Department of Oncology and Radiotherapy, Turku University Hospital and Department of Clinical Oncology, University of Turku, PO Box 52, FI-20521, Turku, Finland.
Nordic Healthcare group, Helsinki, Finland.
BMC Palliat Care. 2020 Mar 24;19(1):37. doi: 10.1186/s12904-020-00547-8.
In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death.
A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 -Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death.
A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and < 14 days 10%). The number of ED visits and inpatient days were highest for patients with no PC decision and lowest for patients with both a PC decision and an PC unit appointment (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p < 0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and an appointment to a PC unit).
The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.
为了避免在生命末期不必要地使用医院服务，姑息治疗应该尽早开始，以便有足够的时间启动和实施高质量的预先护理计划（ACP）。本单中心研究评估了 PC 决策及其时机对生命末期医院服务使用和死亡地点的影响。
从医院数据库中确定的 2737 名患者中，随机选择了 992 名在 2013 年 1 月至 2014 年 12 月期间在三级医院接受治疗的癌症患者，这些患者在 2014 年底前死亡。研究了 PC 决策（终止延长生命的抗癌治疗并专注于以症状为中心的姑息治疗的决策）和使用 PC 单元服务与急诊部（ED）就诊、住院天数和死亡地点的关系。
82%的患者做出了 PC 决策，37%的患者使用了 PC 单元。PC 决策越早，在 PC 单元预约的次数就越多（>180 天前死亡的预约 72%，<14 天的预约 10%）。无 PC 决策的患者 ED 就诊次数和住院天数最高（死亡前 60 天 ED 就诊次数分别为 1.3 和 0.8，住院天数分别为 9.9 和 2.9，p<0.01）。无 PC 决策的患者更常在二级/三级医院死亡（28%与 PC 决策患者相比，6%与 PC 决策和 PC 单元预约患者相比）。
启动姑息治疗目标的 PC 决策对生命末期的医院服务使用有明显影响。与 PC 单元的接触进一步增加了在初级保健中接受生命末期护理的可能性。
