Palliative Care Consultation and Family-Centered Outcomes in Patients With Unplanned Intensive Care Unit Admissions.
Palliative Care Consultation and Family-Centered Outcomes in Patients With Unplanned Intensive Care Unit Admissions.
复制标题
计划外入住重症监护室患者的姑息治疗咨询和以家庭为中心的结果。
DOI：
10.1089/jpm.2023.0436
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发表时间：
2023
影响因子：
2.8
通讯作者：
Jennerich,AnnL
中科院分区：
文献类型：
--
作者：
Nomitch,JamieT;Downey,Lois;Pollack,LaurenR;Bayomy,OmarF;Ramos,KathleenJ;Kross,ErinK;Jennerich,AnnL
背景：经历计划外重症监护病房(ICU)入院的住院患者面临着巨大的挑战，他们的家人有独特的姑息治疗需求。目的：在计划外ICU入院的住院患者中识别姑息咨询的预测因素，并检查姑息咨询与家庭结果之间的关系。方法：我们在西雅图的两个医疗中心对计划外ICU入院的患者进行了前瞻性队列研究。这项研究得到了华盛顿大学机构审查委员会的批准(STUDY00008182)。使用多变量Logistic回归，我们检验了患者特征和姑息治疗咨询之间的关系。家属在患者出院后90天内完成了评估心理痛苦的调查。结果：在我们的队列(n= 413例患者和272名家庭成员)中，24%的患者在住院期间咨询了姑息治疗(n= 100)，其中大多数(93%)咨询发生在入院后。ICU转院后姑息治疗咨询的相关因素包括入院地点(OR，2.29；95%CI：1.17~4.50)、ICU入院时序贯器官衰竭评估评分(OR，1.12；95%CI：1.05~1.19)、入院原因(肾功能障碍[OR，7.02；95%CI：1.08~45.69])。姑息咨询患者抑郁或创伤后应激的家庭症状差异无统计学意义。结论：非计划入住ICU患者的姑息咨询多发生在转院后，且与病情严重程度、合并症、医院所在地有关。患者死亡与家庭心理困扰症状有关。
Context:Hospitalized patients who experience unplanned intensive care unit (ICU) admissions face significant challenges, and their family members have unique palliative care needs.Objectives:To identify predictors of palliative care consultation among hospitalized patients with unplanned ICU admissions and to examine the association between palliative care consultation and family outcomes.Methods:We conducted a prospective cohort study of patients with unplanned ICU admissions at two medical centers in Seattle, WA. This study was approved by the institutional review board at the University of Washington (STUDY00008182). Using multivariable logistic regression, we examined associations between patient characteristics and palliative care consultation. Family members completed surveys assessing psychological distress within 90 days of patient discharge. Adjusted ordinal probit or binary logistic regression models were used to identify associations between palliative care consultation and family symptoms of psychological distress.Results:In our cohort (n= 413 patients and 272 family members), palliative care was consulted for 24% of patients during hospitalization (n= 100), with the majority (93%) of these consultations occurring after ICU admission. Factors associated with palliative care consultation after ICU transfer included enrollment site (OR, 2.29; 95% CI: 1.17–4.50), Sequential Organ Failure Assessment score at ICU admission (OR, 1.12; 95% CI: 1.05–1.19), and reason for hospital admission (kidney dysfunction [OR, 7.02; 95% CI: 1.08–45.69]). There was no significant difference in family symptoms of depression or posttraumatic stress based on palliative care consultation status.Conclusions:For patients experiencing unplanned ICU admission, palliative care consultation often happened after transfer and was associated with illness severity, comorbid illness, and hospital site. Patient death was associated with family symptoms of psychological distress.