Lindley Lisa C, Mack Jennifer W, Bruce Donald J
College of Nursing, University of Tennessee-Knoxville, Knoxville, Tennessee, USA.
Department of Pediatric Oncology and the Division of Population Sciences' Center for Outcomes and Policy Research Harvard Medical School, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Pediatric Hematology/Oncology, Children's Hospital, Boston, Massachusetts, USA.
J Pain Symptom Manage. 2016 May;51(5):868-74. doi: 10.1016/j.jpainsymman.2015.12.310. Epub 2015 Dec 30.
Children at end of life often experience multiple complex chronic conditions with more than 50% of children reportedly having two or more conditions. These complex chronic conditions are unlikely to occur in an entirely uniform manner in children at end of life. Previous work has not fully accounted for patterns of multiple conditions when evaluating care among these children.
The objective of the study was to understand the clusters of complex chronic conditions present among children in the last year of life.
Participants were 1423 pediatric decedents from the 2007 to 2008 California Medicaid data. A latent class analysis was used to identify clusters of children with multiple complex chronic conditions (neurological, cardiovascular, respiratory, renal, gastrointestinal, hematologic, metabolic, congenital, cancer). Multinomial logistic regression analysis was used to examine the relationship between demographic characteristics and class membership.
Four latent classes were yielded: medically fragile (31%); neurological (32%); cancer (25%); and cardiovascular (12%). Three classes were characterized by a 100% likelihood of having a complex chronic condition coupled with a low or moderate likelihood of having the other eight conditions. The four classes exhibited unique demographic profiles.
This analysis presented a novel way of understanding patterns of multiple complex chronic conditions among children that may inform tailored and targeted end-of-life care for different clusters.
临终儿童往往患有多种复杂的慢性疾病，据报道，超过50%的儿童患有两种或更多疾病。这些复杂的慢性疾病在临终儿童中不太可能完全以统一的方式出现。以往的研究在评估这些儿童的护理时，尚未充分考虑多种疾病的模式。
本研究的目的是了解生命最后一年儿童中存在的复杂慢性疾病集群。
参与者为2007年至2008年加利福尼亚医疗补助数据中的1423名儿科死者。采用潜在类别分析来识别患有多种复杂慢性疾病（神经、心血管、呼吸、肾脏、胃肠、血液、代谢、先天性、癌症）的儿童集群。采用多项逻辑回归分析来检验人口统计学特征与类别归属之间的关系。
产生了四个潜在类别：医疗脆弱型（31%）；神经型（32%）；癌症型（25%）；心血管型（12%）。三个类别表现为患有复杂慢性疾病的可能性为100%，同时患有其他八种疾病的可能性较低或中等。这四个类别呈现出独特的人口统计学特征。
本分析提出了一种理解儿童多种复杂慢性疾病模式的新方法，可为针对不同集群的量身定制和有针对性的临终护理提供参考。
