Bordier Violaine, Filbet Marilène, Sissoix Corinne, Tricou Colombe, Pereira Bruno, Guastella Virginie
Palliative Care Unit, South Lyon Hospital Center, Civil Hospices of Lyon, Lyon, France.
Biostatistics unit, Department of Clinical Research and Innovation (DRCI), Clermont- Ferrand University Hospital, Clermont-Ferrand, France.
BMC Palliat Care. 2024 Dec 19;23(1):285. doi: 10.1186/s12904-024-01624-y.
Having a hematological malignancy increases the risk of a poor-quality end of life and of dying in intensive care. There is no prognostic score to predict survival on admission to intensive care, but many patients die there. To identify the criteria used in deciding to transfer patients with hematological malignancies to intensive care.
It is a qualitative study. For each patient with a hematological malignancy who died in intensive care, the resuscitator and hematologist involved in the decision to transfer the patient to intensive care were contacted. The study ran at Lyon Sud Hospital Center, between 1 November 2018 and 30 April 2019. Semi-structured interviews were conducted with data triangulation. Seventeen doctors were contacted, and 17 interviews were conducted.
When transferring a patient with a hematological malignancy to intensive care, we identified (i) patient-specific decision criteria for the transfer, namely prognosis of the disease and treatments received, and (ii) decision criteria specific to hematologists and resuscitators, namely difficulty confronting management failure, convenience of transfer to the ICU for hematologists, and attachment of hematologists to their patients.
Organizational convenience of transfer to intensive care was the main criterion for hematologists, but emotional attachment favored futile obstinacy, doing everything possible to the detriment of the patient's comfort. It would be useful to make an upstream appraisal of the impact that an early evaluation of the level of care of patients with hematological malignancies could have on reducing deaths in intensive care.
患有血液系统恶性肿瘤会增加临终质量差和在重症监护室死亡的风险。目前尚无用于预测重症监护室入院时生存率的预后评分，但仍有许多患者在那里死亡。目的是确定决定将血液系统恶性肿瘤患者转入重症监护室时所使用的标准。
这是一项定性研究。对于每一位在重症监护室死亡的血液系统恶性肿瘤患者，联系了参与决定将患者转入重症监护室的复苏人员和血液科医生。该研究于2018年11月1日至2019年4月30日在里昂南医院中心进行。采用数据三角测量法进行半结构化访谈。共联系了17名医生，并进行了17次访谈。
在将血液系统恶性肿瘤患者转入重症监护室时，我们确定了（i）患者特定的转院决定标准，即疾病预后和接受的治疗，以及（ii）血液科医生和复苏人员特有的决定标准，即应对管理失败的难度、血液科医生将患者转入重症监护室的便利性以及血液科医生对其患者的情感依赖。
转入重症监护室的组织便利性是血液科医生的主要标准，但情感依赖导致了徒劳的固执，即为了患者的舒适而不惜一切代价。对血液系统恶性肿瘤患者护理水平的早期评估对降低重症监护室死亡率可能产生的影响进行上游评估将是有益的。
