The need for palliative care in non-oncologic patients is often underestimated. The clinical records of 787 patients admitted in 2003 to our unit were reviewed for causes of death and terminal treatments. 17 patients died, 4 for unexpected events, and 13 for recurrent pulmonary edema (2), advanced cardiac failure (2), pulmonary fibrosis (2), severe emphysema (4), post-thoracic surgery respiratory failure (1) and lung cancer (2). In the 11 non-oncologic patients (7 males, mean age 76 years, range 68-87) palliation was needed mainly for dyspnea (11), pain (2) or anxiety (6). Only 3 patients (27%) received a structured palliative approach, with the informed consent of the relatives. In none case the patient’s informed consent was searched for. In 8 cases palliative care was left to an as needed basis but doctors’opinion differed largely about timing and type of intervention. Palliative interventions consisted of anti-anxiety agents (6 patients), corticosteroids (10), analgesics (2), opioids (6), invasive (2) and noninvasive ventilation (3), oxygentherapy (11).
Conclusion: needs for palliative care were systematically met only in a minority of non-oncologic patients. The main deficiencies were lack of communication with patients, lack of agreement among doctors, and lack of objective evaluation of the clinical needs of the terminal patients.