Grubbs Vanessa, O'Riordan David, Pantilat Steve
Department of Medicine, Division of Nephrology and.
Department of Medicine, Division of Nephrology, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, California.
Clin J Am Soc Nephrol. 2017 Jul 7;12(7):1085-1089. doi: 10.2215/CJN.12231116. Epub 2017 Jun 27.
Despite significant morbidity and mortality associated with ESRD, these patients receive palliative care services much less often than patients with other serious illnesses, perhaps because they are perceived as having less need for such services. We compared characteristics and outcomes of hospitalized patients in the United States who had a palliative care consultation for renal disease versus other serious illnesses.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this observational study, we used data collected by the Palliative Care Quality Network, a national palliative care quality improvement collaborative. The 23-item Palliative Care Quality Network core dataset includes demographics, processes of care, and clinical outcomes of all hospitalized patients who received a palliative care consultation between December of 2012 and March of 2016.
The cohort included 33,183 patients, of whom 1057 (3.2%) had renal disease as the primary reason for palliative care consultation. Mean age was 71.9 (SD=16.8) or 72.8 (SD=15.2) years old for those with renal disease or other illnesses, respectively. At the time of consultation, patients with renal disease or other illnesses had similarly low mean Palliative Performance Scale scores (36.0% versus 34.9%, respectively; =0.08) and reported similar moderate to severe anxiety (14.9% versus 15.3%, respectively; =0.90) and nausea (5.9% versus 5.9%, respectively; >0.99). Symptoms improved similarly after consultation regardless of diagnosis (≥0.50), except anxiety, which improved more often among those with renal disease (92.0% versus 66.0%, respectively; =0.002). Although change in code status was similar among patients with renal disease versus other illnesses, from over 60% full code initially to 30% full code after palliative care consultation, fewer patients with renal disease were referred to hospice than those with other illnesses (30.7% versus 37.6%, respectively; <0.001).
Hospitalized patients with renal disease referred for palliative care consultation had similar palliative care needs, improved symptom management, and clarification of goals of care as those with other serious illnesses.
尽管终末期肾病（ESRD）伴有较高的发病率和死亡率，但与其他重症患者相比，这些患者接受姑息治疗服务的频率要低得多，这可能是因为人们认为他们对这类服务的需求较少。我们比较了美国因肾病接受姑息治疗咨询的住院患者与因其他重症接受咨询的患者的特征及治疗结果。
设计、地点、参与者及测量方法：在这项观察性研究中，我们使用了姑息治疗质量网络收集的数据，该网络是一个全国性的姑息治疗质量改进协作组织。包含23个项目的姑息治疗质量网络核心数据集涵盖了2012年12月至2016年3月期间所有接受姑息治疗咨询的住院患者的人口统计学信息、护理流程及临床结果。
该队列包括33183名患者，其中1057名（3.2%）因肾病是接受姑息治疗咨询的主要原因。肾病患者或其他疾病患者的平均年龄分别为71.9岁（标准差=16.8）和72.8岁（标准差=15.2）。咨询时，肾病患者和其他疾病患者的姑息治疗表现量表平均得分同样较低（分别为36.0%和34.9%；P=0.08），且报告的中度至重度焦虑（分别为14.9%和15.3%；P=0.90）及恶心症状（分别为5.9%和5.9%；P>0.99）相似。无论诊断结果如何，咨询后症状均有相似程度的改善（P≥0.50），但焦虑症状除外，肾病患者中焦虑症状改善的比例更高（分别为92.0%和66.0%；P=0.002）。尽管肾病患者与其他疾病患者的代码状态变化相似，即最初超过60%为完全代码状态，在接受姑息治疗咨询后降至30%，但转诊至临终关怀机构的肾病患者少于其他疾病患者（分别为30.7%和37.6%；P<0.001）。
因肾病接受姑息治疗咨询的住院患者与因其他重症接受咨询的患者在姑息治疗需求、症状管理改善及护理目标明确方面相似。
