| Sažetak | Uvod: Principi pružanja palijativne skrbi odnose se na kontrolu boli i ostalih simptoma u cilju
poboljšanja kvalitete života. U skrbi se smrt ne odgađa niti ne ubrzava već se pacijentu
osigurava dostojanstveni način umiranja. U bolničkim jedinicama palijativne skrbi pruža se
fizička, psihološka, socijalna i duhovna potpora te se holističkim pristupom pozitivno djeluje
na prisutne simptome i kvalitetu života.
Cilj: Provedeno je istraživanje s ciljem utvrđivanja povezanosti između pružene bolničke
palijativne skrbi i poboljšanja kvalitete života i kontrole simptoma kod pacijenata.
Metode: Prospektivno presječno istraživanje provedeno je na Odjelu za palijativnu medicinu
i palijativnu skrb u Specijalnoj bolnici za plućne bolesti u Zagrebu na 52 ispitanika koji su u
uznapredovaloj fazi maligne bolesti. Postojeći simptomi i kvaliteta života procjenjivani su
prvog dana hospitalizacije te nakon 7 dana pružanja palijativne skrbi. Korištene su skale:
EORTC QLQ - C15 PAL (The European Organisation for Research and Treatment of Cancer
Quality of Life Questionnaire Core 15 Palliative), ESAS–r (Edmonton Symptom Assessment
System Revised), VAS (Visual Analog Scale) i PPSv2 (Palliative Performance Scale version 2).
Rezultati: Većina ispitanika je ženskog spola, prosječne životne dobi 70 – 79 godina te živi u
Zagrebu. Svi ispitanici su oboljeli od malignih bolesti, najčešće tumora pluća (36,5%) s
metastazama (86,5%). Procjena prvog dana hospitalizacije pokazala je kako su najintenzivniji
simptomi (ESAS-r): opstipacija (6,88), zamaranje (6,21), loše blagostanje (5,58), kratkoća daha
(5,02), pospanost (4,31), pomanjkanje apetita (4,21) te bol (4,17). Najučestaliji simptomi
(EORTC QLQ - C15 PAL) bili su: umor (62,82), bol (56,08), gubitak apetita (51,28), nesanica
(50,00), opstipacija (49,35) te loše fizičko funkcioniranje (14,95). Nakon 7 dana simptomatskog
liječenja primjećeno je smanjenje intenziteta simptoma opstipacije, zamaranja, kratkoće daha i
boli (p<0,05). Nije došlo do smanjenja intenziteta pospanosti (p = 0,106), pomanjkanja apetita
(p = 0,053) te osjećaja blagostanja (p = 0,692). Iako mučnina (1,81) i anksioznost (3,38) nisu bili
najintenzivniji simptomi statističkom analizom je dokazano smanjenje intenziteta tih
simptoma (p<0,05). U vezi učestalosti simptoma nakon 7 dana simptomatskog liječenja
primjećeno je poboljšanje opće kvalitete života, emocionalnog funkcioniranja te poboljšanje na
skali boli kao i skalama pojedinačnih simptoma (p<0,05), osim dispneje (p = 0,142). Fizičko
funkcioniranje se nije popravilo u odnosu na procjenu prvog dana hospitalizacije. Rezultati
procjene funkcionalne sposobnosti ispitanika (PPSv2) sedmog dana hospitalizacije (36,54) ne
pokazuju promjene u funkcionalnoj sposobnosti ispitanika u odnosu na procjenu prvog dana
(39,04).
Zaključak: Provedenim istraživanjem potvrđena je hipoteza koja je glasila da se boravkom na
odjelu za palijativnu skrb postiže bolja kontrola simptoma i time bolja kvaliteta života.
Pružena bolnička palijativna skrb povezana je sa smanjenjem intenziteta i učestalosti
simptoma te povećanjem kvalitete života kod pacijenata ali ne i promjenama njihove
funkcionalne sposobnosti. |
| Sažetak (engleski) | Introduction: The principles of providing palliative care relate to the control of pain and other
symptoms in order to improve the quality of life. In care, death is not delayed or accelerated,
but the patient is provided with a dignified way of dying. In palliative care hospital units is
provided physical, psychological, social and spiritual support and a holistic approach has a
positive effect on the present symptoms and quality of life.
Aim: A study was conducted to determine relationship between hospital palliative care and
quality of life and symptom control in patients.
Methods: A prospective cross-sectional study was conducted at Department of Palliative
Medicine and Palliative Care in Special Hospital for Pulmonary Diseases in Zagreb on 52
subjects who are in advanced stage of malignant disease. Existing symptoms and quality of
life were assessed on the first day of hospitalization and after 7 days of palliative care. Scales
were used: EORTC QLQ - C15 PAL (The European Organisation for Research and Treatment
of Cancer Quality of Life Questionnaire Core 15 Palliative), ESAS–r (Edmonton Symptom
Assessment System Revised), VAS (Visual Analog Scale) and PPSv2 (Palliative Performance
Scale version 2).
Results: The majority of respondents are female, with an average age of 70-79 living in Zagreb.
All subjects suffered from malignant diseases, most often lung tumors (36,5%) with metastases
(86,5%). Assessment on the first day of hospitalization showed that the most intense symptoms
(ESAS-r) were: constipation (6,88), fatigue (6,21), poor well-being (5,58), shortness of breath
(5,02), drowsiness (4,31), lack of appetite (4,21) and pain (4,17). The most common symptoms
(EORTC QLQ - C15 PAL) were: fatigue (62,82), pain (56,08), loss of appetite (51,28), insomnia
(50,00), constipation (49,35) and poor physical functioning (14,95). After 7 days of symptomatic
treatment, a decrease in the intensity of symptoms of constipation, fatigue, shortness of breath
and pain was observed (p <0.05). There was no decrease in the intensity of drowsiness (p =
0.106), lack of appetite (p = 0.053) and feelings of well-being (p = 0.692). Although nausea (1,81)
and anxiety (3,38) were not the most intense symptoms, statistical analysis showed a decrease
in the intensity of these symptoms (p <0.05). Regarding the frequency of symptoms after 7
days of symptomatic treatment, it was noticed an improvement in general quality of life,
emotional functioning and improvement on the pain scale as well as the scales of individual
symptoms (p <0.05), except for dyspnoea (p = 0.142). Physical functioning did not improve
compared to the assessment on the first day of hospitalization. The results of the assessments
of the functional abilities of the examinees (PPSv2) on the seventh day of hospitalization (36,54)
do not show changes in the functional abilities of the examinees compared to the assessment
on the first day (39,04).
Conclusion: The hypothesis confirmed the research that by staying in the palliative care
department, better control of symptoms and thus better quality of life is achieved. The hospital
palliative care provided is associated with a decrease in the intensity and frequency of
symptoms and an increase in the quality of life in patients, but not with changes in their
functional ability. |
