Lawlor Peter, Gratton Valérie, Cohen Leila, Adeli Samantha Rose, Besserer Ella, Murphy Rebekah, Warmels Grace, Bruni Adrianna, Kabir Monisha, Noel Chelsea, Heidinger Brandon, Anderson Koby, Arsenault-Mehta Kyle, Wooller Krista, Lapenskie Julie, Webber Colleen, Bedard Daniel, Enright Paula, Desjardins Isabelle, Bhimji Khadija, Dyason Claire, Iyengar Akshai, Bush Shirley H, Isenberg Sarina, Tanuseputro Peter, Vanderspank-Wright Brandi, Parsons Henrique, Downar James
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
Department of Palliative Care, Bruyère Health Research Institute, Ottawa, Ontario, Canada.
BMJ Open. 2025 Mar 22;15(3):e091331. doi: 10.1136/bmjopen-2024-091331.
To determine the occurrence and clinicodemographic associations of hospital-based specialist palliative care (SPC) referral before and during the COVID-19 pandemic, timing of completed SPC consultation and comparative prevalence of 'no cardiopulmonary resuscitation (CPR)' orders, and end-of-life medication use, according to SPC involvement.
Cross-sectional secondary analysis of a retrospective cohort study with a pre-pandemic (November 2019 to February 2020) group (Pre-COVID, n=170) and two intra-pandemic (March to August 2020) groups, one without (COVID-ve, n=170) and one with COVID-19 infection (COVID+ve, n=85). In the cohort study, Pre-COVID and COVID-ve group decedents were matched 2:1 on age, sex and care service (internal medicine/intensive care unit (ICU)) at death with COVID+ve decedents. In our current secondary analysis, clinicodemographic variables associated with SPC referral were examined in multivariable logistic regression, reporting adjusted ORs (aORs) and 95% CIs.
One quaternary and two tertiary acute care hospitals.
Decedent cohort with a terminal hospital admission (N=425).
SPC referral (yes/no) and timing of completed SPC consultation before death. Additional outcomes included 'no CPR' status and end-of-life medication prescription and dosing.
SPC referral occurred in 70 (41.2%), 71 (41.8%) and 26 (30.6%) of the Pre-COVID, COVID-ve and COVID+ve groups, respectively (p=0.18). The aORs for SPC referral were lower for deaths in ICU (0.07; 95% CI 0.03 to 0.16) and admissions from nursing homes/long-term care (0.45; 95% CI 0.23 to 0.9), and higher for active cancer (2.5; 95% CI 1.39 to 4.39). Recipients of SPC consultation, compared with non-recipients, more frequently had a 'no CPR' order, had it placed earlier and were more frequently prescribed palliative end-of-life medications.
Hospital SPC consultation rates early in the COVID-19 pandemic were largely maintained at pre-pandemic levels. Having active cancer was positively associated with SPC referral, whereas both ICU death and having a nursing home/long-term care pre-admission source were negatively associated with referral.
确定在2019冠状病毒病大流行之前及期间基于医院的专科姑息治疗（SPC）转诊的发生率及临床人口统计学关联、完成SPC咨询的时间以及“不进行心肺复苏（CPR）”医嘱的比较患病率，以及根据SPC参与情况确定临终用药情况。
对一项回顾性队列研究进行横断面二次分析，该研究有一个大流行前（2019年11月至2020年2月）组（新冠疫情前，n = 170）和两个大流行期间（2020年3月至8月）组，一组无新冠病毒感染（新冠病毒阴性，n = 170），一组有新冠病毒感染（新冠病毒阳性，n = 85）。在队列研究中，新冠疫情前组和新冠病毒阴性组的死者在年龄、性别和死亡时的护理服务（内科/重症监护病房（ICU））方面与新冠病毒阳性死者按2:1进行匹配。在我们当前的二次分析中，在多变量逻辑回归中检查与SPC转诊相关的临床人口统计学变量，报告调整后的比值比（aORs）和95%置信区间（CIs）。
一家四级和两家三级急性护理医院。
有医院末期住院记录的死者队列（N = 425）。
SPC转诊（是/否）以及死亡前完成SPC咨询的时间。其他结果包括“不进行CPR”状态以及临终用药处方和剂量。
在新冠疫情前组、新冠病毒阴性组和新冠病毒阳性组中，分别有70例（41.2%）、71例（41.8%）和26例（30.6%）发生了SPC转诊（p = 0.18）。在ICU死亡（0.07；95% CI 0.03至0.16）和来自养老院/长期护理机构的入院患者（0.45；95% CI 0.23至0.9）中，SPC转诊的aOR较低，而在活动性癌症患者中较高（2.5；95% CI 1.39至4.39）。与未接受SPC咨询的患者相比，接受SPC咨询的患者更频繁地有“不进行CPR”医嘱，下达时间更早，并且更频繁地开具姑息性临终药物。
在2019冠状病毒病大流行早期，医院SPC咨询率基本维持在大流行前水平。患有活动性癌症与SPC转诊呈正相关，而ICU死亡以及入院前来自养老院/长期护理机构均与转诊呈负相关。
