Prevalence and Clinical Characteristics of Patients with Advanced Chronic Illness and Palliative Care Needs Identified with the NECPAL CCOMS-ICO© Tool at a Tertiary Care Hospital

Abstract

Background: The identification of advanced chronic patients with palliative care needs is essential since the care of advanced chronicity represents one of the main challenges for public health systems. The study aimed to determine the prevalence and characteristics of inpatients with palliative care needs in different services of a tertiary care hospital using the NECPAL CCOMS-ICO© tool.Methods: A descriptive, cross-sectional cohort study was conducted in a tertiary hospital. Patients were classified as Non-NECPAL, NECPAL I-II, and NECPAL III, depending on the NECPAL tool criteria they met. The presence of physical symptoms, emotional distress, and social risk factors was assessed. Results: Of the 602 inpatients, 236 (39.2%) were enrolled. Of them: 34 (14.4%) non-NECPAL, 202 (85.6 %) NECPAL+ [105 (44.5%) NECPAL I-II, and 97 (41.1%) NECPAL III]. Physical symptom burden was high (pain intensity ≥1 in 68.3% of patients; tiredness ≥1 in 83.5%; somnolence ≥1 in 50.6%; dyspnea ≥1 in 37.9%; anorexia ≥1 in 59.5%). 64.1% had emotional distress and 83.6% social risk factors. The NECPAL-III group contained a higher percentage of cancer patients, higher demand for palliative care, and greater need for palliative care (p<0.001). In 50.8% of cases, no referrals were made to psychology, social work, or hospital palliative support care teams. The three services with the higher number of patients with palliative care needs were: Palliative Care Unit (100%), Oncology (54.54%), and Emergency Short-stay Unit (54.16%). Conclusions: A high percentage of patients admitted to tertiary care hospitals presented palliative care needs, with multiple unmet physical, emotional, and social needs. However, these patients are rarely referred to specialized care teams, such as hospital palliative support care teams.