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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We thank Dr Torrente Jimenez and her colleagues<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> for their interest in our study and for giving us an opportunity to discuss it in further depth&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Firstly&#44; we fully agree with the authors when they mention the need to extend knowledge of palliative medicine to professionals who treat chronic respiratory diseases&#46; We have been aware of its importance for more than a decade&#44; but even so&#44; few advances have been made in structured care and training&#46; Our data suggest that a quarter of patients admitted to a pulmonology ward may be candidates for palliative care<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; A recent survey of Spanish pulmonologists found that only 10&#37; of them felt that they had sufficient training in palliative care and only half of their departments used a palliative care protocol<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondly&#44; we would like to reiterate that our study series included all patients admitted to the pulmonology ward in a predetermined period&#44; and of these only 31&#37; had COPD&#44; so specific COPD indices such as BODE were not included the study&#46; In any case&#44; none of the criteria suggested to date for initiating palliative care in COPD patients based on poor short-to-medium-term life expectancy is sufficiently reliable in specific patients<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Timely identification of patients with palliative needs is a complex issue that remains to be resolved&#46; We agree with the authors of the letter that refractory symptoms are certainly an indication for symptomatic treatment&#44; but if we look only at refractory symptoms&#44; we will be engaging a little late in the communication that will progressively facilitate the initiation of a palliative approach and help in decision-making&#46; Therefore&#44; it is important to identify these patients earlier rather than later&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The NECPAL tool is a simple&#44; validated tool for identifying individuals with palliative needs and limited life prognosis&#46; It offers a multidimensional evaluation and its version 3&#46;0<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> explicitly includes the Barthel index to evaluate functional decline&#44; which we also measured in our study &#40;Table 3&#41;&#46; In our paper&#44; Barthel used alone did not achieve statistical significance in the multivariate analysis of mortality&#46; Despite our data&#44; we agree with Torrente Jimenez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that assessing dependence is useful for the pulmonologist&#44; since we are treating an aging population&#44; and dependence has demonstrated prognostic value in a hospital ward<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; as the authors point out&#44; palliative care has much to offer individuals with advanced respiratory disease who have a heavy symptom burden&#46; It comprises more than end-of-life care and addresses the emotional&#44; spiritual&#44; and practical needs of patients and their caregivers&#44; including a discussion of future care&#44; without abandoning medical treatment&#46; For this reason&#44; in our opinion&#44; the situation requires not only awareness of palliation on the part of the pulmonologist&#44; but also a structured multidisciplinary approach&#44; centered on the patient&#8217;s home setting&#44; with psychologists&#44; social workers&#44; home hospitalization&#44; and specific palliative support teams when required by the complexity of the case&#46;</p></span>"
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Letter to the Editor
Reply to “Prevalence and Mortality of Patients with Palliative Needs in an Acute Respiratory Setting”
Respuesta a «Prevalencia y mortalidad de pacientes con necesidades paliativas en una planta de Neumología»
Eva Tabernero Hugueta,b,
Corresponding author
evataberna@yahoo.es

Corresponding author.
, Borja Ortiz de Urbina Antiaa, Beatriz González Queroa, Patricia Sobradillo Ecenarroa,b, Milagros Iriberri Pascuala
a Neumología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
b Biocruces, Barakaldo, Vizcaya, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We thank Dr Torrente Jimenez and her colleagues<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> for their interest in our study and for giving us an opportunity to discuss it in further depth&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Firstly&#44; we fully agree with the authors when they mention the need to extend knowledge of palliative medicine to professionals who treat chronic respiratory diseases&#46; We have been aware of its importance for more than a decade&#44; but even so&#44; few advances have been made in structured care and training&#46; Our data suggest that a quarter of patients admitted to a pulmonology ward may be candidates for palliative care<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; A recent survey of Spanish pulmonologists found that only 10&#37; of them felt that they had sufficient training in palliative care and only half of their departments used a palliative care protocol<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondly&#44; we would like to reiterate that our study series included all patients admitted to the pulmonology ward in a predetermined period&#44; and of these only 31&#37; had COPD&#44; so specific COPD indices such as BODE were not included the study&#46; In any case&#44; none of the criteria suggested to date for initiating palliative care in COPD patients based on poor short-to-medium-term life expectancy is sufficiently reliable in specific patients<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Timely identification of patients with palliative needs is a complex issue that remains to be resolved&#46; We agree with the authors of the letter that refractory symptoms are certainly an indication for symptomatic treatment&#44; but if we look only at refractory symptoms&#44; we will be engaging a little late in the communication that will progressively facilitate the initiation of a palliative approach and help in decision-making&#46; Therefore&#44; it is important to identify these patients earlier rather than later&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The NECPAL tool is a simple&#44; validated tool for identifying individuals with palliative needs and limited life prognosis&#46; It offers a multidimensional evaluation and its version 3&#46;0<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> explicitly includes the Barthel index to evaluate functional decline&#44; which we also measured in our study &#40;Table 3&#41;&#46; In our paper&#44; Barthel used alone did not achieve statistical significance in the multivariate analysis of mortality&#46; Despite our data&#44; we agree with Torrente Jimenez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that assessing dependence is useful for the pulmonologist&#44; since we are treating an aging population&#44; and dependence has demonstrated prognostic value in a hospital ward<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; as the authors point out&#44; palliative care has much to offer individuals with advanced respiratory disease who have a heavy symptom burden&#46; It comprises more than end-of-life care and addresses the emotional&#44; spiritual&#44; and practical needs of patients and their caregivers&#44; including a discussion of future care&#44; without abandoning medical treatment&#46; For this reason&#44; in our opinion&#44; the situation requires not only awareness of palliation on the part of the pulmonologist&#44; but also a structured multidisciplinary approach&#44; centered on the patient&#8217;s home setting&#44; with psychologists&#44; social workers&#44; home hospitalization&#44; and specific palliative support teams when required by the complexity of the case&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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Archivos de Bronconeumología

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