恶性输尿管梗阻患者的姑息治疗、临终关怀和终末期医疗保健利用现状。
The Current Status of Palliative Care, Hospice, and End-of-Life Health Care Utilization in Patients With Malignant Ureteral Obstruction.
机构信息
Department of Urology, Loyola University Medical Center, Maywood, Illinois.
Department of Urology, University of Washington, Seattle, Washington.
出版信息
Urol Pract. 2024 Jan;11(1):187-196. doi: 10.1097/UPJ.0000000000000472. Epub 2023 Dec 20.
INTRODUCTION
Malignant ureteral obstruction is associated with a poor prognosis, with a median survival of 3 to 7 months. These patients are ideal candidates for concurrent palliative care services, consistent with American Society of Clinical Oncology guidelines. We aimed to characterize palliative care, hospice, and end-of-life health care utilization in patients with malignant ureteral obstruction.
METHODS
Patients ≥ 18 years old at our institution and diagnosed with malignant ureteral obstruction between May 2014 and August 2020 were retrospectively identified and pertinent data extracted. Palliative care, hospice, and end-of-life health care utilization was described, and factors associated with each were assessed with logistic regression models. Overall survival was assessed with Cox proportional hazard regression models.
RESULTS
One hundred fifteen patients qualified for analysis; 39.1% (45/115) utilized palliative care and spent a median of 12.5 days (IQR 3-52 days) on nonhospice palliative care. On adjusted analysis Black ethnicity (aOR 3.44, 95% CI: 1.08-10.94) was associated with palliative care utilization. Of the patients, 53.9% (62/115) utilized hospice. The median time from hospice initiation to death was 12 days (IQR 5-23 days). On adjusted analysis, prior extirpative surgery (aOR 3.63, 95% CI 1.01-13.05) and palliative care utilization (aOR 4.38, 95% CI 1.70-11.31) were associated with hospice utilization. Median survival following diagnosis was 141 days (IQR 37.5-442.5). Of the patients, 43.0% (37/86) had high end-of-life health care utilization. On multivariable analysis, only hospice (aOR 0.03, 95% CI 0.01-0.14) was associated with less end-of-life health care utilization.
CONCLUSIONS
Palliative care is underutilized in malignant ureteral obstruction. Hospice, but not palliative care utilization, was associated with decreased end-of-life health care utilization.
简介
恶性输尿管梗阻与预后不良相关，中位生存期为 3 至 7 个月。这些患者是同时提供姑息治疗服务的理想人选，这符合美国临床肿瘤学会的指南。我们旨在描述恶性输尿管梗阻患者的姑息治疗、临终关怀和临终医疗保健的使用情况。
方法
本研究回顾性地确定了我院≥ 18 岁、2014 年 5 月至 2020 年 8 月期间诊断为恶性输尿管梗阻的患者，并提取相关数据。描述了姑息治疗、临终关怀和临终医疗保健的使用情况，并使用逻辑回归模型评估了与每种情况相关的因素。使用 Cox 比例风险回归模型评估总生存率。
结果
共有 115 名患者符合分析条件；39.1%（45/115）接受了姑息治疗，非临终姑息治疗中位数为 12.5 天（IQR 3-52 天）。在调整后的分析中，黑人种族（优势比 3.44，95%置信区间：1.08-10.94）与姑息治疗的使用相关。在这些患者中，53.9%（62/115）使用了临终关怀。从临终关怀开始到死亡的中位时间为 12 天（IQR 5-23 天）。在调整后的分析中，先前的根治性手术（优势比 3.63，95%置信区间 1.01-13.05）和姑息治疗的使用（优势比 4.38，95%置信区间 1.70-11.31）与临终关怀的使用相关。确诊后的中位生存时间为 141 天（IQR 37.5-442.5）。在这些患者中，43.0%（37/86）有较高的临终医疗保健利用率。多变量分析显示，只有临终关怀（优势比 0.03，95%置信区间 0.01-0.14）与临终医疗保健利用率较低相关。
结论
恶性输尿管梗阻患者姑息治疗的使用率较低。临终关怀的使用，但不是姑息治疗的使用，与临终医疗保健利用率的降低相关。
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