Abstract:
CONTEXT:Efforts in developing useful tools to properly identify the end-of-life trajectory of patients with advanced medical diseases have been made, but the calibration and/or discriminative power of these tools has not been optimal. OBJECTIVES:Our objective was to develop a new, reliable prognostic tool to identify the probability of death within six months in patients with chronic medical diseases. METHODS:This was a multicenter, prospective, observational study in 41 Spanish hospitals, which included 1778 patients with one or more of the following: advanced conditions such as heart failure, respiratory failure, chronic renal failure, chronic liver disease, and/or chronic neurological disease. All patients were followed over six months. Each factor independently associated with death in the derivation cohort (884 patients from eastern areas of Spain) was assigned a prognostic weight, and the score was calculated by summing up the factors. The score's accuracy in the validation cohort (894 patients from western areas of Spain) was assessed by analyzing its calibration and discriminative power; we also calculated sensitivity, specificity, and positive and negative predictive values. RESULTS:Mortality in the derivation/validation cohorts was 37.6%/37.7%, respectively. We identified six independent predictors of mortality (≥85 years, three points; New York Heart Association Class IV/Stage 4 dyspnea on the modified Medical Research Council, 3.5 points; anorexia, 3.5 points; presence of pressure ulcer(s), three points; Eastern Cooperative Oncology Group Performance Status of three or more, four points; and albuminemia ≤2.5g/dL, four points). Mortality in the derivation/validation cohorts according to risk group was 20%/21.5% for patients with zero points; 33%/30.5% for those with 3-3.5 points; 46.3%/43% for those with four to seven points; and 67%/61% for those who reached 7.5 or more points, respectively. The calibration was good (Hosmer-Lemeshow test, P=0.39), as was the discriminative power (area under the receiver operating characteristic curve of 0.69 [0.66-0.72]). The sensitivity (85%), specificity (86%), positive and negative predictive values (64% and 80%, respectively) at 180 days were high. CONCLUSION:The PALIAR score is a precise and reliable tool for identifying the end-of-life trajectory in patients with advanced medical diseases.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Bernabeu-Wittel M,Murcia-Zaragoza J,Hernández-Quiles C,Escolano-Fernández B,Jarava-Rol G,Oliver M,Díez-Manglano J,Ruiz-Cantero A,Ollero-Baturone M,PALIAR Researchers.doi
10.1016/j.jpainsymman.2013.04.011subject
Has Abstractpub_date
2014-03-01 00:00:00pages
551-65issue
3eissn
0885-3924issn
1873-6513pii
S0885-3924(13)00387-4journal_volume
47pub_type
杂志文章,多中心研究abstract:CONTEXT:Supplementary support services in palliative care for older people are increasingly common, but with neither recommended tools to measure outcomes nor reviews synthesizing anticipated outcomes. Common clinically focused tools may be less appropriate. OBJECTIVES:To identify stakeholder perceptions of key outcom...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
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abstract:CONTEXT:There is an increasing use of palliative care units (PCUs) for the treatment of terminally ill cancer patients. Thus, it is important to evaluate the care and quality of life of terminally ill cancer patients treated in PCUs so that improvements can be made. Limited research has investigated the quality of dyin...
journal_title:Journal of pain and symptom management
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abstract::In 2011, Rwanda's Ministry of Health set a goal of universal access to palliative care by 2020. Toward this audacious egalitarian and humanitarian goal, the Ministry of Health worked with partners to develop palliative care policies and a strategic plan, secure adequate supplies of opioid for the country, initiate pal...
journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2011.11.010
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journal_title:Journal of pain and symptom management
pub_type: 共识发展会议,杂志文章
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2011.08.007
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journal_title:Journal of pain and symptom management
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abstract:CONTEXT:Hospice care is traditionally used for patients with advanced cancer, but it is increasingly considered for patients with end-stage heart failure. OBJECTIVES:We compared enrollment patterns and clinical events of hospice patients with end-stage heart failure with those of patients with advanced cancer. METHOD...
journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2008.10.006
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abstract::To improve assessment and management of pain in nonverbal older adults with dementia, an effective means of recognizing and evaluating pain in this vulnerable population is needed. The purpose of this review is to critically evaluate the existing tools used for pain assessment in this population to provide recommendat...
journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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