Integrated Care Pathway of the dying on the palliative care unit - comprehensive evaluation of the patients' needs in terminal phase of cancer disease

Palliative care of the dying is a big organisational and therapeutic challenge due to the complexity of the patients' and their caregivers' needs. The aim of the research was to analyse the results achieved during Integrated Care Pathway implementation in cancer patients in the Palliative Care Ward. The ICP documentation consists of 3 parts. The first part includes a list of the patients' needs and the required activities aiming at improving the patients' comfort; the second one deals with current care and monitoring patients' comfort every 4 and 12 hours; the third one concerns evaluation of the aims implementation and improvement of the quality of care and also comprises a form for noting discrepancies. The analysis of medical documentation of 36 out of 64 patients in ICP was carried out from January to May 2010. One of the inclusion criteria was hospitalisation lasting at least 48 hours and completing records in ICP documentation for at least 12 hours. The most common symptoms included weakness (94.4%), consciousness disorder (80.5%), amentia (69.4%), respiratory tract secretion (50%), dyspnea (44.4%) and pain (47.2%). The control of such symptoms as pain, amentia and death rattle showed that the first two ones were mastered in almost all the patients 12 and 24 hours before death. The results of the observation carried out every 4 hours demonstrated that in 16 patients (44.4%) symptoms from the respiratory tract were not totally controlled. In 4 patients the control of high body temperature was not effective. The remaining symptoms were mastered in the majority of patients. Ensuring mental and spiritual comfort in preparation for the coming death was not achieved in 5 individuals (13.8%). According to the medical staff's evaluation, all the patients provided with Integrated Care Pathway were dying peacefully - with no pain or agitation.