Reasons for Neurology Consultation in Palliative Care Patients

Yıl 2023, Cilt: 1 Sayı: 2, 111 - 118, 25.09.2023

Ümit Görgülü , Fatma Seda Bingöl , Hesna Bektaş , Kadriye Kahveci

Öz

Neurological diseases are the second most common group of diseases requiring palliative care (PC) after cancer, and neurological evaluations may be required frequently in PC patients. In this study, we aimed to investigate the reasons for neurology consultation of patients followed in a PC center (PCC). The medical records of patients assessmented with neurological consultation at our hospital PCC between 2020 and 2022 were retrospectively reviewed. Our study included 223 patients with a mean age of 78 (18-98) years; 54.3% were female, with a mean GCS score of 10 (4–14). At least one neurological diagnosis was present in 65.5% of the patients. The most common neurological diseases were dementia (30.9%), stroke (27.4%), Parkinson’s disease (12.6%) and epilepsy (10.8%). Reasons for neurological consultations included re-treatment planning related to neurological diseases (34.5%; most commonly for stroke 19.3%), swallowing assessment (29.1%), healthcare documentation needs (20.6%; medications, guardianship, bed, care, and disability) and seizures (5.4%). In conclusion, neurological diseases are frequently observed in PC patients, often necessitating neurological assessments for disease re-treatment planning, nutritional support, and care requirements during the care process.

Anahtar Kelimeler

Palliative care, neurological assessment, neurological diseases, Neurology Consultation

Palyatif Bakım Hastalarında Nöroloji Konsültasyon Nedenleri

Öz

Nörolojik hastalıklar, kanserden sonra palyatif bakımın (PB) gerektiren en yaygın hastalık grubudur ve PB hastalarında sıkça nörolojik değerlendirme gerekebilir. Bu çalışmada, PB merkezinde (PBM) takip edilen hastaların nöroloji konsültasyon nedenlerini araştırmayı amaçladık. 2020 ile 2022 yılları arasında hastanemiz PBM’nde nöroloji konsültasyonu ile değerlendirilen hastaların tıbbi kayıtları retrospektif olarak incelendi. Çalışmamız ortalama yaşın 78 (18-98) yıl olduğu 223 hastayı içeriyordu; %54.3'ü kadındı ve ortalama GKS skoru 10 (4-14)'du. Hastaların %65.5'inde en az bir nörolojik hastalık tanısı bulunmaktaydı. En yaygın nörolojik hastalıklar sırasıyla demans (%30.9), inme (%27.4), Parkinson hastalığı (%12.6) ve epilepsiydi (%10.8). Nöroloji konsültasyon nedenleri arasında nörolojik hastalıklara yönelik yeniden tedavi planlaması (%34.5; en sık inme için [19.3%]), yutma değerlendirmesi (%29.1), sağlık belgesi ihtiyaçları (%20.6; ilaçlar, vesayet, yatak, bakım ve engellilik) ve nöbet (%5.4) yer almaktaydı. Sonuç olarak nörolojik hastalıklar, PB hastalarında sıkça görülmekte olup, bakım sürecinde sıklıkla yeniden tedavi planlaması, beslenme desteği ve bakım gereksinimleri için nörolojik değerlendirme gerektirebilmektedir.

Anahtar Kelimeler

Palyatif bakım, nörolojik değerlendirme, nörolojik hastalıklar, Nöroloji Konsültasyonu

Kaynakça

• American Academy of Neurology Ethics and Humanities Subcommittee (1996). Palliative care in neurology. Neurology, 46, 870-872.
• American Board of Psychiatry and Neurology, Inc. (2013). Initial certification statistics. Retrieved June 15, 2023, from http://www.abpn.com/cert_statistics.html.
• Anneser, J., Arenz, V., & Borasio, G. D. (2018). Neurological symptoms in palliative care patients. Frontiers in Neurology, 9, 275. https://doi.org/10.3389/fneur.2018.00275
• Bužgová, R., Kozáková, R., & Bar, M. (2020). The effect of neuropalliative care on quality of life and satisfaction with quality of care in patients with progressive neurological disease and their family caregivers: an interventional control study. BMC Palliative Care, 19(1), 1-10. https://doi.org/10.1186/s12904-020-0534-1
• Chahine, L. M., Malik, B., & Davis, M. (2008). Palliative care needs of patients with neurologic or neurosurgical conditions. European Journal of Neurology, 15(12), 1265-1272. https://doi.org/10.1111/j.1468-1331.2008.02220.x
• Dallara, A., & Tolchin, D. W. (2014). Emerging subspecialties in neurology: palliative care. Neurology, 82(7), 640-642. https://doi.org/10.1212/WNL.0000000000000247
• Fernando, G. V. M. C., & Hughes, S. (2019). Team approaches in palliative care: a review of the literature. International Journal of Palliative Nursing, 25(9), 444-451. https://doi.org/10.12968/ijpn.2019.25.9.444
• Gorgulu, U., Polat, U., Kahraman, B., Ozen, S., & Arslan, E. (2016). Factors affecting the burden on caregivers of stroke survivors in Turkey. Medical Science and Discovery, 3(4), 159-165.
• Gott, M., Gardiner, C., Ryan, T., et al. (2013). Prevalence and predictors of transition to a palliative care approach among hospital inpatients in England. Journal of Palliative Care, 29, 147-153.
• Heigener, D. F., & Rabe, K. F. (2011). Palliative care concepts in respiratory disease. Respiration, 82, 483-491. https://doi.org/10.1159/000334189
• Howlett, J. G. (2011). Palliative care in heart failure: addressing the largest care gap. Current Opinion in Cardiology, 26, 144-148. https://doi.org/10.1097/hco.0b013e3283437468
• Hussain, J. A., & Russon, L. (2012). Supportive and palliative care for people with end-stage renal disease. British Journal of Hospital Medicine, 73, 640-644. https://doi.org/10.12968/hmed.2012.73.11.640
• Hussain, J., Adams, D., & Campbell, C. (2013). End-of-life care in neurodegenerative conditions: outcomes of a specialist palliative neurology service. International Journal of Palliative Nursing, 19, 162-169. https://doi.org/10.12968/ijpn.2013.19.4.162
• Liu, Y., Kline, D., Aerts, S., Youngwerth, J. M., Kutner, J. S., Sillau, S., & Kluger, B. M. (2017). Inpatient palliative care for neurological disorders: lessons from a large retrospective series. Journal of Palliative Medicine, 20(1), 59-64. https://doi.org/10.1089/jpm.2016.0247
• Sarıçam, G., Kahveci, K., & Akdoğan, D. (2020). Palliative Care Requirement in Neurologic Diseases. Turkish Journal of Neurology/Turk Noroloji Dergisi, 26(2). https://doi.org/10.4274/tnd.galenos.2019.46910
• Tran, L. N., Back, A. L., & Creutzfeldt, C. J. (2016). Palliative care consultations in the neuro-ICU: a qualitative study. Neurocritical Care, 25, 266-272. https://doi.org/10.1007/s12028-016-0306-1
• World Health Organization (WHO) (2020). Palliative care. Retrieved June 20, 2023, from https://www.who.int/news-room/fact-sheets/detail/palliative-care.