Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA.
Pediatr Blood Cancer. 2022 Sep;69(9):e29841. doi: 10.1002/pbc.29841. Epub 2022 Jun 10.
We previously developed stakeholder-informed quality measures to assess end-of-life care quality for children with cancer. We sought to implement a subset of these quality measures in the multi-center pediatric palliative care (PPC) database.
We utilized the Shared Data and Research database to evaluate the proportion of childhood cancer decedents from 2017-2021 who, in the last 30 days of life, avoided chemotherapy, mechanical ventilation, intensive care unit admissions, and > 1 hospital admission; were enrolled in hospice services, and reported ≤ 2 highly distressing symptoms. We then explored patient factors associated with the attainment of quality benchmarks.
Across 79 decedents, 82% met ≥ 4 quality benchmarks. Most (76%) reported > 2 highly distressing symptoms; 17% were enrolled in hospice. In univariable analyses, patients with an annual household income ≤$50,000 had lower odds of hospice enrollment and avoidance of mechanical ventilation or intensive care unit admissions near end of life (odds ratio [OR] 0.10 [95% confidence interval (C.I.) 0.01, 0.86], p = 0.04; OR 0.13 [0.02, 0.64], p = 0.01; OR 0.36 [0.13, 0.98], p = 0.04, respectively). In multivariable analyses, patients with an income ≤$50,000 remained less likely to enroll in hospice, after adjusting for cancer type (OR 0.10 [0.01, 0.87]; p = 0.04).
Childhood cancer decedents who received PPC met a large proportion of quality measures near the end of their life. Yet, many reported highly distressing symptoms. Moreover, patients with lower household incomes appeared less likely to enroll in hospice and more likely to receive intensive hospital services near the end of life. This study identifies opportunities for palliative oncology quality improvement.
我们之前开发了基于利益相关者的质量指标来评估儿童癌症患者的临终关怀质量。我们试图在多中心儿科姑息治疗（PPC）数据库中实施这些质量指标的一个子集。
我们利用共享数据和研究数据库来评估 2017 年至 2021 年期间的儿童癌症死亡患者，在生命的最后 30 天里，避免接受化疗、机械通气、重症监护病房入院和> 1 次住院；是否接受临终关怀服务，以及报告的≤ 2 个高度痛苦症状。然后，我们探讨了与实现质量基准相关的患者因素。
在 79 名死亡患者中，82%符合≥ 4 个质量基准。大多数（76%）报告有> 2 个高度痛苦症状；17%接受临终关怀。在单变量分析中，年收入≤50,000 美元的患者接受临终关怀的可能性较低，在生命末期避免机械通气或重症监护病房入院的可能性较低（比值比 [OR] 0.10 [95%置信区间（CI）0.01，0.86]，p=0.04；OR 0.13 [0.02，0.64]，p=0.01；OR 0.36 [0.13，0.98]，p=0.04，分别）。在多变量分析中，在调整癌症类型后，年收入≤50,000 美元的患者接受临终关怀的可能性较低（OR 0.10 [0.01，0.87]；p=0.04）。
接受 PPC 的儿童癌症死亡患者在生命的最后阶段符合很大比例的质量指标。然而，许多患者报告有高度痛苦的症状。此外，家庭收入较低的患者接受临终关怀的可能性较低，在生命的最后阶段接受强化医院服务的可能性较高。这项研究确定了姑息肿瘤学质量改进的机会。
