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Estimating the short-term prognosis to adjust the transfer of patients with terminal cancer to medium-stay palliative care units.

Abstract：

BACKGROUND AND OBJECTIVES:Clinical management for terminal patients should consider various aspects, particularly the patient's functional assessment, which correlates well with the short-term prognosis. The prognosis could improve if the presence of symptoms strongly associated with a poorer progression were included. The study's main objective was to assess whether the prognosis according to the Palliative Performance Scale (PPS) improved with the presence/absence of pain-dyspnoea-delirium symptoms. The secondary objective was to determine caregiver satisfaction with the transfer to medium-stay palliative care units (MSPCUs), which are prepared for medium stays of approximately one month. PATIENTS AND METHOD:We conducted a prospective, observational, multicentre (regional) study that analysed survival in MSPCUs according to the PPS dichotomized to>20% and≤20%. We estimated the mean survival functions using the Kaplan-Meier method and compared them according to the Cox proportional hazards ratios (HR). Caregiver satisfaction was studied using an anonymous self-administered Likert questionnaire. RESULTS:The study included 130 patients. The PPS≤20% and PPS>20% subgroups had a median survival of 6 (3-13) days and 21 (11-42) days, respectively, with an unadjusted mortality HR 3.1-fold greater in the PPS≤20% subgroup. The HR did not change when adjusted for the symptoms. Eighty-three percent of the caregivers found the transfer beneficial, and 40% observed better patient care. CONCLUSIONS:For patients transferred from general hospitals to MSPCUs, PPS scores≤20% were associated with survival shorter than one week, with a 3-fold higher mortality HR than patients with PPS scores>20%, without the analysis adjusted for the presence of pain-dyspnoea-delirium providing greater prognostic accuracy. The caregivers found benefits mainly in the convenience of the facilities and distance.

journal_name

Rev Clin Esp

journal_title

Revista clinica espanola

authors

Sancho Zamora MA,Plaza Canteli S,Pita Carranza AJ,González García N

doi

10.1016/j.rce.2019.01.003

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

303-309

issue

eissn

0014-2565

issn

1578-1860

pii

S0014-2565(19)30022-0

journal_volume

219

pub_type

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Estimating the short-term prognosis to adjust the transfer of patients with terminal cancer to medium-stay palliative care units.