Main regional center for pain relief and supportive/palliative care, La Maddalena Cancer center.
Department of Sciences for Health Promotion and Mother Child Care, University of Palermo, Palermo, Italy.
Am J Clin Oncol. 2019 Mar;42(3):265-269. doi: 10.1097/COC.0000000000000510.
The aim of this study was to assess the factors which influence the care pathway after discharge from an acute palliative supportive care unit (APSCU).
Patients' demographics, indications for admission, kind of admission, the presence of a caregiver, awareness of prognosis, data on anticancer treatments in the last 30 days, ongoing treatment (on/off or uncertain), the previous care setting, analgesic consumption, and duration of admission were recorded. The Edmonton Symptom Assessment Scale (ESAS) at admission and at time of discharge (or the day before death), CAGE (cut down, annoy, guilt, eye-opener), and the Memorial Delirium Assessment Scale (MDAS), were used. At time of discharge, the subsequent referral to other care settings (death, home, home care, hospice, oncology), and the pathway of oncologic treatment were reconsidered (on/off, uncertain).
A total of 314 consecutive cancer patients admitted to the APSCU were surveyed. Factors independently associated with on-therapy were the lack of a caregiver, home discharge, and short hospital admission, in comparison with off-treatment, and less admission for other symptoms, shorter hospital admission, discharge at home, and better well-being, when compared with "uncertain." Similarly, many factors were associated with discharge setting, but the only factor independently associated with discharge home was being "on-therapy."
The finding of this study is consistent with an appropriate selection of patients after being discharged by an APSCU, that works as a bridge between active treatments and supportive/palliative care, according the concept of early and simultaneous care.
本研究旨在评估影响急性姑息支持治疗病房（APSCU）出院后护理路径的因素。
记录患者的人口统计学资料、入院指征、入院类型、是否有照顾者、对预后的了解、过去 30 天内的抗癌治疗数据、正在进行的治疗（开/停或不确定）、之前的护理环境、镇痛剂的使用量和住院时间。入院时和出院时（或死亡前一天）使用埃德蒙顿症状评估量表（ESAS）、CAGE（减少、烦恼、内疚、警醒）和纪念谵妄评估量表（MDAS）进行评估。出院时，重新考虑其他护理环境（死亡、家庭、家庭护理、临终关怀、肿瘤学）的后续转介和肿瘤治疗路径（开/停、不确定）。
共调查了 314 例连续入住 APSCU 的癌症患者。与停药相比，无照顾者、家庭出院和住院时间短与继续治疗独立相关，与不确定相比，其他症状入院少、住院时间短、家庭出院和更好的舒适度也与继续治疗相关。同样，许多因素与出院环境有关，但唯一与家庭出院独立相关的因素是“继续治疗”。
本研究的发现与 APSCU 出院后对患者进行适当选择的结果一致，该病房作为积极治疗和支持/姑息治疗之间的桥梁，根据早期和同步治疗的概念发挥作用。
