Underutilization of palliative care services in the liver transplant population.
Underutilization of palliative care services in the liver transplant population.
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DOI：
10.5500/wjt.v6.i3.594
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发表时间：
2016-09-24
期刊：
影响因子：
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通讯作者：
Lai, Jennifer C
中科院分区：
文献类型：
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作者：
Kathpalia, Priya;Smith, Alexander;Lai, Jennifer C
目的：评价姑息治疗服务的使用终末期肝病患者谁没有获得肝transplant.METHODS：评价终末期肝病患者从肝移植等待名单中删除或移植前死亡在一个单一的移植中心超过2年的时间。那些因不依从而被移除或最终移植到其他地方的患者被排除在本研究之外。使用logistic回归分析评估与姑息治疗咨询相关的患者特征。结果：2013-2014年，683例患者被列为肝移植，其中107例（16%）死亡（n = 62）或因肝移植前临床失代偿而被移除（n = 45）：中位年龄为58岁，大多数为男性（66%），白人（53%），患有Child C型肝硬化（61%）或肝细胞癌（52%）。在107名死亡或被移除的患者中，只有18名（17%）接受了姑息治疗团队的咨询，其中89%发生在住院患者中。这些咨询中有一半发生在死亡后72小时内。在单变量分析中，年龄较小、白色人种和在列名和除名时终末期肝病评分较高的患者更有可能接受姑息治疗服务。只有年轻的年龄[比值比（OR）= 0.92; P = 0.02]和白人种族（OR = 4.90; P = 0.02）仍然与姑息治疗services.CONCLUSION整合：姑息治疗服务是严重利用不足的老年人，非白人肝硬化患者的肝移植等待名单。我们鼓励尽早将这些服务整合到移植人群的临床决策中，并进一步研究旨在了解咨询的障碍。
AIM: To evaluate use of palliative care services in patients with end-stage liver disease who do not have access to liver transplant.METHODS: Evaluated were end-stage liver disease patients who were removed from the liver transplant wait-list or died prior to transplant at a single transplant center over a 2-year period. Those who were removed due to noncompliance or ultimately transplanted elsewhere were excluded from this study. Patient characteristics associated with palliative care consultation were assessed using logistic regression analysis.RESULTS: Six hundred and eighty-three patients were listed for liver transplant in 2013-2014 with 107 (16%) dying (n = 62) or removed for clinical decompensation prior to liver transplant (n = 45): Median age was 58 years, and the majority were male (66%), Caucasian (53%), had Child C cirrhosis (61%) or hepatocellular carcinoma (52%). The palliative care team was consulted in only 18 of the 107 patients (17%) who died or were removed, 89% of which occurred as inpatients. Half of these consultations occurred within 72 h of death. In univariable analysis, patients of younger age, white race, and higher end-stage liver disease scores at time of listing and delisting were more likely to receive palliative care services. Only younger age [Odds ratio (OR) = 0.92; P = 0.02] and Caucasian race (OR = 4.90; P = 0.02) were still associated with integration of palliative care services through multivariable analysis.CONCLUSION: Palliative care services are grossly underutilized in older, non-white patients with cirrhosis on the liver transplant wait-list. We encourage early integration of these services into clinical decision-making in the transplant population, with further studies aimed at understanding barriers to consultation.