Lee Hee-Ja, Na Im-Il, Kang Kyung-Ah
Special Nursing Team, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
Hospice Care Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
J Hosp Palliat Care. 2021 Sep 1;24(3):184-193. doi: 10.14475/jhpc.2021.24.3.184.
This study attempted to develop clinical guidelines to help patients use hospice and palliative care (HPC) at an appropriate time after writing physician orders for life-sustaining treatment (POLST) by identifying the characteristics of HPC use of patients with terminal cancer.
This retrospective study was conducted to understand the characteristics of HPC use of patients with terminal cancer through decision tree analysis. The participants were 394 terminal cancer patients who were hospitalized at a cancer-specialized hospital in Seoul, South Korea and wrote POLST from January 1, 2019 to March 31, 2021.
The predictive model for the characteristics of HPC use showed three main nodes (living together, pain control, and period to death after writing POLST). The decision tree analysis of HPC use by terminal cancer patients showed that the most likely group to use HPC use was terminal cancer patients who had a cohabitant, received pain control, and died 2 months or more after writing a POLST. The probability of HPC usage rate in this group was 87.5%. The next most likely group to use HPC had a cohabitant and received pain control; 64.8% of this group used HPC. Finally, 55.1% of participants who had a cohabitant used HPC, which was a significantly higher proportion than that of participants who did not have a cohabitant (1.7%).
This study provides meaningful clinical evidence to help make decisions on HPC use more easily at an appropriate time.
本研究试图通过确定晚期癌症患者使用临终关怀与姑息治疗（HPC）的特征，制定临床指南，以帮助患者在医生下达维持生命治疗医嘱（POLST）后适时使用HPC。
本回顾性研究通过决策树分析来了解晚期癌症患者使用HPC的特征。研究对象为2019年1月1日至2021年3月31日期间在韩国首尔一家癌症专科医院住院并下达POLST的394例晚期癌症患者。
HPC使用特征的预测模型显示出三个主要节点（共同生活、疼痛控制以及下达POLST后的死亡时间）。晚期癌症患者使用HPC的决策树分析表明，最有可能使用HPC的群体是有同居者、接受疼痛控制且在下达POLST后2个月或更长时间死亡的晚期癌症患者。该组使用HPC的概率为87.5%。其次最有可能使用HPC的群体是有同居者且接受疼痛控制的患者；该组64.8%的患者使用了HPC。最后，有同居者的参与者中有55.1%使用了HPC，这一比例显著高于没有同居者的参与者（1.7%）。
本研究提供了有意义的临床证据，有助于在适当的时候更轻松地做出关于使用HPC的决策。
