Need for palliative care in patients with chronic diseases in a hospital in a developing country

Abstract

Introduction: The World Health Organization defines palliative care (PC) as an approach aimed at improving the quality of life of patients and families facing life-threatening illness. In developing countries, gaps persist in coverage, late referrals, and limited integration of PC into hospital care, especially for non-oncologic conditions. Objective: To evaluate the relationship between chronic diseases and the need for PC among hospitalized patients in a hospital in southern Peru. Methods: Analytical cross-sectional study in a public referral hospital. We included adults ⩾18 years admitted to Internal Medicine, General Surgery, Obstetrics and Gynecology, or the Emergency Department; we excluded pregnant/postpartum patients, those managed exclusively in the ICU/Trauma Shock Unit, urgent surgical cases precluding assessment, and patients with cognitive impairment (Pfeiffer ⩾2). The need for PC was assessed using the SPICT-TM-ES (⩾2 general indicators + ⩾1 clinical indicator). Sociodemographic and clinical variables were collected via interview and chart review. Associations were estimated using Poisson regression with robust variance, reporting adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI). Results: We included 150 patients; 67.3% met criteria for PC need. Multimorbidity (⩾2 comorbidities) and ⩾2 hospitalizations in the past year were associated with a higher need for PC. In adjusted models, dementia (aPR = 1.15; 95% CI: 1.05–1.26) and malignancy (aPR = 1.14; 95% CI: 1.05–1.24) were positively associated with PC need, whereas type 2 diabetes mellitus was inversely associated (aPR = 0.85; 95% CI: 0.77–0.93). Conclusion: The need for PC among hospitalized patients with chronic conditions was high.