End-of-Life Care in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation.
| Autor: | Salazar, Marisa M., DeCook, Lori J., Butterfield, Richard J., Zhang, Nan, Sen, Ayan, Wu, Kelly L., Vanness, David J., Khera, Nandita |
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| Předmět: |
MEDICAL quality control
HOSPITALS INTENSIVE care units LENGTH of stay in hospitals CARDIOPULMONARY resuscitation HOSPICE care BONE marrow transplantation ACQUISITION of data methodology CANCER chemotherapy MULTIPLE regression analysis PATIENT selection POSTOPERATIVE care SURGERY PATIENTS RETROSPECTIVE studies ARTIFICIAL respiration SOCIOECONOMIC factors ADVANCE directives (Medical care) DOCUMENTATION SYMPTOMS MEDICAL records HOSPITAL care MEDICAL referrals DESCRIPTIVE statistics HEMATOPOIETIC stem cell transplantation TUMORS HEMODIALYSIS ODDS ratio DEATH PALLIATIVE treatment |
| Zdroj: | Journal of Palliative Medicine; Jan2022, Vol. 25 Issue 1, p97-105, 9p |
| Abstrakt: | Background: Patients receiving allogeneic hematopoietic cell transplantation (HCT) have high morbidity and mortality risk, but literature is limited on factors associated with end-of-life (EOL) care intensity. Objectives: Describe EOL care in patients after allogeneic HCT and examine association of patient and clinical characteristics with intense EOL care. Design: Retrospective chart review. Setting/Subjects: A total of 113 patients who received allogeneic HCT at Mayo Clinic Arizona between 2013 and 2017 and died before November 2019. Measurements: A composite EOL care intensity measure included five markers: (1) no hospice enrollment, (2) intensive care unit (ICU) stay in the last month, (3) hospitalization >14 days in last month, (4) chemotherapy use in the last two weeks, and (5) cardiopulmonary resuscitation, hemodialysis, or mechanical ventilation in the last week of life. Multivariable logistic regression modeling assessed associations of having ≥1 intensity marker with sociodemographic and disease characteristics, palliative care consultation, and advance directive documentation. Results: Seventy-six percent of patients in our cohort had ≥1 intensity marker, with 43% receiving ICU care in the last month of life. Median hospital stay in the last month of life was 15 days. Sixty-five percent of patients died in hospice; median enrollment was 4 days. Patients with higher education were less likely to have ≥1 intensity marker (odds ratio 0.28, p = 0.02). Patients who died >100 days after HCT were less likely to have ≥1 intensity marker than patients who died ≤100 days of HCT (p = 0.04). Conclusions: Death within 100 days of HCT and lower educational attainment were associated with higher likelihood of intense EOL care. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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