Miyashita Mitsunori, Arai Kazuko, Yamada Yosuke, Owada Machiko, Sasahara Tomoyo, Kawa Masako, Mukaiyama Taketo
Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Palliat Med. 2009 Feb;12(2):142-9. doi: 10.1089/jpm.2008.0216.
Selecting a place for end-of-life care is an important issue for patients with cancer. In this study we conducted a retrospective analysis on the prevalence of discharge from a palliative care unit (PCU) and explored factors related to discharge based on individual-level data from 5 years of experience at the Tokyo Metropolitan Toshima Hospital PCU.
We retrospectively collected information on patients and families from the admission database of the PCU. We calculated the prevalence of patients discharged from the PCU and explored the factors related to discharge using bivariate and multivariate analysis.
The subjects were 498 terminal patients with cancer. The overall discharge rate was 33%. For subjects who were admitted for symptom control, the discharge rate was 54%. The duration of the period from referral to death (odds ratio [OR] = 4.98, p < 0.001), Eastern Cooperative Oncology Group Performance States [ECOG PS]_OR = 0.51, p = 0.003), problems with oral intake (OR = 0.41, p = 0048), presence of nausea (OR = 0.41, p = 0.046), experience of radiation therapy (OR = 0.27, p = 0.003), and patient's anxiety for family (OR = 0.35, p = 0.029) were independent related factors for discharge from the PCU, according to logistic regression.
Early referral to the PCU and development of alleviation methods for symptoms such as nausea and anxiety and depression are important for promoting discharge and would contribute to the patient's quality of life at the end of life.
为癌症患者选择临终关怀场所是一个重要问题。在本研究中，我们对姑息治疗病房（PCU）的出院率进行了回顾性分析，并根据东京都丰岛医院PCU 5年的个体水平数据探讨了与出院相关的因素。
我们从PCU的入院数据库中回顾性收集患者和家属的信息。我们计算了PCU出院患者的比例，并使用双变量和多变量分析探讨了与出院相关的因素。
研究对象为498例晚期癌症患者。总体出院率为33%。因症状控制入院的患者出院率为54%。从转诊到死亡的时间（比值比[OR]=4.98，p<0.001）、东部肿瘤协作组体能状态[ECOG PS]_OR=0.51，p=0.003）、经口摄入问题（OR=0.41，p=0.048）、恶心的存在（OR=0.41，p=0.046）、放疗经历（OR=0.27，p=0.003）以及患者对家人的焦虑（OR=0.35，p=0.029）是根据逻辑回归得出的PCU出院的独立相关因素。
早期转诊至PCU以及开发缓解恶心、焦虑和抑郁等症状的方法对于促进出院很重要，并将有助于提高患者临终时生活质量。
