Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification and Regression Tree Analysis
| Autor: | Connie M. Ulrich, Liming Huang, Nina O'Connor, Salimah H. Meghani, Lauren T Starr, Paul Junker |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Terminal Care
medicine.medical_specialty Palliative care business.industry Regression tree analysis Patient risk Palliative Care macromolecular substances General Medicine Article 03 medical and health sciences 0302 clinical medicine Risk Factors 030220 oncology & carcinogenesis Intensive care Terminal care Humans Medicine 030212 general & internal medicine Risk factor business Intensive care medicine Goals Referral and Consultation Retrospective Studies |
| Zdroj: | Am J Hosp Palliat Care |
| ISSN: | 1938-2715 1049-9091 |
| DOI: | 10.1177/1049909120934292 |
| Popis: | Background: Early palliative care consultation (“PCC”) to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed. Objective: To identify risk factor patient profiles associated with PCC timing before death. Methods: Secondary analysis of an observational study was conducted at an urban, academic medical center. Patients aged 18 years and older admitted to the medical center, who had PCC, and died July 1, 2014 to October 31, 2016, were included. Patients admitted for childbirth or rehabilitationand patients whose date of death was unknown were excluded. Classification and Regression Tree modeling was employed using demographic and clinical variables. Results: Of 1141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15 to 60 days before death; 21% had PCC >60 days before death (median 13 days before death). Variables associated with receiving PCC close to death included being Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%), with age 75 increasing this probability (98%). Intensive care patients with extreme illness severity were also likely to receive PCC close to death (64%) as were 50% of intensive care patients with less than extreme illness severity. Conclusions: A majority of patients received PCC close to death. A complex set of variable interactions were associated with PCC timing. A systematic process for engaging patients with PCC earlier in the care continuum, and in intensive care regardless of illness severity, is needed. |
| Databáze: | OpenAIRE |
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