What determines referral of UK patients with haematological malignancies to palliative care services? An exploratory study using hospital records
What determines referral of UK patients with haematological malignancies to palliative care services? An exploratory study using hospital records
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DOI：
10.1177/0269216307082020
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发表时间：
2007-01-01
影响因子：
4.4
通讯作者：
Howard, Martin
中科院分区：
文献类型：
--
作者：
Ansell, Pat;Howell, Debra;Howard, Martin
我们调查了血液恶性肿瘤(HMS)患者转诊或未转诊到专科姑息治疗(SPC)的频率和特征。数据摘录自108名死亡患者的医院记录--27人死于白血病，11人死于骨髓增生异常综合征，48人死于淋巴瘤，22人死于骨髓瘤。93例患者(86.1%)确诊时年龄为60岁，其中33例(30.6%)为80岁，31例(28.7%)存在合并症。33名患者(30.6%)被转介到SPC服务。在转诊患者中，年龄或HM诊断的差异很小。在67名在医院病房死亡的患者中，17名(25.4%)接受了SPC治疗，相比之下，6/7名患者(85.7%)在家中死亡。从确诊到死亡的时间对转诊有影响--24/52名患者(46.2%)在确诊后30天内死亡，而8/42名患者(19.1%)在30天内死亡。14例死亡后确诊为HM。这14名患者的识别可能是我们研究的一个独特特点，因为患者是从具有集中诊断服务的地区性、基于人群的登记中挑选出来的，从而能够识别所有HM患者。HM的根治和姑息治疗之间的接口比国家临床卓越研究所建议的要复杂得多。
We investigated the frequency and characteristics of patients with haematological malignancies (HMs) who were, or were not, referred for specialist palliative care (SPC). Data were abstracted from hospital records of 108 patients who died - 27 with leukaemia, 11 with myelodysplastic syndromes, 48 with lymphoma and 22 with myeloma. Ninety-three patients (86.1 %) were >60 years of age at diagnosis, with 33 (30.6%) being >= 80 years and 31 (28.7%) having existing comorbidities. Thirty-three patients (30.6%) were referred to SPC services. There was little difference by age or HM diagnosis in referred patients. Seventeen of 67 patients (25.4%) dying on a hospital ward received SPC compared with 6/7 (85.7%) dying at home. Time between diagnosis and death influenced the referral - 24/52 patients (46.2%) dying >= 30 days after diagnosis received SPC compared with 8/42 (19.1 %) dying within 30 days. In 14 patients, HM diagnosis was confirmed after death. Identification of these 14 patients is likely to be a unique feature of our study, as patients were selected from a regional, population-based register with centralized diagnostic services, enabling the identification of all patients with HM. The interface between curative and palliative treatment in HM is more complex than the National Institute for Clinical Excellence recommendations suggest.