Association between Early Palliative Care Referrals, Inpatient Hospice Utilization, and Aggressiveness of Care at the End of Life
Association between Early Palliative Care Referrals, Inpatient Hospice Utilization, and Aggressiveness of Care at the End of Life
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DOI：
10.1089/jpm.2014.0132
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发表时间：
2015-03-01
影响因子：
2.8
通讯作者：
Takagi, Ibuki
中科院分区：
文献类型：
--
作者：
Amano, Koji;Morita, Tatsuya;Takagi, Ibuki
背景：姑息治疗对许多临床结果有积极的影响，但大多数转诊姑息治疗发生较晚。生命末期（EOL）癌症护理变得越来越积极。在日本，还没有研究调查早期姑息治疗转诊和积极的EOL护理之间的关系。目的：本研究旨在通过调查癌症死亡者，探讨早期姑息治疗转诊、住院临终关怀利用和积极的EOL护理之间的关系。设计：在日本癌症指定医院进行的回顾性队列研究。设置/受试者：这项研究调查了266名连续的癌症死亡者。入选标准为成年人和死于癌症或癌症相关原因的患者。排除了死于与癌症无关的原因的患者。共有265例患者符合标准。测量：我们探讨了早期转诊（死亡前>3个月）和住院临终关怀利用率之间的关联，以及转诊时间和积极的EOL护理之间的关系，采用Earle和同事的综合评分进行测量。结果：患者分为早期转诊组（n=54）和对照组（n=211）。早期转诊组的临终关怀利用率显著高于早期转诊组（74%对47%，调整后P <0.05）。
Background: Palliative care has a positive effect on many clinical outcomes, yet most referrals to palliative care have occurred late. End-of-life (EOL) cancer care has become increasingly aggressive. There have been no studies investigating the association between early palliative care referrals and aggressive EOL care in Japan.Objective: This study was designed to explore the association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of EOL care by investigating cancer decedents.Design: A retrospective cohort study in a cancer-designated hospital in Japan.Setting/Subjects: This study examined 266 consecutive cancer decedents. Inclusion criteria were adults and patients who died from cancer or causes related to cancer. Patients who died from causes unrelated to cancer were excluded. A total of 265 patients met the criteria.Measurements: We explored the association between early referrals (>3 months before death) and inpatient hospice utilization and the relationship between the timing of referrals and aggressive EOL care measured by a composite score adapted from Earle and colleagues.Results: Patients were divided into an early referral group (n=54) and a control group (n=211). The rate of inpatient hospice utilization was significantly higher in the early referral group (74% versus 47%, adjusted p