From January 2007 to December 2011,80 terminal cancer pts have been assessed before hospital discharge in favor of a palliative care customized program in order to assess the psycho-emotional experience and the critical factors.
Method:The sample was represented by 52 males(65%,average age 67.6,range:53-81)and 28 females(35%,average age 73.2,range:58-83),who have been submitted to a semi-structured interview which track included:state of conscience,interactive skills,communication,awareness (diagnosis and/or prognosis),evaluation of the prevalence of neuropsychiatric disorders (anxiety/depression)
Results:63.7% (51/80 pts)was vigilant in relation to mental status,23.7% (19/80 pts)conscious, 12.9%(10/80 pts)confused or unconscious.Interactive skills were spontaneous in 61.2% (49/80 pts), mediated by the family in 19.7% (15/80 pts),under stimulation in 14.7% (11/88 pts),absent in 6.5%. (5/80pts).The communication has been convenient and truthful in 36.2%(29/80 pts),with awareness of the diagnosis in 25% (20/80 pts) and of the prognosis in 11, 2% (9/80 pts).Overall,in 20% of the cases (16/80 pts) neuropsychiatric disorders have been detected abnormal cognitive-behavioral and affective disorders)and in 36.2%(29/80)anxiety disorders(17/29 pts, 58.6%)and depression(12/29 pts, 41.3%).
Conclusions: Altogether our data indicate an intense psycho-emotional distress at the time of hospital discharge, with a percentage of neuropsychiatric disorders in line with literature (10-20%) but with a higher prevalence of two symptoms: anxiety (58.6%) and depression (41.3%). The critical factors are as follows: awareness of illness (diagnosis and/or prognosis to terminality)and communication patient/caregiver/family.Even on the basis of these data,we believe that,within the relational process with patient and family,even at this stage of disease,it is necessary to implement the provision of counseling to facilitate relationship with the person and to improve the performance of care giving assistance.