Transitions into a Palliative Care Unit in Portugal: descriptive analysis of patient characteristics and documented care-process changes (potential indicators of “added value”)

This retrospective, single-center, observational descriptive audit characterises patients admitted to a regional Palliative Care Unit in Portugal during 2024 and examines a set of record-extractable care-process indicators — presented as potential indicators of “added value” — associated with transition into the Palliative Care Unit. “Added value” is defined operationally, and strictly at the process level, as documented adjustments in medication, psychosocial support, and communication that occur after admission. A retrospective single-center audit of 206 patient records was conducted. Variables included demographics, referral source, medication changes, psychosocial interventions, documented understanding of diagnosis and prognosis (coded separately) and symptom/palliative-needs ratings reconstructed retrospectively from clinical notes using the validated Portuguese version of the Integrated Palliative care Outcome Scale (0–4 response scale) and a 0–10 numeric rating scale. Inclusion criteria were all patients admitted to the Palliative Care Unit during calendar year 2024 with an accessible clinical record. Data were extracted from routine clinical records by two trained reviewers (AM and ST) and analysed descriptively (frequencies, means ± SD, and unadjusted paired comparisons). The cohort comprised 206 patients (mean age 67.2 ± 14.9 years, range 24–98; 58.3% oncological diagnoses). Most referrals originated from hospital services (Hospital Palliative Care Team 33.0%; Oncology 23.3%). The mean number of medications withdrawn per patient over 30 days was 1.91 ± 1.34. Documented psychological support was recorded in 128/198 patients (64.6%), documented understanding of diagnosis in 120/198 (60.6%), and documented understanding of prognosis in 120/198 (60.6%). Prior psychological support was associated with documented understanding of diagnosis (29.8% vs. 15.2%; p = 0.017). Mean per-item Integrated Palliative care Outcome Scale scores improved from admission to 48 h (Δ = −0.49, 95% CI − 0.72 to − 0.26; p < 0.001). Exploratory mortality comparisons involving non-steroidal anti-inflammatory drugs withdrawal and antidepressant introduction have been removed from this version because they were post-hoc, unadjusted, and vulnerable to confounding by indication. These descriptive findings document rapid care-process changes — not patient-centred outcomes — after transition to the Palliative Care Unit. Given the retrospective single-centre design, the reliance on documentation-based process indicators, and the reconstruction of Integrated Palliative care Outcome Scale/numeric rating scale from routine notes, causal inferences cannot be made; the results are exploratory and hypothesis-generating and identify priorities for prospective evaluation, including routine prospective patient-reported outcome collection and confounder-adjusted analyses.