Palliative care consultation team: symptom relief in first 48 hours of hospitalization

Silva, Magda Aparecida dos Santos; Diniz, Marcio Augusto; Carvalho, Ricardo Tavares de; Chiba, Toshio; Mattos-Pimenta, Cibele Andrucioli de

doi:10.1590/0034-7167-2019-0391

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (6) • 2020 • https://doi.org/10.1590/0034-7167-2019-0391 copy

Palliative care consultation team: symptom relief in first 48 hours of hospitalization

Equipo interconsultor en cuidados paliativos: alivio de síntomas en las primeras 48 horas de hospitalización

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To compare the relief of symptoms provided by palliative care consultation team (PCCT) compared to the traditional care team (TC), in patients with advanced cancer in the first 48 hours of hospitalization.

Method:

Allocated to PCCT Group and TC Group, this study assessed 290 patients according to the Edmonton Symptom Assessment System (ESAS) within the first 48 hours of hospitalization. The main outcome was a minimum 2-point reduction in symptom intensity.

Results:

At 48 hours, the PCCT Group had a 2-point reduction in the mean differences (p <0.001) in pain, nausea, dyspnea, and depression; and TC Group, on nausea and sleep impairment (p <0.001). Multiple Logistic Regression found for the PCCT Group a greater chance of pain relief (OR 2.34; CI 1.01-5.43; p = 0.049).

Conclusion:

There was superiority of the PCCT Group for pain relief, dyspnea and depression. There is a need for more studies that broaden the understanding of team modalities.

Descriptors:
Palliative care; Terminal Patient Care; Symptom Assessment; Pain Management; Treatment Effectiveness

Variables	PCCT = 127* n(%)	TC = 163^† n(%)	p value
Gender			0.52^‡
Male	68(53.5)	74(45.4)
Female	59(46.5)	89(54.6)
Marital situation			0.65^‡
With partner	79(62.2)	96(58.9)
Without partner	48(37.8)	67(41.1)
Age			0.34^§
Mean(SD)	59.6(1.3)	57.2(1.5)
Median (minimum - maximum)	60(24-87)	59(19-84)
Schooling (years)			0.77 ^§
Mean(SD)	5.9(0.4)	7.7(0.5)
Median (minimum - maximum)	4.0(1-16)	8.0(1-19)
Monthly income^¶			0.22^§
Mean(SD)	3.1(0.2)	3.5(0.4)
Median (minimum - maximum)	3.0(0-15)	3.0(0-20)
Religious Practice			0.80^‡
No	52(40.9)	78(47.9)
Yes	75(59.1)	85(52.1)
Setting			< 0.001^{‡ \|\|}
Emergency Room	56(44.1)	119(73.0)
First aid room	71(55.9)	44(27.0)
Tumor location			0.10^‡
Gastrointestinal	75(59.0)	82(50.3)
Genitourinary	11(08.7)	14(08.6)
Lungs	18(14.2)	23(14.1)
Others**	23(18.1)	44(27.0)
KPS^§			0.86^§
Mean(SD)	43(1.5)	52(1.4)
Median (minimum - maximum)	40(20-70)	50(20-70)
Number of deaths			0.20
Up to 30 days	44(34.6)	42(25.8)
30-90 days	14(11.0)	24(14.7)
Symptoms on admission
Pain	7.1(0.2);7.5	7.9(0.2);8.0	0.59
Tiredness	6.9(0.2);7.0	7.1(0.3);7.0	0.92
Nausea	6.3(0.3);7.0	6.7(0.3);7.0	0.86
Anxiety	7.2(0.3);8.0	7.3(0.3);8.0	0.10
Drowsiness	7.0(0.3);7.0	7.7(0.2);8.0	0.13
Appetite	7.6(0.3);8.0	8.1(0.3);9.0	0.19
Wellbeing	6.6(0.3);6.5	6.2(0.3);6.0	0.25
Dyspnea	6.1(0.3);6.0	6.7(0.3);7.0	0.02^{\| §}
Depression	5.6(0.4);5.5	4.6(0.4);5.0	0.59
Sleep	7.3(0.3);8.0	7.4(0.3);8.0	0.70
Symptom Burden	47(1.6);47	48(1.4);46	0.30

Symptoms	0-24 hours n = 100	0-48 hours n = 83
Pain
n(%)	75(75)	58(70)
Mean(SD);Median	4.9(0.5);6.0	5.1(0.6);5.0
Differences Mean	-2.1(0.4);-1.0	-2.5(0.5);-2.0
p value	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**
Tiredness
n(%)	77(77)	60(84)
Mean (SD); Median	5.3(0.6);6.5	5.3(0.6);6.0
Differences Mean	-1.0(0.3);0.0	-1.3(0.5);-0.5
p value	0.015*	0.013*
Nausea
n(%)	46(46)	36(43)
Mean (SD); Median	2.6(0.5);0.0	3.1(0.6);0.0
Differences Mean	-2.3(0.6);-2.0	-3.2(0.7);-3.0
p value	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**
Anxiety
n(%)	60(60)	46(55)
Mean (SD); Median	5.8(0.6);6.0	6.1(0.6);6.0
Differences Mean	-1.0(0.4);0.0	-1.6(0.5);-0.5
p value	0.025*	0.02*
Drowsiness
n(%)	78(78)	60(72)
Mean (SD); Median	5.9(0.5);7.0	6.5(0.5);7.0
Differences Mean	-1.0(0.5);0.0	-0.7(0.5);0.0
p value	0.074	0.118
Appetite
n(%)	65(65)	48(56)
Mean (SD); Median	7.2(0.5);9.5	7.1(0.6);10
Differences Mean	-0.6(0.4);0.0	-1.2(0.5);0.0
p value	0.001*	0.022*
Wellbeing
n(%)	86(86)	67(81)
Mean (SD); Median	6.1(0.5);7.0	6.4(0.5);6.0
Differences Mean	-0.6(0.3);0.0	-0.8(0.3);0.0
p value	0.031	0.022*
Dyspnea
n(%)	51(51)	41(49)
Mean (SD); Median	1.4(0.4);0.0	1.4(0.4);0.0
Differences Mean	-1.5(0.4);0.0	-2.0(0.5);-2.0
p value	0.002*	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**
Depression
n(%)	43(43)	32(38)
Mean (SD); Median	3.1(0.6);0.0	3.7(0.7);0.0
Differences Mean	-0.7(0.6);0.0	-2.4(0.6);-1.0
p value	0.001*	*< 0.001^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.**
Sleep
n(%)	69(69)	52(63)
Mean (SD); Median	5.7(0.6);7.0	4.9(0.6);5.0
Differences Mean	-1.8(0.5);0.0	-1.6(0.5);0.0
p value	<0.001*	0.005*
Symptom Burden
Mean (SD); Median	48.0(2.7);45.5	49.5(3.4);46
Differences Mean	-5.0(1.3);-4.0	-5.6(1.7);-5.5
p value	< 0.001*	0.001*

Symptoms	0-24 hours n = 96	0-48 hours n = 75
Pain
n(%)	76(79)	62(83)
Mean(SD);Median	4.1(0.5);5.0	3.3(0.5);3.0
Differences Mean	-3.1(0.5);-2.0	-1.3(0.6);1.5
p value	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.	0.10
Tiredness
n(%)	73(76)	57(93)
Mean (SD); Median	5.9(0.4);6.0	5.8(0.5);7.0
Differences Mean	-1.7(0.4);0.0	-1.2(0.5);0.0
p value	0.001^* * p <0.05 (Statistically significant). Wilcoxon Test	0.054
Nausea
n(%)	52(54)	40(53)
Mean (SD); Median	2.6(0.4);0.0	2.6(0.5);1.0
Differences Mean	-3.4(0.6);-3.0	-3.4(0.6);-4.0
p value	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.
Anxiety
n(%)	66(69)	53(71)
Mean (SD); Median	4.9(0.5);5.0	5.1(0.6);6.0
Differences Mean	-1.7(0.4);0.0	-1.5(0.5);0.0
p value	*< 0.001^ * p <0.05 (Statistically significant). Wilcoxon Test**	0.001^* * p <0.05 (Statistically significant). Wilcoxon Test
Drowsiness
n(%)	68(71)	56(75)
Mean (SD); Median	5.5(0.4);6.0	5.6(0.5);6.0
Differences Mean	-1.7(0.4);0.0	-1.1(0.4);0.0
p value	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test	0.025^* * p <0.05 (Statistically significant). Wilcoxon Test
Appetite
n(%)	74(77)	59(79)
Mean (SD); Median	4.8(0.5);5.0	4.8(0.6);5.0
Differences Mean	-1.1(0.4);0.0	-1.3(0.5);0.0
p value	0.018^* * p <0.05 (Statistically significant). Wilcoxon Test	0.009^* * p <0.05 (Statistically significant). Wilcoxon Test
Wellbeing
n(%)	77(80)	62(83)
Mean (SD); Median	5.5(0.4);5.0	5.7(0.5);5.0
Differences Mean	-0.2(0.3);0.0	-0.3(0.4);0.0
p value	0.635	0.564
Dyspnea
n(%)	34(35)	30(40)
Mean (SD); Median	2.7(0.5);0.0	-2.7(0.7);-2.0
Differences Mean	-1.7(0.5);-1.5	-1.8(0.5);-1.0
p value	0.003^* * p <0.05 (Statistically significant). Wilcoxon Test	0.001^* * p <0.05 (Statistically significant). Wilcoxon Test
Depression
n(%)	41(43)	31(41)
Mean (SD); Median	2.3(0.4);0.0	2.4(0.5);0.0
Differences Mean	-1.5(0.6);0.0	-1.3(0.6);0.0
p value	0.039	0.057
Sleep
n(%)	77(80)	63(84)
Mean (SD); Median	4.3(0.4);5.0	4.5(0.6);5.0
Differences Mean	-2.2(0.4);0.0	-2.3(0.5);-2.0
p value	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.	< 0.001^* * p <0.05 (Statistically significant). Wilcoxon Test ^† † Reduction of 2 points in the symptoms or 20 points in the Symptoms Burden.
Symptom Burden
Mean (SD); Median	42.9(2.3);42	42.5(2.6);40
Differences Mean	-6.9(1.6);-5.0	-5.3(1.9);-7.0
p value	*< 0.001^ * p <0.05 (Statistically significant). Wilcoxon Test**	0.008^* * p <0.05 (Statistically significant). Wilcoxon Test

Symptoms	0-24 hours		0-48 hours
Symptoms	OR (95% CI)	p value	OR (95% CI)	p value
Pain	1.42 (0.67-2.99)	0.360	2.34 (1.01-5.43)	0.049^* * p <0.05 (Statistically significant) ^† † Possibility in reducing 2 points in the intensity of the symptoms or 20 points in the burden of symptoms
Tiredness	0.84 (0.40-1.76)	0.645	0.97 (0.43-2.21)	0.948
Nausea	0.96 (0.37-2.51)	0.940	1.27 (0.42-3.81)	0.668
Anxiety	0.87 (0.40-1.90)	0.722	1.02 (0.41-2.51)	0.959
Drowsiness	0.72 (0.34-1.51)	0.382	0.95 (0.40-2.25)	0.909
Appetite	1.72 (0.75-3.91)	0.197	1.39 (0.59-3.29)	0.449
Wellbeing	1.68 (0.72-3.91)	0.222	1.52 (0.63-3.68)	0.350
Dyspnea	0.60 (0.20-1.80)	0.361	0.55 (0.16-1.92)	0.350
Depression	0.90 (0.33-2.51)	0.850	1.31 (0.39-4.42)	0.664
Sleep	0.78 (0.37-1.64)	0.510	0.55 (0.24-1.25)	0.146
Symptom Burden	0.63 (0.31-1.24)	0.174	0.93 (0.45-1.93)	0.845

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[1] Corresponding author: Magda Aparecida dos Santos Silva E-mail: magda_mass@yahoo.com.br