What Have You Been Told? Awareness of Prognosis of Patients in an Italian Home Palliative Care Service

Abstract

Background: In palliative care, investigating prognosis awareness is a milestone for effective and comprehensive patient intake care. The literature shows that over the past half-century, regarding prognoses, the data report less willingness to provide information, despite patients' wishes.

Objective: To investigate the varying degrees of awareness of prognosis of patients and their caregivers admitted to an Italian Palliative Home Based Care Service.

Design: A monocentric observational survey study with questionnaires created by the research team and completed by physicians, caregivers, and healthcare professionals (HCPs) during the intake. The assessment of any statistically significant differences was evaluated through McNemar's test.

Subjects: Forty patients (±75 years old, 60% females) with an estimated prognosis of more than 10 days, and for whom there was an opportunity to provide informed consent, who were intake at the Home Palliative Care Service of the Domus Salutis Clinic in Italy, from January 1 to June 30, 2022 were recruited.

Results: In total, 52% of patients were fully aware of their prognosis at the time of intake, although 75% had asked to be informed about their prognosis. Before death, the total percentage of patients who were aware of their prognosis was 72. Twenty percent of patients were informed of their prognosis during the course of treatment. The total number of patients aware of prognosis, from the caregiver's perspective before death, was 28 (71%). The postmortem questionnaire revealed that the team had discussed prognoses with 86% of patients.

Conclusion: Periodic re-evaluation of prognosis awareness during the course of care is essential, awareness increased significantly.

Keywords: awareness; clinical ethics; communication; home care; palliative care.