Patient’s Factors at Entering Hospice Affecting Length of Survival in a Hospice Center
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose In order to provide effective hospice care, adequate length of survival (LOS) in hospice isnecessary. However the reported average LOS is much shorter. Analysis of LOS in hospicehas not been reported from Korea. We evaluated the duration of LOS and the factorsassociated with LOS at our hospice center. Materials and MethodsWe retrospectively examined 446 patients who were admitted to our hospice unit betweenJanuary 2010 and December 2012. We performed univariate and multivariate analysis foranalysis of factors associated with LOS. ResultsThe median LOS was 9.5 days (range, 1 to 186 days). The LOS of 389 patients (86.8%)was< 1 month. At the time of admission to hospice, 112 patients (25.2%) were completelybedridden, 110 patients (24.8%) had mouth care only without intake, and 134 patients(30.1%) had decreased consciousness, from confusion to coma. The median time intervalbetween the day of the last anticancer treatment and the day of hospice admission was 75days. By analysis of the results of multivariate analysis, decreased intake and laboratoryresults showing increased total white blood cell (WBC), decreased platelet count, increasedserum creatinine, increased aspartate aminotransferase (AST), alanine aminotransferase(ALT), and lactate dehydrogenase (LDH) level were poor prognostic factors for survival inhospice. ConclusionBefore hospice admission, careful evaluation of the patient’s performance, particularly theoral intake, and total WBC, platelet, creatinine, AST, ALT, and LDH level is essential, becausethese were strong predictors of shorter LOS. In the future, conduct of prospective controlledstudies is warranted in order to confirm the relationship between potential prognostic factorsand LOS in hospice.
Abstract
Purpose In order to provide effective hospice care, adequate length of survival (LOS) in hospice isnecessary. However the reported average LOS is much shorter. Analysis of LOS in hospicehas not been reported from Korea. We evaluated the duration of LOS and the factorsassociated with LOS at our hospice center. Materials and MethodsWe retrospectively examined 446 patients who were admitted to our hospice unit betweenJanuary 2010 and December 2012. We performed univariate and multivariate analysis foranalysis of factors associated with LOS. ResultsThe median LOS was 9.5 days (range, 1 to 186 days). The LOS of 389 patients (86.8%)was< 1 month. At the time of admission to hospice, 112 patients (25.2%) were completelybedridden, 110 patients (24.8%) had mouth care only without intake, and 134 patients(30.1%) had decreased consciousness, from confusion to coma. The median time intervalbetween the day of the last anticancer treatment and the day of hospice admission was 75days. By analysis of the results of multivariate analysis, decreased intake and laboratoryresults showing increased total white blood cell (WBC), decreased platelet count, increasedserum creatinine, increased aspartate aminotransferase (AST), alanine aminotransferase(ALT), and lactate dehydrogenase (LDH) level were poor prognostic factors for survival inhospice. ConclusionBefore hospice admission, careful evaluation of the patient’s performance, particularly theoral intake, and total WBC, platelet, creatinine, AST, ALT, and LDH level is essential, becausethese were strong predictors of shorter LOS. In the future, conduct of prospective controlledstudies is warranted in order to confirm the relationship between potential prognostic factorsand LOS in hospice.
참고문헌 (22)
- Chow E, "How accurate are physicians' clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review", Clin Oncol(R Coll Radiol), 13, pp.209~218 (2001)
- Christakis NA, "Extent and determinants of error in doctors' prognoses in terminally ill patients : prospective cohort study", BMJ, 320, pp.469~472 (2000)
- Lamont EB, "Physician factors in the timing of cancer patient referral to hospice palliative care", Cancer, 94, pp.2733~2737 (2002)
- Christakis NA, "Impact of individual and market factors on the timing of initiation of hospice terminal care", Med Care, 38, pp.528~541 (2000)
- Somova MJ, "Factors associated with length of stay in a mid-sized, urban hospice", Am J Hosp Palliat Care, 17, pp.99~105 (2000)
- Tang VL, "Trends in hospice referral and length of stay at a veterans hospital over the past decade", Am J Hosp Palliat Care, 30, pp.432~436 (2013)
- Rickerson E, "Timing of hospice referral and families' perceptions of services: are earlier hospice referrals better?", J Am Geriatr Soc, 53, pp.819~823 (2005)
- Kapo J, "Are we referring patients to hospice too late? Patients' and families'opinions", J Palliat Med, 8, pp.521~527 (2005)
- Younis T, "Length of survival in hospice for cancer patients referred from a comprehensive cancer center", Am J Hosp Palliat Care, 26, pp.281~287 (2009)
- Younis T, "Length of survival of patients with cancer in hospice : a retrospective analysis of patients treated at a major cancer center versus other practice settings", J Palliat Med, 10, pp.381~389 (2007)
- Lau F, "Using the Palliative Performance Scale to provide meaningful survival estimates", J Pain Symptom Manage, 38, pp.134~144 (2009)
- Head B, "Prognostication in hospice care: can the palliative performance scale help?", J Palliat Med, 8, pp.492~502 (2005)
- McCarthy EP, "Barriers to hospice care among older patients dying with lung and colorectal cancer", J Clin Oncol, 21, pp.728~735 (2003)
- Morita T, "Late referrals to specialized palliative care service in Japan", J Clin Oncol, 23, pp.2637~2644 (2005)
- Lau F, "Use of Palliative Performance Scale in end-of-life prognostication", J Palliat Med, 9, pp.1066~1075 (2006)
- Harrold J, "Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?", J Palliat Med, 8, pp.503~509 (2005)
- Virik K, "Validation of the palliative performance scale for inpatients admitted to a palliative care unit in Sydney, Australia", J Pain Symptom Manage, 23, pp.455~457 (2002)
- Pirovano M, "A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care", J Pain Symptom Manage, 17, pp.231~239 (1999)
- Rosenthal MA, "Prediction of life-expectancy in hospice patients : identification of novel prognostic factors", Palliat Med, 7, pp.199~204 (1993)
- Teno JM, "Timing of referral to hospice and quality of care : length of stay and bereaved family members' perceptions of the timing of hospice referral", J Pain Symptom Manage, 34, pp.120~125 (2007)
- Teno JM, "It is"too late"or is it? Bereaved family member perceptions of hospice referral when their family member was on hospice for seven days or less", J Pain Symptom Manage, 43, pp.732~738 (2012)
- Earle CC, "Identifying potential indicators of the quality of end-of-life cancer care from administrative data", J Clin Oncol, 21, pp.1133~1138 (2003)