Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, St. Louis, MO, United States.
Gynecol Oncol. 2017 Nov;147(2):460-464. doi: 10.1016/j.ygyno.2017.08.002. Epub 2017 Aug 4.
To evaluate the effect of palliative care (PC) consultation on hospice enrollment and end-of-life care in gynecologic oncology patients.
A retrospective chart review of gynecologic oncology patients who died 1year before and after 2014 implementation of a PC initiative for patients at a single NCI-designated comprehensive cancer center. Patient demographics, admission and procedural history, anti-cancer therapy, and end-of- life care were collected retrospectively. Data was analyzed using Student's t-test, Mann-Whitney U test, Chi-Square test, or Fisher's exact test.
We identified 308 patients. Median age at death was 63years (range 17 to 91). Most patients were white (78.2%), married (47.4%), and had ovarian (35.7%) or uterine cancers (35.4%). Introduction of the PC initiative was associated with increased PC consultations (40%, 53%, p=0.02), increased hospice enrollment (57%, 61%, p=0.29), and fewer procedures in the last 30days of life (44%, 31%, p=0.01). The rate of enrollment to inpatient hospice doubled from 12.5% to 25.7% (p=0.02) while time from inpatient hospice enrollment to death increased from 1.9 to 6.0days (p=0.02). Time from outpatient hospice enrollment to death increased from 26.2 to 35.4days (p=0.18). PC consultation was associated with a doubling of outpatient (40%) and inpatient (80%) hospice enrollment.
The PC quality improvement initiative was associated with more palliative care consults, increased rates of inpatient and outpatient hospice utilization, increased time on hospice, and fewer procedures in the last 30days of life, although most women were not enrolled until the last days of life.
评估姑息治疗（PC）咨询对妇科肿瘤患者临终关怀和临终关怀的影响。
对一家 NCI 指定的综合性癌症中心的妇科肿瘤患者进行回顾性图表审查，这些患者在 2014 年实施 PC 计划前后 1 年内死亡。回顾性收集患者人口统计学、入院和程序史、抗癌治疗和临终关怀数据。使用学生 t 检验、Mann-Whitney U 检验、卡方检验或 Fisher 精确检验进行数据分析。
我们确定了 308 名患者。死亡时的中位年龄为 63 岁（范围 17 至 91 岁）。大多数患者为白人（78.2%）、已婚（47.4%），患有卵巢癌（35.7%）或子宫癌（35.4%）。PC 计划的引入与 PC 咨询的增加（40%，53%，p=0.02）、临终关怀的增加（57%，61%，p=0.29）和生命最后 30 天内的程序减少（44%，31%，p=0.01）有关。住院临终关怀的入组率从 12.5%增加到 25.7%（p=0.02），而从住院临终关怀入组到死亡的时间从 1.9 天增加到 6.0 天（p=0.02）。从门诊临终关怀入组到死亡的时间从 26.2 天增加到 35.4 天（p=0.18）。PC 咨询与门诊（40%）和住院（80%）临终关怀的入组率增加两倍有关。
PC 质量改进计划与更多的姑息治疗咨询、更高的住院和门诊临终关怀利用率、临终关怀时间增加以及生命最后 30 天内的程序减少有关，尽管大多数女性直到生命的最后几天才被纳入临终关怀。
