Hospice utilization in patients with malignant gliomas
Hospice utilization in patients with malignant gliomas
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DOI：
10.1093/neuonc/nox196
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发表时间：
2018-04-01
期刊：
影响因子：
15.9
通讯作者：
Jordan, Justin T.
中科院分区：
文献类型：
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作者：
Forst, Deborah;Adams, Eric;Jordan, Justin T.
尽管专业组织建议支持癌症患者的早期临终关怀登记，但关于恶性胶质瘤患者的临终实践(EOL)的研究很少。我们评估了MG患者的临终关怀登记和临终关怀住院时间(LOS)的比率和相关性。使用监测、流行病学和最终结果(SEER)-医疗保险链接的数据库，我们确定了2002年1月1日至2011年12月31日期间被诊断为MG的成年患者，他们在2012年12月31日之前死亡。我们提取了社会人口学和临床数据，并使用单变量Logistic回归分析比较了临终关怀接受者和非接受者的特征。我们进行了多变量Logistic回归分析，以检验临终关怀登记登记的预测因素。我们确定了12437名符合条件的患者(46%为女性)，其中7849人(63%)在去世前登记了临终关怀。在多变量回归分析中，年龄较大、女性、较高教育水平、白人种族和较低的家庭收入中位数预测临终关怀登记人数。在登记了临终关怀的人中，6996人(89%)登记了3天，6047人(77%)登记了7天。多变量分析表明，高龄、女性和城市居住地是较长LOS(最短3天或7天)的预测因子。所有登记的患者在临终关怀上的平均损失为21天(四分位数范围，8-45天)。我们发现了MG患者在临终关怀利用方面的重要差异，不同种族、性别、年龄、教育水平以及城乡居民的差异。需要进一步调查这些障碍，以便更早和更广泛地利用临终关怀。
Despite recommendations from professional organizations supporting early hospice enrollment for patients with cancer, little research exists regarding end-of-life (EOL) practices for patients with malignant glioma (MG). We evaluated rates and correlates of hospice enrollment and hospice length of stay (LOS) among patients with MG.Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database, we identified adult patients who were diagnosed with MG from January 1, 2002 to December 31, 2011 and who died before December 31, 2012. We extracted sociodemographic and clinical data and used univariate logistic regression analyses to compare characteristics of hospice recipients versus nonrecipients. We performed multivariable logistic regression analyses to examine predictors of hospice enrollment > 3 or > 7 days prior to death.We identified 12437 eligible patients (46% female), of whom 7849 (63%) were enrolled in hospice before death. On multivariable regression analysis, older age, female sex, higher level of education, white race, and lower median household income predicted hospice enrollment. Of those enrolled in hospice, 6996 (89%) were enrolled for > 3 days, and 6047 (77%) were enrolled for > 7 days. Older age, female sex, and urban residence were predictors of longer LOS (3- or 7-day minimum) on multivariable analysis. Median LOS on hospice for all enrolled patients was 21 days (interquartile range, 8-45 days).We identified important disparities in hospice utilization among patients with MG, with differences by race, sex, age, level of education, and rural versus urban residence. Further investigation of these barriers to earlier and more widespread hospice utilization is needed.