Construcción de un protocolo de atención del paciente al final de la vida en la unidad de cuidados intensivos. Consenso de expertos por metodología Delphi.

Abstract

Introduction: Satisfying the terminal patient’s biological, psychological, and social needs in clinical situations of proximate fatal or poor prognosis, requires aptness for taking decisions from an interdisciplinary qualified team of health professionals. Clinical protocols for the patient at end of life stages have shown their value in hospital scenarios, improving the quality of patient care, and must be adjusted to the available resources and attention level in every institution. Aim: To develop a clinical protocol for the patient with poor or fatal prognosis in an intensive care unit by expert consensus using the Delphi methodology. Methods: We designed a study using Delphi methodology with affected mixed experts. The determination of dimensions, attributes and criteria was based in the revision of best available evidence to date. The stability, convergence and saturation of expert opinions was obtained by quantitative methods. Results: After interaction with experts, we got the dimensions, attributes and consensus criteria that will be part of the protocol about comprehensive and humanized management of cardinal symptoms such as pain and anxiety and those related to the airway of patients with terminal disease that allow the early beginning of end of life integral and worthy care. Conclusions: Two rounds were needed to obtain an expert consensus by Delphi methodology, which allowed the making of a script of medical orders, that lead to determine dimension, attributes and criteria of humanized care in the chronic patient in terminal phase, evaluated as viable for the clinical use an it’s validation in the general practice.