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is the issue of spiritual needs addressed in the EAPC&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> These needs are difficult to investigate&#44; given that they are not measurable and differ between cultures&#44; religions and societal circumstances&#46; However&#44; projects are being developed with innovative humanist and multidisciplinary viewpoints to understand the entire issue of humans at the end of life &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Examples of these projects include London&#39;s &#8220;The Art of Dying&#8221; and California&#39;s &#8220;Seeing the Difference Project&#8221;&#44; which include the vision of artists and healthcare practitioners&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In this issue&#44; Sancho Zamora et al&#46; assessed a prognostic model for patients at the end-of-life&#46; The model consists of a functional assessment using the Palliative Performance Scale &#40;PPS&#41; plus the presence of pain&#47;delirium&#47;dyspnea&#46; Consistent with previous studies&#44; the authors found a strong association between low scores and mortality in periods as short as 6 days &#40;for scores of 20&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">8&#8211;10</span></a> The authors related this prediction with better relative&#47;caregiver satisfaction by having improved patient selection before being transferred to a medium-stay center&#46; For a better prognosis&#44; the EAPC specifically recommends using the subjective criteria of the healthcare practitioner responsible for the patient&#44; added to objective scales with proven validity and reproducibility&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> The subjective prognosis is more reliable if the clinician has experience and has been able to determine the patient&#39;s progress more recently&#46; The objective scales and indices are based on assessing the functional state&#44; from the simplest Eastern Cooperative Oncology Group&#44; Karnofsky index &#40;KI&#41;&#44; the modified KI or its variant PPS&#44; which adds the presence of adynamia&#44; signs of disease&#44; delirium and dysphagia&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#8211;15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The most complex models contain other predictors from various clinical&#44; demographic&#44; social-familial and laboratory areas&#44; such as the Palliative Prognostic Score &#40;PaP&#41;&#44; the Glasgow Palliative Score&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> the Palliative Prognostic Index &#40;PPI&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> PROFUND<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> and PALIAR&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18&#44;19</span></a> All have shown good reproducibility and correlation&#46; PPS and PIP have been validated in complex chronic patients and in patients with cancer in terminal conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#8211;16</span></a> The PROFUND index<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> was validated for numerous diseases to predict mortality at 12 months&#44; while the PALIAR index<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18&#44;19</span></a> predicts mortality at 6 months for patients with advanced disease of one or more systems&#46; In oncological palliative care&#44; the most widely used prognostic scale is PPS&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#8211;15</span></a> followed by the PIP and modified KI&#46; These indices are interchangeable&#44; and proportionality between them has been established&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> The PPS scale is also validated in Spanish<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> and for a considerable variety of clinical scenarios &#40;e&#46;g&#46;&#44; chronically ill patients without cancer and not terminal&#44; as well as numerous other conditions&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#8211;15</span></a> The validity and accuracy of the PIP&#44; which was recalibrated in almost 2000 chronic patients without cancer in advanced conditions&#44; have also been demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> Therefore&#44; the most reproducible prognostic factors would be those associated with the burden and consequences of disease<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> and not so much with the type of disease&#44; whether it is cancer or not&#46; Furthermore&#44; Zimmermann et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> stated that the subjective opinion of physicians and nurses&#44; coupled with objective data&#44; such as functional impairment&#44; symptoms of severity &#40;dyspnea&#44; pain&#44; asthenia&#44; anorexia&#44; etc&#46;&#41;&#44; laboratory changes and tumor aggressiveness &#40;histopathology&#44; tumor location and metastases&#41; are reasonably associated with more advanced disease and poorer survival&#46; A recent systematic review<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> on the prognostic value of the PPS included 17 studies &#40;9 in oncology&#41; and showed that a score &#60;30&#37; predicted mortality at 5&#8211;36 days&#59; if the scores were &#60;10&#37;&#44; the patients died in only 1&#8211;3 days&#46; In the article by Sancho et al&#46;&#44; the satisfaction survey was not validated&#59; however&#44; there is currently no standard for assessing satisfaction in palliative care&#46; Numerous factors influence satisfaction&#44; such as the accommodations&#44; convenience and closeness to relatives&#8217; homes or public transportation&#44; thereby requiring qualitative methods to assess satisfaction&#46; In this study&#44; the authors address the usefulness of the prognosis in the decision-making process&#44; a relationship that in palliative care is particularly relevant&#46;</p></span>"
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Vol. 219. Issue 6.
Pages 324-326 (August - September 2019)
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Vol. 219. Issue 6.
Pages 324-326 (August - September 2019)
Editorial
Internal medicine and palliative care: Science and humanism
Medicina interna y cuidados paliativos: ciencia y humanismo
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J. Galindo Ocañaa,
Corresponding author
galinx2@gmail.com

Corresponding author.
, C. Aguilera Gonzálezb
a Medicina Interna, UHD/ESCP, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Unidad de Hospitalización Domiciliaria/Equipo de Soporte de Cuidados Paliativos, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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