Hannon Breffni, Taback Nathan, Zimmermann Camilla, Granton John, Krzyzanowska Monika
Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Support Palliat Care. 2022 Dec;12(e6):e826-e833. doi: 10.1136/bmjspcare-2019-001861. Epub 2019 Jul 11.
Patients with advanced cancer are increasingly discharged from inpatient settings following focused symptom management admissions. Thromboprophylaxis (TP) is recommended for patients with cancer admitted to acute care settings; less is known about TP use in palliative care (PC) settings. This study explored the opinions of Canadian medical oncologists (MO) and PC physicians regarding the use of TP for inpatients with advanced cancer.
A fractional factorial survey designed to evaluate the impact of patient factors (age, clinical setting, reason for admission, pre-admission performance status (Eastern Cooperative Oncology Group; ECOG), and risk of bleeding on anticoagulation) and physician demographics on recommending TP was administered by email to Canadian MO and PC physicians. Each respondent received eight vignettes randomly selected from a set of 32. Hierarchical regression was used to evaluate the odds of prescribing TP adjusted for patient factors.
606 MO and 491 PC physicians were surveyed; response rates were 11.1% and 15.0%, respectively. MO were predominantly male (59.7%); PC female (60.3%); most worked in academic environments (90.3% MO; 73.9% PC). Multivariable hierarchical logistic regression demonstrated that all patient factors except age were associated with prescribing TP (ORs range: from 1.34 (95% CI 1.01 to 1.77) for good ECOG, to 2.53 (95% CI 1.9 to 3.37), for reversible reason for admission). Controlling for these factors, medical specialty was independently associated with recommending TP (OR for MO 2.09 (95% CI 1.56 to 2.8)).
MO have higher odds of recommending TP for inpatients with advanced cancer than PC physicians. Further research exploring the drivers of these differing practices is warranted.
在接受针对症状管理的住院治疗后，晚期癌症患者越来越多地从住院环境中出院。对于入住急性护理机构的癌症患者，推荐进行血栓预防（TP）；而对于姑息治疗（PC）环境中TP的使用情况，人们了解较少。本研究探讨了加拿大医学肿瘤学家（MO）和PC医生对于晚期癌症住院患者使用TP的看法。
通过电子邮件向加拿大MO和PC医生发放一项部分因子调查，旨在评估患者因素（年龄、临床环境、入院原因、入院前的体能状态（东部肿瘤协作组；ECOG）以及抗凝时的出血风险）和医生人口统计学特征对推荐TP的影响。每位受访者从32个病例中随机收到8个病例描述。采用分层回归来评估根据患者因素调整后开具TP的几率。
共调查了606名MO和491名PC医生；回复率分别为11.1%和15.0%。MO中男性占主导（59.7%）；PC中女性占主导（60.3%）；大多数人在学术环境中工作（MO为90.3%；PC为73.9%）。多变量分层逻辑回归表明，除年龄外，所有患者因素均与开具TP有关（优势比范围：ECOG状态良好时为1.34（95%可信区间1.01至1.77），入院可逆原因时为2.53（95%可信区间1.9至3.37））。在控制这些因素后，医学专业与推荐TP独立相关（MO的优势比为2.09（95%可信区间1.56至2.8））。
与PC医生相比，MO为晚期癌症住院患者推荐TP的几率更高。有必要进一步研究探索这些不同做法的驱动因素。
