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To estimate the need for palliative care, it is useful to examine
the likely prevalence of problems. This is based on estimates
of the prevalence of problems in the last year of life, drawn
from research among random samples of patients who died. Details
of the calculation are provided in the Epidemiologically-Based
Needs Assessment for Palliative and Terminal Care. The figure
below shows the percentage of cancer and non-cancer patients with
some common symptoms.
Figure
16.1 Percentage of Patients Experiencing
Different Symptoms in the Last Year of Life
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These
estimates are supported by individual studies. A palliative care
needs assessment of 63 patients in the Trent region with end-stage
respiratory disease, including COPD, pneumoconiosis, and bronchiectasis,
revealed a poor quality of life, relating to a high degree of
social isolation and emotional distress, low physical functioning
and disability. The study population also frequently reported
physical symptoms, most commonly: breathlessness (95%), pain (68%),
fatigue (68%), difficulty sleeping (55%), and thirst (54%) (Skilbeck
et al., 1998).
More recently,
the SUPPORT study, a major US study of decision making in the
last days of life, reported that in the last three days of life
two-fifths of patients across all disease categories included
had severe pain at least half the time, and at least a quarter
had moderate or severe dyspnea (Lynn
et al., 1997). Two thirds were reported by family members
to have found it difficult to tolerate physical and emotional
problems.
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