Intervenciones médicas no proporcionales al final de la vida en un hospital de alta complejidad en Colombia

Abstract

Resumen
 Objetivo: Analizar las intervenciones realizadas en una cohorte de pacientes fallecidos en un hospital universitario de alta complejidad y definir la proporcionalidad terapéutica de las mismas, a partir del estudio de la prevalencia de “tratamientos no benéficos”. Metodología Estudio observacional descriptivo retrospectivo, basado en la revisión de historias clínicas de los pacientes fallecidos en el periodo de dos años en un hospital universitario de alta complejidad Resultados: Se analizaron 931 historias de pacientes fallecidos y en la categorización de acuerdo con el criterio de “proporcionalidad terapéutica” se encontró que en el 54,7% de los pacientes se realizaron intervenciones diagnosticas o terapéuticas clasificadas como “desproporcionadas” de acuerdo con la definición aplicada. Conclusión: En la práctica las intervenciones no proporcionales o no benéficas al final de la vida son prevalentes, lo que constituye un problema mayor y persistente, a pesar de sus repercusiones negativas sobre los pacientes, las familias, los profesionales de la salud y el sistema de salud.
 Palabras claves
 Bioética - Ética médica - Inutilidad Médica (Futilidad) - Humanización de la atención

Co-Designing a Strategy for Implementing the SPARC Holistic Needs Assessment Tool in the Colombian Clinical Context

“…In addition, as with the first co-design workshop, we also identified the existence of many misconceptions about PC: many specialists seem to consider referral to a PC service as a professional failure; patients and caregivers fear that they will be abandoned by their doctors and the system in general when they are in PC, which can be associated with dying and feelings of despair [11,18,19]. For this reason, we decided to also work on ways to educate professionals, patients and caregivers on what palliative care and holistic care needs are and the importance of implementing PC as early as possible.…”

Validation of the Spanish translation Sheffield Profile for Assessment and Referral for Care (SPARC-Sp) at the Hospital Universitario San Jose of Popayan, Colombia

“…PC services in Colombia are primarily available in main cities (Calvache et al 2020), with a significant lack of offer in rural areas, compounded by other barriers such as limited supply of healthcare, lack of awareness among policymakers, health professionals, the general community, myths, cultural and social barriers framed by beliefs about death and dying well, and issues surrounding opioid drugs (Organización Mundial de la Salud 2022a). Health professionals, patients, and relatives associate PC with death and abandonment, leading to delays in accessing services (Cuadrado 2018;Gempeler et al 2021;Kaasa et al 2018). Poor communication of patients' wishes for treatment and objectives and preferences for care were recently shown to be associated with increased suffering among Colombian cancer patients (Arango-Gutiérrez et al 2023).…”

Translation and linguistic validation of the Sheffield Profile for Assessment and Referral for Care (SPARC) to Colombian Spanish

“…Decisions regarding referral to PC represent challenges for health professionals, who may see it as a sign of their failure, and for patients and families -who frequently associate PC with abandonment and death. Consequently, access to these services is often delayed 2 Socorro Moreno et al (Cuadrado Franco 2019;Gempeler et al 2021;Kaasa et al 2018).…”

“…In addition, about 73% of physicians consider death a negative outcome and even an indicator of therapeutic failure (Cuadrado Franco 2019), probably one of the causes of the frequent administration of disproportionate treatments to patients with poor health status or prognosis (Cuadrado Franco 2019;Gempeler et al 2021).…”