulatory, Care, Ethics, Clinical, Aged, Analgesia
Abstract
Introduction: Palliative care for end-of-life patients in Bogotá is still in the process of consolidation. This type of care demands high technical and scientific standards, in addition to supporting the patient and family in making end-of-life ethical decisions, particularly with respect to sedation, hydration and feeding.
Methodology: Statistical descriptive analysis of a cohort comprised of 164 terminally ill patients treated in private practice in Bogotá between 2008 and 2012.
Results: Out of the 90 patients who received care until their demise, the average age was 77 years old, including 63% women, 30%, university students, 41% widowers, and 84% Catholics. 8 patients had no medical insurance. 52% of the patients were cancer patients, 91% received home care, the average number of care days was 45 and the usual route of administration of medicines was subcutaneous. The most commonly used drugs were tramadol, ranitidine and midazolam. 73% of the patients required superficial sedation. In some cases, feeding and hydration were administered through alternate routes and in others were discontinued.
Analysis: there is a need to study the conditioning factors for private medical home care and for maintaining this type of care until the end of life. Characterizing this population enables the identification of some useful information for the administration of end-of-life care in the country.
References
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18. Ibarra P, Galindo M, Molano A, Niño C, Rubiano A, Echeverry P, et al. Recomendaciones para la sedación y la analgesia por médicos no anestesiólogos y odontólogos de pacientes mayores de 12 años. Rev Colomb Anestesiol. 2012;40:67-74, http://dx.doi.org/10.1016/S0120-3347(12)700112-6.
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20. Alcaldía Mayor de Bogotá. Política Distrital de Salud Ambiental para Bogotá, DC 2011-2023, April; 2011.
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23. Balboni TA, Vanderwerker LC, Block SD, Paulk E, Lathan CS, Peteet JR, et al. Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol. 2007;25:555-60 [accessed june 16, 2012] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515558/
24. National Hospice and Palliative care organization. Hospice care in America. Facts and figures; 2012. Available from: http://www.nhpco.org/sites/default/files/public/StatisticsResearch/2012FactsFigures.pdf. [accessed june 16, 2012].
25. Gomes B, Calanzani N, Gysels M, Hall S, Higginson LJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care. 2013;12:7. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623898/
26. Sepúlveda C, Marlin A, Yoshida T, Ulrich A. Palliative care: the World Health Organization's global perspective. J Pain Symptom Manage. 2002;24:91-6. Available from: http://www.hpca.co.za/pdf/publications/Sepulveda.pdf
27. Quill TE, Byock IR. Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. Ann Intern Med. 2000;132:404-8.
28. De Lima L, Bruera E, Joranson DE, Vanegas G, Cepeda S, Quesada L, et al. Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis. J Pain Symptom Manage. 1997;13: 213-9.
29. Gwyther L, Brennan F, Harding R. Advancing palliative care as a human right. J Pain Symptom Manage. 2009;38:767-74.
2. WHO. Cancer pain relief with a guide to opioid availability. 2nd ed. Geneva: World Health Organization; 1996.
3. Townsend J, Frank AO, Fermont D, Dyer S, Karran O, Walgrove A, et al. Terminal cancer care and patients preference for place of death: a prospective study. Br Med J. 1990;301: 415-7.
4. Spiller J, Alexander D. Domiciliary care: a comparison of views of terminally ill patients and their family caregivers. Palliat Med. 1993;7:109-15.
5. Támara L. Medición de la calidad de vida de un grupo de pacientes terminales en una unidad de cuidado paliativo domiciliario en Santafé de. Bogotá. Colombia: Bioética y Calidad de Vida. Colección Bios y Ethos. Ediciones El Bosque; 2000.
6. Twycross R. Medicina paliativa: filosofía y consideraciones éticas. Acta Bioeth. 2000;6:29-46.
7. De Lima L. El uso de medicamentos opioides en al alivio del dolor por cáncer en Latinoamérica. Rev Colomb Anestesiol. 2000;28:227-30.
8. Acuña Z. Disponibilidad de medicamentos opioides en Latinoamérica y Colombia. In: ACED. Dolor y cáncer; 2009. p. 251-6.
9. Wenk R, Bertolino M, De Lima L. Analgésicos opioides en Latinoamérica: la barrera de. accesibilidad supera la de disponibilidad. Med Pal (Madrid). 2004;11: 148-51.
10. República de Colombia. Ley 1384/2010.
11. Restrepo MH. Cuidado paliativo una aproximación a los aspectos éticos del paciente con cáncer. Persona y Bioética. 2005;9:6-45.
12. Sociedad Española de Cuidados Paliativos. Organización médica colegial de España. Madrid, España: Guía de sedación paliativa; 2011. p. 11.
13. Grupo de trabajo de Tratamientos del Programa Regional de Cuidados Paliativos del Servicio Extremeño de Salud. Guía médica. Sedación en Cuidados Paliativos. Servicio Central de publicaciones del Gobierno Vasco. Vitoria-Gasteiz, 2008.
14. Kirk TW. National Hospice and Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. J Pain Symptom Manage. 2010;39.
15. Royal Society of Canada Expert Panel: Report End-of-Life Decision Making; 2011. Available at: http://www.rsc.ca/documents/RSCEndofLifeReport2011ENFormattedFINAL.pdf. [accessed june 16, 2012].
16. Jairo M, Carlos G, Sofía Z, Ángela H. Anestesiología y sedación paliativa: pertinencia, aspectos éticos y clínicos. Rev Colomb Anestesiol. 2006;34:202-4.
17. Rivera AM. Sedación terminal temprana. Anamnesis. Revista de Bioética PUJ. 2011:70-4.
18. Ibarra P, Galindo M, Molano A, Niño C, Rubiano A, Echeverry P, et al. Recomendaciones para la sedación y la analgesia por médicos no anestesiólogos y odontólogos de pacientes mayores de 12 años. Rev Colomb Anestesiol. 2012;40:67-74, http://dx.doi.org/10.1016/S0120-3347(12)700112-6.
19. Taboada P. Desafíos y principios éticos en medicina paliativa. In: Palma C, et al., editors. Medicina paliativa y cuidados continuos. U Católica de Chile; 2010. p. 41-51.
20. Alcaldía Mayor de Bogotá. Política Distrital de Salud Ambiental para Bogotá, DC 2011-2023, April; 2011.
21. DANE. Proyecciones nacionales y departamentales de población 2005-2020; 2014. Available from: http://www.dane.gov.co/files/investigaciones/poblacion/proyepobla0620/7Proyecciones poblacion.pdf. [accessed june 16, 2012].
22. UNDP. Indicadores internacionales sobre desarrollo humano. Esperanza de vida al nacer por país 1980-2011; 2014. Available from: http://hdrstats.undp.org/es/indicadores/69206.html. [accessed june 16,2012].
23. Balboni TA, Vanderwerker LC, Block SD, Paulk E, Lathan CS, Peteet JR, et al. Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol. 2007;25:555-60 [accessed june 16, 2012] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515558/
24. National Hospice and Palliative care organization. Hospice care in America. Facts and figures; 2012. Available from: http://www.nhpco.org/sites/default/files/public/StatisticsResearch/2012FactsFigures.pdf. [accessed june 16, 2012].
25. Gomes B, Calanzani N, Gysels M, Hall S, Higginson LJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care. 2013;12:7. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623898/
26. Sepúlveda C, Marlin A, Yoshida T, Ulrich A. Palliative care: the World Health Organization's global perspective. J Pain Symptom Manage. 2002;24:91-6. Available from: http://www.hpca.co.za/pdf/publications/Sepulveda.pdf
27. Quill TE, Byock IR. Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. Ann Intern Med. 2000;132:404-8.
28. De Lima L, Bruera E, Joranson DE, Vanegas G, Cepeda S, Quesada L, et al. Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis. J Pain Symptom Manage. 1997;13: 213-9.
29. Gwyther L, Brennan F, Harding R. Advancing palliative care as a human right. J Pain Symptom Manage. 2009;38:767-74.
How to Cite
1.
Támara LM. Descriptive cohort trial of terminal patients in medical home care in Bogotá – 2008–2012. Colomb. J. Anesthesiol. [Internet]. 2014 Apr. 1 [cited 2024 Jul. 2];42(2):100-6. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/530
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2014-04-01
How to Cite
1.
Támara LM. Descriptive cohort trial of terminal patients in medical home care in Bogotá – 2008–2012. Colomb. J. Anesthesiol. [Internet]. 2014 Apr. 1 [cited 2024 Jul. 2];42(2):100-6. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/530
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