Factores Asociados con la Derivación de Pacientes con Cáncer Avanzado Utilizando un Protocolo de Derivación a Cuidados Paliativos
DOI:
https://doi.org/10.32635/2176-9745.RBC.2025v71n2.5015Palabras clave:
Cuidados Paliativos, Protocolos Clínicos, Selección de PacienteResumen
Introducción: Numerosas barreras dificultan la derivación oportuna hacia cuidados paliativos (CP), resultando en una gestión inadecuada de los síntomas y menor calidad de vida. Estandarizar los criterios de derivación es fundamental para mejorar el acceso a los CP. Especialistas desarrollaron el Protocolo de Derivación a Cuidados Paliativos (PDCP), herramienta que clasifica a los pacientes oncológicos según la urgencia clínica, priorizando citas en 90, 45 y 15 días. Objetivo: Evaluar los factores que influyen en los patrones de derivación a los cuidados paliativos. Método: Este estudio de cohorte retrospectivo se llevó a cabo en el Hospital de Cáncer de Barretos (Barretos, São Paulo, Brasil). Basado en datos de historias clínicas electrónicas. Fueron analizadas utilizando tres cuestionarios: Caracterización Sociodemográfica y Clínica del Paciente; Evaluación de Derivaciones a través del PDCP según el desempeño clínico; Evaluación de Derivaciones sin el protocolo PDCP. Los análisis estadísticos se realizaron utilizando los softwares IBM-SPSS v.27.0, R v.4.3.2 y la biblioteca GGPLOT2, con significación p<0,05. Resultados: Se identificaron 1492 registros de pacientes; 323 fueron aleatorizados (226 con PDCP; 97 sin PDCP). Los pacientes derivados con PDCP eran predominantemente mujeres diagnosticadas con cáncer del aparato digestivo con educación superior. Los predictores para derivación incluyeron, tratamiento exclusivo en CP, mayor KPS y grupo de desempeño amarillo. Las derivaciones realizadas con el protocolo fueron más detalladas y justificadas. Conclusión: Se necesitan intervenciones específicas e iniciativas educativas dirigidas a los proveedores de atención médica para garantizar el acceso oportuno, enfatizando su papel fundamental en la práctica clínica. Se necesitan ensayos longitudinales para validar aún más la eficacia del PDCP en la práctica clínica.
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