Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Gynecol Oncol. 2014 May;133(2):319-25. doi: 10.1016/j.ygyno.2014.02.031. Epub 2014 Mar 1.
Determine predictors of inpatient palliative care (PC) consultation and characterize PC referral patterns with respect to recommendations from the American Society of Clinical Oncology (ASCO).
Women with a gynecologic malignancy admitted to the gynecologic oncology service 3/2012-8/2012 were identified. Demographic information, disease and treatment details and date of death were abstracted from medical records. Student's t-test, Fischer's exact test or χ(2)-test was used for univariate analysis. Binomial logistic regression was used for multivariate analysis.
Of 340 patients analyzed, 82 (24%) had PC consultation. Univariate predictors of PC consultation included race, cancer type and stage, recurrent disease, admission frequency, admission for symptom management or malignant bowel obstruction (MBO), discharge to skilled nursing facility (SNF) and number of lines of chemotherapy. On multivariate analysis, significant predictors of PC consultation were recurrent disease (OR 2.4, 95% CI 1.1-5.3), number of admissions (≥ 3, OR 10.9, 95% CI 3.4-34.9), admission for symptom management (OR 19.4, 95% CI 7.5-50.1), discharge to SNF (OR 5, 95% CI 1.9-13.5) and death within 6 months (OR 16.5, 95% CI 6.9-39.5). Of patients considered to meet ASCO guidelines, 53% (63/118) had PC referral. Of patients referred to PC, 51.2% (42/82) died within 6 months of last admission.
Patients referred to inpatient PC have high disease and symptom burden and poor prognosis. High-risk patients, including those meeting ASCO recommendations, are not captured comprehensively. We continue to use PC referrals primarily for patients near the end of life, rather than utilizing early integration as recommended by ASCO.
确定住院姑息治疗（PC）咨询的预测因素，并根据美国临床肿瘤学会（ASCO）的建议描述 PC 转诊模式。
确定 2012 年 3 月至 8 月期间入住妇科肿瘤科的妇科恶性肿瘤患者。从病历中提取人口统计学信息、疾病和治疗细节以及死亡日期。使用学生 t 检验、Fisher 确切检验或 χ(2)检验进行单变量分析。使用二项逻辑回归进行多变量分析。
在 340 例患者中，82 例（24%）接受了 PC 咨询。PC 咨询的单变量预测因素包括种族、癌症类型和分期、复发性疾病、入院频率、因症状管理或恶性肠梗阻（MBO）入院、入住熟练护理机构（SNF）和化疗线数。多变量分析显示，PC 咨询的显著预测因素包括复发性疾病（OR 2.4，95%CI 1.1-5.3）、入院次数（≥3，OR 10.9，95%CI 3.4-34.9）、因症状管理入院（OR 19.4，95%CI 7.5-50.1）、入住 SNF（OR 5，95%CI 1.9-13.5）和 6 个月内死亡（OR 16.5，95%CI 6.9-39.5）。在被认为符合 ASCO 指南的患者中，有 53%（63/118）接受了 PC 转诊。在被转诊至 PC 的患者中，有 51.2%（42/82）在最后一次入院后 6 个月内死亡。
接受住院 PC 治疗的患者疾病和症状负担重，预后差。包括符合 ASCO 建议的高危患者在内的患者并没有被全面覆盖。我们继续主要在患者生命末期使用 PC 转诊，而不是按照 ASCO 的建议早期整合。
