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עמוד בית
Fri, 03.05.24

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February 2012
V. Semionov, Y. Singer and P. Shvartzman

Background: The prevalence and severity of the most troublesome symptoms in terminally ill patients are well known and have been studied in many settings. However, these symptoms change during the course of advanced disease.

Objectives: To evaluate the range and trajectory of symptoms in the final stage of life as measured a month prior to death.

Methods: Patients with an expected prognosis of less than 6 months were recruited for the study. Excluded were non-Hebrew or Russian speakers, and patients with a diagnosis of brain tumor or with cognitive impairment. A structured questionnaire was used to interview patients and their caregivers at home every 2 weeks until death. We present a comparison analysis of 45 patients who completed both interviews 2 and 4 weeks before death.

Results: There were five symptoms (fatigue, pain, reduced well-being, lack of appetite, somnolence) that were reported most frequently, occurring in more than 70% of the patients. Most of the symptoms showed a worsening trend towards death.

Conclusions: Assessing the presence and severity of symptoms as a guide to start or modify treatment is recommended. Knowledge of how symptoms change in the final stage of life could better assist in the management of resources and could help patients and their families in their final preparations.

October 2008
A. Neville, R. Peleg, Y. Singer, M. Sherf and P. Shvartzman

Background: The prevalence of chronic pain in the general population ranges from 10% to over 40%, depending on the definition and the population studied. No large study has been conducted in Israel.

Objectives: To evaluate the prevalence of patients with chronic pain, and characterize them in a large community random sample.

Methods: We conducted a survey of Clalit Health Services members, interviewing them by phone. A random sample of 4063 Clalit members, 25 years or older and Hebrew speakers, were screened for chronic pain, defined as: any pain or discomfort that in the last 6 months has persisted continuously or intermittently for more than 3 months.

Results: Eight percent (n=325) refused to participate. Of the 3738 included in the study, 1722 (46%) reported chronic pain in at least one site. Most of the patients were over 50 years old (62%) (mean age 56 ± 16, range 27–97 years). Women suffered significantly more than men, as did those who were older, less educated and born in Israel and Eastern Europe. Prevalent painful sites were the back (32%), limbs (17%) and head (13%). More than a third reported severe pain and impaired life activities. Only 4.8% of the patients suffering from chronic pain were referred to pain specialists and 11% used complementary medicine. A logistic regression model showed that women and patients with lower education level were the only significant variables predicting higher life impact index and higher pain severity.

Conclusions: We found a high prevalence of chronic pain in the study population. Chronic pain causes severe disturbance to quality of life. A low rate of referral to pain specialists and complementary medicine was observed.

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