Vpliv epidemije covida-19 na izvajanje akutne paliativne oskrbe v onkologiji The impact of covid-19 epidemic to the implementation of acute palliative care in oncology

Abstract

Izhodišče: Spomladi 2020 je izbruhnila pandemija covida-19 in močno vplivala na globalno družbo, posebno na zdravstveni sistem. Epidemiološke razmere in posledični ukrepi so vplivali na obravnavo bolnikov, ki so vključeni v specializirano paliativno obravnavo.
Metode: V raziskavi so bili zbrani podatki o številu in vrsti obravnav bolnikov z rakom, vključenih v akutno paliativno oskrbo na Onkološkem inštitutu Ljubljana (OI), in podana opažanja v povezavi s covidom-19 v primerjavi s podatki pred izbruhom epidemije.
Rezultati: Leta 2020 smo beležili 25 % več napotitev kot leta 2019. Povprečna ležalna doba se je zmanjšala s 6,2 na 5,1 dneva. Povprečno število družinskih sestankov v obdobju pred covidom-19 je bilo 148, lani 214. Koledarsko leto covida-19 in število odpustov oziroma smrti sta statistično značilno povezana med seboj. Leta 2020 je na Oddelku za akutno paliativno oskrbo (OAPO) umrlo več oseb, kot bi bilo pričakovano (p < 0,05, z vrednostjo = 2,76), statistično značilno manj oseb, je bilo premeščenih v hospic (p < 0,05, z vrednostjo = –2,01) in drugam (p < 0,05, z vrednostjo = –2,56). V vsem letu 2020 je bilo izvedenih 22 % ambulantnih pregledov, kar je 22 % več od povprečja preteklih let. Pandemija je vplivala na izvajanje obravnav specializirane paliativne oskrbe.
Zaključek: Oskrba za bolnike z rakom in paliativno oskrbo je bila v času covida-19 omejena. Pred nas je postavila pomembne izzive v zagotavljanju paliativne oskrbe. Krizni model organizacije paliativne oskrbe je bil bolj ali manj usmerjen v oskrbo umirajočih. O zagotavljanju celostne integrirane paliativne oskrbe pri obravnavi bolnikov z rakom v tem obdobju ne moremo govoriti. A vendar je paliativna oskrba postala bolj prepoznavana na globalni ravni.

Abstract (Eng)

Introduction: In the spring of 2020, the covid-19 pandemic broke out with a major impact on global society, particular on the healthcare system. Epidemiological conditions and consequent measures have affected the treatment of patients enrolled in specialized palliative care.
Methods: The study collected data about the number and type of treatments for cancer patients included in acute palliative care at the Institute of Oncology Ljubljana (OI) and provided observations on the covid-19 outbreak compared to pre-epidemic data.
Results: In 2020, we recorded 25% more referrals than in 2019. The average length of stay decreased from 6,2 days to 5,1 days. The average number of family meetings in the period before covid-19 was 148 but last year 214. The calendar year and dismissals or deaths are statistically significantly related. In 2020, statistically significantly more people died at OAPO than expected (p <0.05, with a value = 2.76), statistically significantly fewer people than would be expected were transferred to hospice (p <0, 05, with value = -2.01) and elsewhere (p <0.05, with value = -2.56). In 2020, 22% of outpatient examinations were performed, which is 22% more than the average of previous years. The pandemic has had and continues to have implications for the conduct of specialized palliative care treatments.
Conclusion: Care for cancer patients and palliative care was limited during covid-19. It has led us to important challenges in providing palliative care. The crisis model of palliative care organization was more or less focused on caring for the dying. Unfortunately, we cannot talk about providing comprehensive integrated palliative care in the treatment of cancer patients during this period. There has been a greater recognition of palliative care globally