Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
J Pain Symptom Manage. 2018 May;55(5):1327-1334. doi: 10.1016/j.jpainsymman.2018.01.015. Epub 2018 Feb 2.
There is limited literature regarding outpatient palliative care and factors associated with unscheduled clinic visits.
To compare characteristics of patients with unscheduled vs. scheduled outpatient palliative care clinic visits.
Medical records of 183 unscheduled cancer new outpatients and 104 unscheduled follow-up (FU) patients were compared with random samples of 361 and 314 scheduled new patients and FU patients, respectively. We gathered data on demographics, symptoms, daily opioid usage, and performance status.
Compared with scheduled new patients, unscheduled new patients had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P = 0.002), nausea (P = 0.016), depression (P = 0.003), anxiety (P = 0.038), drowsiness (P = 0.002), sleep (P < 0.001), and overall feeling of well-being (P = 0.001); had a higher morphine equivalent daily dose of opioids (median of 45 mg for unscheduled vs. 30 mg for scheduled; P < 0.001); and were more likely to be from outside the greater Houston area (P < 0.001). Most unscheduled and scheduled new and FU visits were for uncontrolled physical symptoms. Unscheduled FU patients, compared with scheduled FU patients, had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P < 0.001), depression (P = 0.002), anxiety (P = 0.004), drowsiness (P = 0.010), appetite (P = 0.023), sleep (P = 0.022), overall feeling of well-being (P < 0.001), and higher morphine equivalent daily dose of opioid (median of 58 mg for unscheduled FU visits vs. 40 mg for scheduled FU visits; P = 0.054).
Unscheduled new FU patients have higher levels of physical and psychosocial distress and higher opioid intake. Outpatient palliative care centers should consider providing opportunities for walk-in visits for timely management and close monitoring of such patients.
有关门诊姑息治疗和与非计划性门诊就诊相关因素的文献有限。
比较非计划性与计划性门诊姑息治疗门诊就诊患者的特征。
比较了 183 例非计划性癌症新门诊患者和 104 例非计划性随访（FU）患者的病历，以及随机抽取的 361 例和 314 例计划性新门诊患者和 FU 患者的病历。我们收集了患者人口统计学特征、症状、每日阿片类药物使用情况和体力状况。
与计划性新门诊患者相比，非计划性新门诊患者的 Edmonton 症状评估量表子量表中的疼痛评分（P<0.001）、疲劳评分（P=0.002）、恶心评分（P=0.016）、抑郁评分（P=0.003）、焦虑评分（P=0.038）、嗜睡评分（P=0.002）、睡眠评分（P<0.001）和整体幸福感评分（P=0.001）均更差；每日阿片类药物等效剂量更高（中位数为 45mg 非计划性 vs. 30mg 计划性；P<0.001）；且更可能来自休斯顿大都市区以外（P<0.001）。大多数非计划性和计划性新门诊和 FU 就诊都是为了控制身体症状。与计划性 FU 患者相比，非计划性 FU 患者的 Edmonton 症状评估量表子量表中的疼痛评分（P<0.001）、疲劳评分（P<0.001）、抑郁评分（P=0.002）、焦虑评分（P=0.004）、嗜睡评分（P=0.010）、食欲评分（P=0.023）、睡眠评分（P=0.022）、整体幸福感评分（P<0.001）和阿片类药物等效每日剂量更高（中位数为 58mg 非计划性 FU 就诊 vs. 40mg 计划性 FU 就诊；P=0.054）。
非计划性新 FU 患者的身体和心理困扰程度更高，阿片类药物用量更大。门诊姑息治疗中心应考虑为这些患者提供即时就诊的机会，以便及时管理和密切监测。
