Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA.
J Palliat Med. 2020 Oct;23(10):1335-1341. doi: 10.1089/jpm.2019.0530. Epub 2020 Mar 16.
Multiple chronic conditions (MCCs) are associated with increased intensity of end-of-life (EOL) care, but their effect is not well explored in patients with cancer. We examined EOL health care intensity and advance care planning (ACP) documentation to better understand the association between MCCs and these outcomes. Retrospective cohort study. Patients aged 18+ years at UW Medicine who died during 2010-2017 with poor prognosis cancer, with or without chronic liver disease, chronic pulmonary disease, coronary artery disease, dementia, diabetes with end-stage organ damage, end-stage renal disease, heart failure, or peripheral vascular disease. ACP documentation 30+ days before death, in-hospital death, and inpatient or intensive care unit (ICU) admission in the last 30 days. We performed logistic regression for outcomes. Of 15,092 patients with cancer, 10,596 (70%) had 1+ MCCs (range 1-8). Patients with cancer and heart failure had highest odds of hospitalization (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.46-1.91), ICU admission (OR 2.06, 95% CI 1.76-2.41), or in-hospital death (OR 1.62, 95% CI 1.43-1.84) versus patients with cancer and other conditions. Patients with ACP 30+ days before death had lower odds of in-hospital death (OR 0.65, 95% CI 0.60-0.71), hospitalization (OR 0.67, 95% CI 0.61-0.74), or ICU admission (OR 0.71, 95% CI 0.64-0.80). Patients with ACP 30+ days before death had lower odds of high-intensity EOL care. Further research needs to explore how to best use ACP to ensure patients receive care aligned with patient and family goals for care.
多种慢性疾病（MCCs）与终末期生命（EOL）护理的强度增加相关，但在癌症患者中，其影响尚未得到充分探索。我们检查了 EOL 医疗保健强度和预先医疗指示（ACP）文件，以更好地了解 MCCs 与这些结果之间的关系。回顾性队列研究。在 2010-2017 年期间，年龄在 18 岁以上的 UW 医学患者死于预后不良的癌症，无论是否伴有慢性肝病、慢性肺病、冠状动脉疾病、痴呆、终末期器官损伤的糖尿病、终末期肾病、心力衰竭或外周血管疾病。在死亡前 30 天内、院内死亡以及在最后 30 天内住院或入住重症监护病房（ICU）的 ACP 文件。我们对结果进行了逻辑回归分析。在 15092 名癌症患者中，有 10596 名（70%）患有 1 种以上的 MCC（范围 1-8）。患有癌症和心力衰竭的患者住院的可能性最高（优势比 [OR] 1.67，95%置信区间 [CI] 1.46-1.91）、入住 ICU（OR 2.06，95% CI 1.76-2.41）或院内死亡（OR 1.62，95% CI 1.43-1.84），而癌症患者的其他情况。在死亡前 30 天内进行 ACP 的患者，院内死亡（OR 0.65，95% CI 0.60-0.71）、住院（OR 0.67，95% CI 0.61-0.74）或 ICU 入住（OR 0.71，95% CI 0.64-0.80）的可能性较低。在死亡前 30 天内进行 ACP 的患者，接受高强度 EOL 护理的可能性较低。需要进一步研究如何最好地利用 ACP，以确保患者接受符合患者和家属护理目标的护理。
