Goble Spencer R, Sultan Amir, Debes Jose D
Division of Gastroenterology, Department of Medicine, Hepatology, and Nutrition, University of Minnesota.
Department of Medicine, University of Minnesota, Mayo Memorial Building, Minneapolis, MN.
J Clin Gastroenterol. 2024 Oct 24. doi: 10.1097/MCG.0000000000002091.
Investigate the impacts of palliative care consults, race, and socioeconomic status on the prevalence of invasive procedures in patients with hepatocellular carcinoma (HCC).
Palliative care, race, and socioeconomic status can all influence end-of-life care preferences, but their roles in HCC have not been adequately explored.
This is a cross-sectional study of patients with HCC from 2016 to 2019 using the National Inpatient Sample. Terminal and nonterminal hospitalizations were assessed with logistical regression evaluating associations between palliative care, race, income, and procedures along with do-not-resuscitate orders and cost. Procedures included mechanical ventilation, tracheostomy, and cardiopulmonary resuscitation (CPR) among others.
A total of 217,060 hospitalizations in patients with HCC were included, 18.1% of which included a palliative care encounter. The mean age was 65.0 years (SD = 11.3 y), 73.9% were males and 55.5% were white. Procedures were increased in terminal hospitalizations in black [CPR adjusted odds ratio (aOR) = 2.57, P < 0.001] and Hispanic patients (tracheostomy aOR = 3.64, P = 0.018) compared with white patients. Palliative care encounters were associated with reduced procedures during terminal hospitalizations (mechanical ventilation aOR = 0.47, P < 0.001, CPR aOR = 0.24, P < 0.001), but not in nonterminal hospitalizations. No association between income and end-of-life procedures was found. Palliative care was associated with decreased mean cost in terminal ($23,608 vs $31,756, P < 0.001) and nonterminal hospitalizations ($15,786 vs $19,914, P < 0.001).
Palliative care is associated with less aggressive end-of-life care and decreased costs in patients with HCC. Black and Hispanic race were both associated with more aggressive end-of-life care.
研究姑息治疗会诊、种族和社会经济地位对肝细胞癌（HCC）患者侵入性操作发生率的影响。
姑息治疗、种族和社会经济地位都会影响临终关怀偏好，但它们在HCC中的作用尚未得到充分研究。
这是一项使用全国住院患者样本对2016年至2019年HCC患者进行的横断面研究。通过逻辑回归评估姑息治疗、种族、收入和操作之间的关联，以及不复苏医嘱和费用，对终末期和非终末期住院情况进行评估。操作包括机械通气、气管切开术和心肺复苏（CPR）等。
共纳入217,060例HCC患者的住院病例，其中18.1%包括姑息治疗会诊。平均年龄为65.0岁（标准差=11.3岁），73.9%为男性，55.5%为白人。与白人患者相比，黑人患者（CPR调整优势比[aOR]=2.57，P<0.001）和西班牙裔患者（气管切开术aOR=3.64，P=0.018）在终末期住院时的操作增加。姑息治疗会诊与终末期住院期间操作减少相关（机械通气aOR=0.47，P<0.001，CPR aOR=0.24，P<0.001），但在非终末期住院时无此关联。未发现收入与临终操作之间存在关联。姑息治疗与终末期（23,608美元对31,756美元，P<0.001）和非终末期住院（15,786美元对19,914美元，P<0.001）的平均费用降低相关。
姑息治疗与HCC患者临终关怀的积极性降低和费用减少相关。黑人及西班牙裔种族均与更积极的临终关怀相关。
