Palliative Care Unit, Oscar Lambret Center, 3 rue Frédéric Combemale, 59300, Lille, France.
Palliative Care Unit, Lille University Hospital and Medical School, 59000, Lille, France.
BMC Palliat Care. 2021 Jan 26;20(1):24. doi: 10.1186/s12904-021-00720-7.
Home hospitalization at the end of life can sometimes be perturbed by unplanned hospital admissions (UHAs, defined as any admission that is not part of a preplanned care procedure), which increase the likelihood of death in hospital. The objectives were to describe the occurrence and causes of UHAs in cancer patients receiving end-of-life care at home, and to identify factors associated with UHAs and death in hospital.
A retrospective, single-center study (performed at a regional cancer center in the city of Lille, northern France) of advanced cancer patients discharged to home hospitalization between January 2014 and December 2017. We estimated the incidence of UHA over time using Kaplan-Meier method and Kalbfleish and Prentice method. We investigated factors associated with the risk UHA in cause-specific Cox models. We evaluated factors associated with death in hospital in logistic regressions.
One hundred and forty-two patients were included in the study. Eighty-two patients (57.7 %) experienced one or more UHAs, a high proportion of which occurred within 1 month after discharge to home. Most UHAs were related to physical symptoms and were initiated by the patient's family physician. A post-discharge palliative care consultation was associated with a significantly lower incidence of UHAs. Sixty-five patients (47.8 % of the deaths) died in hospital. In a multivariate analysis, living alone and the presence of one or more children at home were associated with death in hospital.
More than 40 % of cancer patients receiving end of life home hospitalization were not readmitted to hospital, reflecting the effectiveness of this type of palliative care setting. However, over half of the UHAs were due to an acute intercurrent event. Our results suggest that more efforts should be focused on anticipating these events at home - primarily via better upstream coordination between hospital physicians and family physicians.
在生命末期，患者有时会因非计划性住院（定义为任何非预先计划的治疗程序所导致的住院）而中断家庭住院治疗，这增加了患者在医院死亡的可能性。本研究的目的是描述接受临终家庭住院治疗的癌症患者中计划性外住院（UHAs）的发生和原因，并确定与 UHAs 和医院死亡相关的因素。
这是一项回顾性、单中心研究（在法国北部里尔市的一家区域癌症中心进行），纳入了 2014 年 1 月至 2017 年 12 月期间出院至家庭住院治疗的晚期癌症患者。我们使用 Kaplan-Meier 法和 Kalbfleish 和 Prentice 法估计随时间推移 UHA 的发生率。我们在特定原因的 Cox 模型中调查了与 UHA 风险相关的因素。我们在逻辑回归中评估了与医院死亡相关的因素。
本研究共纳入 142 名患者。82 名患者（57.7%）经历了一次或多次 UHA，其中大部分发生在出院后 1 个月内。大多数 UHA 与身体症状有关，是由患者的家庭医生发起的。出院后接受姑息治疗咨询与 UHA 发生率显著降低相关。65 名患者（死亡患者的 47.8%）死于医院。在多变量分析中，独居和家中有一个或多个孩子与医院死亡相关。
接受临终家庭住院治疗的癌症患者中，超过 40%的患者无需再次住院，这反映了这种姑息治疗环境的有效性。然而，超过一半的 UHA 是由急性并发事件引起的。我们的研究结果表明，应更加关注在家中预测这些事件，主要是通过医院医生和家庭医生之间更好的上游协调。
