Effect of Palliative Care Services on the Aggressiveness of End-of-Life Care in the Veteran's Affairs Cancer Population
Effect of Palliative Care Services on the Aggressiveness of End-of-Life Care in the Veteran's Affairs Cancer Population
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DOI：
10.1089/jpm.2011.0131
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发表时间：
2011-11-01
影响因子：
2.8
通讯作者：
Subbiah, Shanmuga
中科院分区：
文献类型：
--
作者：
Gonsalves, Wilson I.;Tashi, Tsewang;Subbiah, Shanmuga
背景：近年来，接近生命末期（EOL）的癌症护理变得更加积极。姑息治疗服务（PCS）可能会减少这种侵略性的癌症护理在晚期癌症患者。我们的目的是观察癌症护理的侵略性接近EOL退伍军人事务部癌症患者之前和之后的PCS团队的机构。我们还评估了死亡前启动PCS咨询和其对癌症护理的侵略性的影响EOL.Methods：这是一个回顾性的图表回顾分析，在当地退伍军人事务部医院在过去的100例患者在每年，2002年和2008年，谁死于活动性癌症。只有患者在2008年获得了PCS team.Results：在生命的最后30天，与2002年相比，患者在2008年有较高的发病率：化疗管理，一个以上的入院，超过14天的住院时间，重症监护室入院，并在医院死亡。2008年及时进行PCS咨询的患者似乎具有较低的发生率：化疗管理、一次以上急诊就诊、一次以上住院、14天以上住院、重症监护室入院和院内死亡。及时的PCS咨询与早期和更频繁的临终关怀referreration.Conclusions：癌症护理近EOL已成为更具侵略性的时间在退伍军人事务部医疗保健系统（VAHS）的医院之一。PCS服务机构无法完全降低接近EOL的癌症护理侵略性增加的趋势。然而，及时的PCS咨询可能有助于减弱这种侵略性。
Background: Cancer care near the end of life (EOL) has become more aggressive over the years. Palliative care services (PCS) may decrease this aggressive cancer care in terminally ill cancer patients. Our objective was to observe the aggressiveness of cancer care near the EOL among Veterans Affairs cancer patients before and after the institution of a PCS team. We also assessed the time taken prior to death to initiate a PCS consultation and its effect on the aggressiveness of cancer care near the EOL.Methods: This is a retrospective chart review analysis performed at the local Veterans Affairs hospital looking at the last 100 patients in each of the years, 2002 and 2008, who died with active cancer. Only patients in 2008 had access to a PCS team.Results: In the last 30 days of life, compared to 2002, patients in 2008 had a higher incidence of: chemotherapy administration, more than one hospital admission, more than 14 days of hospital stay, intensive care unit admissions, and in-hospital deaths. Patients with timely PCS consults in 2008 appeared to have a lower incidence of: chemotherapy administration, more than one emergency department visit, more than one hospital admission, more than 14-day hospital stays, intensive care unit admissions, and deaths in the hospital. Timely PCS consults were associated with earlier and more frequent hospice referral.Conclusions: Cancer care near the EOL has become more aggressive with time at one of the hospitals in the Veterans Affairs healthcare system (VAHS). Institution of a PCS service was unable to completely decrease this trend of increasing aggressiveness of cancer care near the EOL. However, timely PCS consults may help attenuate this aggressiveness.