Terminal dönemdeki kanser hastalarına uygulanan tıbbi yaklaşımlar ve destek tedavilerinin değerlendirilmesi

Abstract

ÖZET Terminal Dönemdeki Kanser Hastalarına Uygulanan Tıbbi Yaklaşımlar ve Destek Tedavilerinin Değerlendirilmesi Amaç: 1- Terminal dönem kanser hastalarında uygulanan tıbbi yaklaşımları ve görülen semptomları tanımlamak, 2- Hasta yalanlarının hastane yatışıyla ilgili beklentilerini ve evde tıbbi bakım ile ilgili düşüncelerini öğrenmek, 3- Hasta ve yakınlarının uygulanan tıbbi işlemler ve tedavilerle ilgili görüşlerini öğrenmek. Yöntem

SUMMARY Evaluation of End of Life Care and Medical Approach for Terminally 111 Caneer Patients Objective: The aims of this study are 1- evaluating of end of life care in terminally ill cancer patients, 2- learning expectations of patients' relatives about patients hospitalization and their opinions about end of life care at home, 3- learning patients' and their relatives' opinions about medical procedures and treatments. Methods: We retrospectively evaluated the patients who died at hospital in 2004. We also compared these patients with other patients who were followed prospectively between October 2004 and August 2005, in terms of chemotherapy, invasive procedures, morbidities during hospitalization and supportive care by venous line. Furthermore, the patients' relatives were prospectively assessed by questionnaires about their expectancies from hospitalization. Both the patients and their relatives were asked about their opinions on symptoms, hospital staff and supportive care weekly. We communicated with the patients' relatives to learn whether they had any suggestion about hospitalization, within 3 and 6 months after patients' death. Results: There was no difference between groups who were evaluated retrospectively and prospectively, in terms of chemotherapy, morbidities during hospitalization and invasive procedures (respectively, p=0.689, p=0.677, p=0.908). Symptoms such as pain, loss of appetite, nausea, vomiting, constipation, dyspnea and insomnia were less in prospectively followed group (p=0.002, p=0.004, p=0.004, p=0.013, p=0.000, p=0.003, p=0.008, respectively). According to the questionnaire, 68% of patients' relatives' expectancies from hospitalization was symptom relief._At the beginning, 74% of patients and 92% of patients' relatives considered that the patients should be applied everything necessary, whereas the rates were 58% and 82%, respectively, in the last questionnaire. None of the patients' relatives had any idea about supportive care at home. The patients' relatives defined that they expected both interest and empathy from the hospital staff, and 90% of them reported that their expectancy was fulfilled in the following weeks. Conclusion: We were successful in treatment of most of the symptoms during hospitalization. However, we found that we were aggressive at planning chemotherapy, invasive procedures and laboratory tests, in both retrospective and prospective evaluations. We concluded that the patients and their relatives should be informed, educated, and encouraged about supportive care at home. Finally, we consider that the hospital staff fulfills most of patients' and their relatives' expectancies. Keywords: Supportive care, attitudes of medical staff, end of life care, terminally ill cancer patients 53