Symptom and problem burden, performance status and palliative care phases in specialist palliative care: cross-sectional analysis of care episodes.

IF 2 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES BMJ Supportive & Palliative Care Pub Date : 2025-01-20 DOI:10.1136/spcare-2024-005017

Eva Lehmann-Emele, Daniela Gesell, Farina Hodiamont, Julia Wikert, Claudia Bausewein

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Abstract

Objectives: Palliative care phases (stable, unstable, deteriorating, terminal and bereavement) are useful in describing the palliative care situation of patients/relatives and their care needs as well as the suitability of care plans. Little is known about care setting-specific differences of the phases and their association with burden of symptoms/problems and functional status. We aimed to describe the presence and association of symptom/problem burden and functional status with the palliative care phase at the beginning of care episodes in specialist palliative care units, specialist home care teams and advisory services.

Methods: This study is a secondary analysis of a prospective, cross-sectional, multicentre study collecting data on patients' complexity in Germany. Analyses using the palliative care phase, symptom/problem burden measured by the Integrated Palliative care Outcome Scale (IPOS), functional status measured by the Australian-modified Karnofsky Performance Status (AKPS), severity of confusion and agitation, age and gender were conducted, including descriptive statistics, non-parametric tests and multinomial logistic regression.

Results: 3115 phases from three settings were included, with an average age of 72 years (SD±13.3) and 49% male. The distribution of phases at episode start varied among settings: data showed in palliative care units 20.3% stable, 43.4% unstable, 31.5% deteriorating and 4.8% terminal; in palliative care advisory, 26% stable, 33.9% unstable, 32.8% deteriorating and 7.3% terminal; and in specialist palliative home care, 42.4% stable, 21.3% unstable, 29.1% deteriorating and 7.2% terminal phases. Multinomial logistic regression showed that besides functional status, in palliative care units and specialist palliative home care, high physical symptom burden and palliative care advisory, high emotional burden increased the odds of being in an unstable phase.

Conclusions: Setting-specific differences in patient characteristics and symptom and problem burden associated with palliative care phases lead towards different demands on the teams providing patient care.

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专科姑息治疗的症状和问题负担、表现状况和姑息治疗阶段：姑息治疗发作的横断面分析。

目的：姑息治疗阶段（稳定，不稳定，恶化，终末期和丧亲）有助于描述患者/亲属的姑息治疗情况及其护理需求以及护理计划的适用性。对于这些阶段的护理环境特异性差异及其与症状/问题负担和功能状态的关联，我们知之甚少。我们的目的是描述在专科姑息治疗单位、专科家庭护理团队和咨询服务中，症状/问题负担和功能状态与姑息治疗阶段开始时的存在和关联。方法：本研究是对一项收集德国患者复杂性数据的前瞻性、横断面、多中心研究的二次分析。采用姑息治疗阶段、综合姑息治疗结局量表（IPOS）测量的症状/问题负担、澳大利亚修正Karnofsky绩效量表（AKPS）测量的功能状态、精神错乱和躁动的严重程度、年龄和性别进行分析，包括描述性统计、非参数检验和多项逻辑回归。结果：共纳入3组3115例患者，平均年龄72岁（SD±13.3），男性占49%。发作开始时的阶段分布因环境而异：数据显示，在姑息治疗单位，20.3%稳定，43.4%不稳定，31.5%恶化，4.8%终末期；在姑息治疗咨询中，稳定的占26%，不稳定的占33.9%，恶化的占32.8%，临终的占7.3%；在专科姑息家庭护理中，42.4%为稳定，21.3%为不稳定，29.1%为恶化，7.2%为终末期。多项logistic回归显示，除功能状态外，在姑息治疗单位和专科姑息家庭护理中，高身体症状负担和姑息治疗咨询、高情绪负担增加了处于不稳定阶段的几率。结论：与姑息治疗阶段相关的患者特征、症状和问题负担的环境特异性差异导致了对提供患者护理的团队的不同需求。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.