Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer
Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer
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DOI：
10.1089/jpm.2014.0431
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发表时间：
2015-10-01
影响因子：
2.8
通讯作者：
Lorenz, Karl A.
中科院分区：
文献类型：
--
作者：
Ahluwalia, Sangeeta C.;Tisnado, Diana M.;Lorenz, Karl A.
背景：早期患者与医生护理计划的讨论可能会影响患有晚期癌症的退伍军人接受临终 (EOL) 护理的强度。目的：本研究的目的是评估患有晚期癌症的退伍军人中患者与医生护理计划讨论的病历记录与 EOL 护理强度之间的关联。方法：这是一项回顾性队列研究。受试者为 665 名在 2008 年诊断出患有 IV 期结直肠癌、肺癌或胰腺癌的退伍军人，并进行随访直至死亡或 2011 年研究期结束。我们使用多元 Logistic 回归模型，评估了转移诊断后 1 个月内记录的患者与医生护理计划讨论对 EOL 护理强度的影响，EOL 护理的强度通过接受急性护理、强化干预、化疗和临终关怀来衡量。结果：我们研究中的退伍军人主要是男性（97.1%）、白人（74.7%），诊断时的平均年龄为 66.4 岁。大约 31% 的人接受了一些紧急护理，9.3% 的人接受了一些强化干预，6.5% 的人在生命的最后一个月开始了新的化疗方案。大约 41% 的死者没有接受临终关怀或在死亡后三天内入院。几乎一半 (46.8%) 在诊断后第一个月内记录了护理计划讨论的记录，而那些记录了记录的人在 EOL 时接受急性护理的可能性显着降低 (OR: 0.67；p=0.025)。记录在案的讨论与强化干预、化疗或临终关怀没有显着相关。结论：在 EOL 重症护理率本来就很低的系统中，早期护理计划讨论与 EOL 时急性护理使用率较低有关。
Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care.