Frecuencia y pesquisa de síntomas en pacientes crónicos en fases avanzadas en un hospital clínico: ¿Existe concordancia entre pacientes y médicos?

Abstract

Frequency and assessment of symptoms in hospitalized patient with advanced chronic diseases. Is there concordance among patients and doctors?Background: Physicians tend to over or underestimate symptoms reported by patients. Therefore standardized symptom scoring systems have been proposed to overcome this drawback. Aim: To estimate the prevalence and the diagnostic accuracy of physical and psychological symptoms and delirium in patients admitted to an internal medicine service at a university hospital. Material and Methods: We studied 58 patients, 45 with metastasic cancer and 13 with other advanced chronic diseases. The following scales were used: the Confusion Assessment Method for the diagnosis of delirium; the Edmonton Symptom Assessment Scale (ESAS) for pain and other physical symptoms; the Hospital Anxiety and Depression Scale to assess anxiety and depression. The ESAS was simultaneously applied to patients without delirium and their doctors to assess the level of diagnostic concordance. Results: Twenty two percent of patients had delirium. Among the 45 patients without delirium, 11 (25%) had at least eight symptoms and 39 (88.6%) had four symptoms. The prevalence of symptoms was very high, ranging from 22 to 78%. Pain, restlesness, anorexia and sleep disorders were the most common. The concordance between symptoms reported by patients and those recorded by doctor was very low, with a Kappa index between 0.001 and 0.334. Conclusions: In our sample of chronic patients, there is a very high frequency of psychological and physical symptoms that are insufficiently recorded by the medical team (Rev Méd Chile 2008; 136: 561-9).

Percepción De Carga De La Enfermedad en La Persona Con Enfermedad Crónica

“…Sobre los niveles de Percepción de carga de la enfermedad, llamó la atención un mayor reporte de la carga física comparado con las otras dimensiones, debido, probablemente, a la dificultad para reconocer la carga no física, pues el no contar con una manifestación corporal fácilmente reconocible, dificulta la identificación del factor que produce carga. Este hallazgo es coherente con lo reportado por Palma et al (12) , quienes, en el campo de los síntomas, encontraron que los pacientes crónicos tenían mayor dificultad en autoinformar síntomas psicológicos y sociales que cuando se trataba de síntomas físicos, sumado a una alta discordancia en la valoración de estas dimensiones entre los profesionales y los pacientes. A pesar de que este estudio no revela mayor afectación en estas áreas, la literatura ha evidenciado que la percepción de carga emocional, espiritual, social, familiar y cultural, es un problema frecuente para las personas con EC (13)(14)(15) y de relevancia clínica para los profesionales de salud, que deben procurar el reconocimiento y el reporte de la carga de la enfermedad con el fin de brindar abordajes de atención más integradores, que vayan más allá de asistir solo la carga física y/o manejar los síntomas.…”

Diseño, validez facial y de contenido del instrumento carga de la enfermedad crónica para el paciente – GPCP-UN

“…Aunque existen herramientas para valorar múltiples expresiones de la EC tales como el dolor [24,25], La funcionalidad [26,27], el autoconcepto [28], la relación entre aspectos biológicos y psicológicos (29,30), la condición espiritual (31), la capacidad de descansar [32,33], la situación económica [34,35], e incluso el nivel de apoyo social que el paciente recibe junto con su cuidador (36), hay también evidencia de que muchos de los síntomas y quejas del paciente con EC se quedan sin valorar [37] y que la valoración quizá por ello se ha enfatizado en la necesidad de tener en cuenta la perspectiva subjetiva del paciente [38], con base en la cual se abren importantes posibilidades para el cuidado de su salud [39].…”

Evaluation of the symptoms and treatment prescribed to hospitalized patients

“…2 Chronic degenerative diseases are illnesses that require greater monitoring, evaluation and long-term interventions, with the need for major human and material resources. [3][4][5][6] The majority of patients with chronic diseases in advanced stages, whether oncologic or non-oncologic, present multiple physical and psychological symptoms that produce a significant decrease in their quality of life. 7 Physicians often underestimate the symptoms reported by the patient and, therefore, do not offer proper treatment.…”

“…7 Physicians often underestimate the symptoms reported by the patient and, therefore, do not offer proper treatment. [3][4][5][6][7][8][9] Studies show that patients who die in hospitals have poorly controlled symptoms and often suffer from pain, dyspnea and restlessness. [9][10][11][12] Based on the perspective that patients with chronic degenerative diseases have a major reduction in quality of life, knowledge of palliative care is essential.…”

“…9,16 In order to systematize and facilitate this investigation, certain scales have been created, such as the Edmonton Symptom Assessment System (ESAS), which allows us to assess the presence and intensity of nine symptoms: pain, fatigue, nausea , depression, anxiety, drowsiness, changes in appetite, dyspnea and malaise. 3 By allowing gradation of such, this scale can also assist the team in monitoring the results obtained with the therapeutic measures implemented. A major limitation of the ESAS scale is the patient's need for communicative integrity.…”