Assessing the impact of palliative care admission of end-of-life cancer adults.

IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES Palliative Care and Social Practice Pub Date : 2023-01-01 DOI:10.1177/26323524231198545
Jose F Díez-Concha, Diego Mauricio Gómez-García, Julián Alberto Agudelo, Edwin Alexander Lizarazo Herrera
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Abstract

Background: There is evidence that early admission to the palliative care (PC) program in adult cancer patients improves symptoms management, reduces unplanned hospital admissions, minimizes aggressive cancer treatments, and enables patients to make decisions about their end-of-life (EOL) care.

Objectives: This retrospective cohort study aimed to determine whether late admission to a PC program is associated with aggressive treatment at the EOL in adult patients with oncological diseases from their admission until death.

Design/methods: The study evaluated the aggressiveness in EOL management in patients with advanced stage oncological diseases who died between 2017 and 2019. The study population was divided into two groups based on the time of admission to the PC program. Aggressiveness at the EOL was measured using five criteria: treatment, hospital admission and duration, emergency department care, and/or intensive care unit utilization.

Results: The study found a significant difference in the rate of aggressive EOL treatments between late admission to PC care and early admission [adjusted EOL 79.6% versus 70.4%; relative risk (RR): 1.98, 90% CI: 1.08-3.59, p: 0.061]; In the analysis of secondary variables, a significant association was observed between early admission to PC and the suspension of active treatments at the EOL, leading to a decrease in aggressiveness (77% versus 55.8%; RR: 1.38, 95% CI: 1.14-1.67, p: 0.004).

Conclusion: Our findings suggest that early referral to PC services is associated with less aggressive treatment at the EOL, including suspension of active treatments.

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评估临终癌症成人接受姑息治疗的影响。
背景:有证据表明,成年癌症患者早期接受姑息治疗(PC)可以改善症状管理,减少计划外住院,最大限度地减少积极的癌症治疗,并使患者能够决定他们的临终关怀(EOL)。目的:本回顾性队列研究旨在确定晚期入院的PC计划是否与成年肿瘤患者从入院到死亡的EOL积极治疗相关。设计/方法:本研究评估了2017年至2019年死亡的晚期肿瘤患者EOL管理的积极性。研究人群根据进入PC项目的时间分为两组。EOL的侵略性使用五个标准来衡量:治疗、住院和持续时间、急诊科护理和/或重症监护病房的利用。结果:研究发现,在PC护理的晚期和早期入院患者中,积极的EOL治疗率存在显著差异[调整后的EOL分别为79.6%和70.4%;相对危险度(RR): 1.98, 90% CI: 1.08-3.59, p: 0.061;在次要变量分析中,观察到早期入住PC和在EOL暂停积极治疗之间存在显著关联,导致侵袭性降低(77%对55.8%;RR: 1.38, 95% CI: 1.14-1.67, p: 0.004)。结论:我们的研究结果表明,早期转介到PC服务与EOL中较少的积极治疗有关,包括暂停积极治疗。
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来源期刊
Palliative Care and Social Practice
Palliative Care and Social Practice Nursing-Advanced and Specialized Nursing
CiteScore
2.90
自引率
0.00%
发文量
37
审稿时长
9 weeks
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