Advance Directives, Hospitalization, and Survival Among Advanced Cancer Patients with Delirium Presenting to the Emergency Department: A Prospective Study
| Autor: | Knox H. Todd, Eduardo Bruera, Ahmed F. Elsayem, Patricia A. Brock, Geraldine L Wood, Carla L. Warneke, Alan D Valentine, Valda D. Page, Sai Ching J. Yeung, Julio Silvestre |
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| Rok vydání: | 2017 |
| Předmět: |
Male
China Cancer Research medicine.medical_specialty Medical Oncology behavioral disciplines and activities Group B law.invention 03 medical and health sciences 0302 clinical medicine law Neoplasms mental disorders medicine Humans Prospective Studies 030212 general & internal medicine Prospective cohort study Aged business.industry Medical record Delirium Cancer Emergency department Length of Stay Middle Aged medicine.disease Intensive care unit humanities Confidence interval nervous system diseases Hospitalization Oncology Symptom Management and Supportive Care 030220 oncology & carcinogenesis Emergency medicine Female medicine.symptom Advance Directives Emergency Service Hospital business |
| Zdroj: | The Oncologist. 22:1368-1373 |
| ISSN: | 1549-490X 1083-7159 |
| Popis: | BACKGROUND To improve the management of advanced cancer patients with delirium in an emergency department (ED) setting, we compared outcomes between patients with delirium positively diagnosed by both the Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS), or group A (n = 22); by the MDAS only, or group B (n = 22); and by neither CAM nor MDAS, or group C (n = 199). MATERIALS AND METHODS In an oncologic ED, we assessed 243 randomly selected advanced cancer patients for delirium using the CAM and the MDAS and for presence of advance directives. Outcomes extracted from patients' medical records included hospital and intensive care unit admission rate and overall survival (OS). RESULTS Hospitalization rates were 82%, 77%, and 49% for groups A, B, and C, respectively (p = .0013). Intensive care unit rates were 18%, 14%, and 2% for groups A, B, and C, respectively (p = .0004). Percentages with advance directives were 52%, 27%, and 43% for groups A, B, and C, respectively (p = .2247). Median OS was 1.23 months (95% confidence interval [CI] 0.46-3.55) for group A, 4.70 months (95% CI 0.89-7.85) for group B, and 10.45 months (95% CI 7.46-14.82) for group C. Overall survival did not differ significantly between groups A and B (p = .6392), but OS in group C exceeded those of the other groups (p |
| Databáze: | OpenAIRE |
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