St George Hospital, Sydney, New South Wales, Australia.
Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia.
Australas J Ageing. 2024 Sep;43(3):591-599. doi: 10.1111/ajag.13308. Epub 2024 Apr 1.
The Supportive and Palliative Care Indicators Tool (SPICT™) has been used to identify patients at risk of deteriorating and dying within 1 year. Early identification and integration of advance care planning (ACP) provides the opportunity for a better quality of life for patients. The aims of this study were to identify the number of patients who were SPICT™ positive; their mortality rates at 6 and 12 months of the SPICT™ assessment; and level of adherence to ACP documentation.
A retrospective audit of the Supportive and Palliative Care database was conducted at an acute aged care precinct in a major metropolitan tertiary referral hospital in New South Wales, Australia. Data comprising demographics, clinical conditions, SPICT™ positivity and compliance with ACP documentation were collected. SPICT™-positive patients and mortality were tracked at 6 and 12 months, respectively.
Data from 153 patients were collected. The mean age of the patients was 84.1 (±7.8) years, and the length of hospital stay was 10 (±24.7) (range 1-269) days. Approximately 37% were from residential care, and 80% had family deciding on their care. About 15% died during hospitalisation, and 48% were discharged to a care facility. The ACP documentation showed various levels of completion. Mortality rates at 6 and 12 months were 36% and 39%, respectively. Most patients (99%) were SPICT™-positive, with indicators correlating with higher mortality rates at both follow-ups.
The study emphasises the critical need for addressing ACP and palliative care among older patients with life-limiting conditions. It underscores the importance of timely discussions, documentation, and cessation of futile interventions.
支持性和姑息治疗指标工具（SPICT）已被用于识别在 1 年内有恶化和死亡风险的患者。早期识别和整合预先医疗指示（ACP）为患者提供了提高生活质量的机会。本研究的目的是确定 SPICT 阳性患者的数量；他们在接受 SPICT 评估后 6 个月和 12 个月的死亡率；以及 ACP 文件记录的遵守程度。
在澳大利亚新南威尔士州一家主要大都市三级转诊医院的急性老年护理区进行了支持性和姑息治疗数据库的回顾性审计。收集了人口统计学、临床状况、SPICT 阳性和 ACP 文件记录合规性的数据。分别在 6 个月和 12 个月时跟踪 SPICT 阳性患者和死亡率。
共收集了 153 名患者的数据。患者的平均年龄为 84.1（±7.8）岁，住院时间为 10（±24.7）（范围 1-269）天。约 37%的患者来自养老院，80%的患者由家属决定其护理。约 15%的患者在住院期间死亡，48%的患者出院到护理机构。ACP 文件记录显示了不同程度的完成情况。6 个月和 12 个月的死亡率分别为 36%和 39%。大多数患者（99%）为 SPICT 阳性，在两次随访中，与死亡率较高相关的指标。
该研究强调了在生命有限的老年患者中解决 ACP 和姑息治疗的迫切需要。它强调了及时讨论、文件记录和停止无效干预的重要性。
