Palliative Care Unit Admission Research Articles

Impact of Palliative Care Unit Admission on Symptom Control Evaluated by the Edmonton Symptom Assessment System

The aim of the present study was to evaluate the impact of palliative care on patients' symptoms, using the Edmonton Symptom Assessment System (ESAS) to measure symptom intensity at the time of admission and variations registered during the first 7 days' hospitalization. Three hundred fourteen patients were admitted to the unit during its first year of activity. Of these, 162 patients (51.6%) completed, 62 (19.7%) partially completed, and 90 (28.7%) did not complete the ESAS. The mean (±SD) value of the Symptom Distress Score (SDS) (sum of the values of the different symptoms) for the 162 evaluable patients on Day 1 was 33.93 (±16.24). On Day 7 the mean was 28.14 (±15.11) (ANOVA for repeated measurements, P < 0.0001). ESAS values for patients with moderate-severe symptom intensity (average values Day 1–Day 7 and P value, ANOVA for repeated measurements) were as follows: pain (7.12–4.23, P < 0.0001), fatigue (7.46–5.68, P < 0.0001), nausea (7.12–1.96, P < 0.0001), depression (7.26–5.28, P < 0.0001), anxiety (7.13–5.14, P < 0.0001), drowsiness (7.42–6.40, P = 0.002), anorexia (7.33–4.33, P < 0.0001), well-being (6.83–3.85, P < 0.0001), and dyspnea (7.08–3.86, P < 0.0001). These data seem to indicate that the patients who benefit most from inpatient palliative care are those with the most complex symptomatology.

Changes in Medical and Nursing Care in Cancer Patients Transferred from a Palliative Care Team to a Palliative Care Unit

The primary aim of this study was to explore the changes in medical/nursing care in patients who transferred from a palliative care team (PCT) to a palliative care unit (PCU) in the same hospital, and to explore the reasons why new or modified interventions were required. This was a retrospective study of 50 consecutive patients who were transferred from PCT to PCU in a 750-bed general hospital. A trained nurse performed a chart review and recorded the changes in 1) medical/nursing care, 2) help with decision-making within 48 hours after PCU admission, and 3) documentation of family and psycho-existential care. Group discussions among PCT and PCU staff members explored the potential reasons for the changes. Five patients were excluded due to admission periods of shorter than 48 hours. The number of new/modified medical and nursing care interventions after PCU admission averaged 1.9 ± 1.5 and 1.5 ± 1.3 per patient, respectively. The most common medical treatments were: reduction in hydration volume, dose titration of opioids, change in opioid administration device, opioid rotation, and addition of NSAIDs and steroids. The most common nursing interventions were: allowing patient to take a bath, changing mattress, use of massage, and discontinuation of bronchial suctioning. In addition, PCU staff newly coordinated opportunities to discuss preferred end-of-life care with primary caregivers in 38% of the cases, family members other than primary caregivers in 16%, and patients in 6.7%. The chart documentation of family care and psycho-existential care increased considerably after PCU admission. The chief reasons for these changes were: under-recognition of the problems and unavailability of treatments (pharmacological treatments), no intention to intervene and recommendations not followed by primary physicians (rehydration therapy), no intention to intervene (nursing care), and no intention to intervene and under-recognition of the problems (help with decision-making). These data demonstrate that many patients under PCT consultation receive new or modified interventions after PCU admission. Potentially useful strategies to strengthen the PCT interventions are: modification of intervention structure to minimize under-recognition of symptoms and decision making problems (e.g., use of standardized assessment tools, regular conferences), changes in the health care system to allow unlicensed drugs, clinical studies to clarify the benefits of artificial hydration therapy, and greater efforts to intervene in the areas of nursing care, help with decision making, family care, and psycho-existential care.

The impact of a palliative care service on overall hospital mortality in a comprehensive cancer center

8034 Background: Dying in a hospital, particularly on an intensive care unit (ICU), can be traumatic for patients and families. Palliative care services (PCS) and a palliative care unit (PCU) improve severe physical and psychosocial symptoms, but they are not available in the majority of cancer centers and tertiary hospitals. The purpose of this paper is to review the impact of a PCS/PCU on overall hospital mortality at the University of Texas M.D. Anderson Cancer Center. Methods: We reviewed inpatient hospital deaths (including number of deaths, hospital location of death, and medical service), hospital discharges, and medical service information from the years 1999–2003. We determined the number of patients who accessed PCS before death (via consults or PCU admission). The Cochran-Armitage Trend Test was used to test for trends over time. Results: See table below. Conclusions: Establishment of PCS and PCU resulted in no significant increase in hospital mortality or length of stay. Coordinated efforts between PCS, ICU, and an ethics consult service resulted in a decrease in ICU deaths. By 2003, PCS had increased significantly. No significant financial relationships to disclose.

The impact of a palliative care service on overall hospital mortality in a comprehensive cancer center

8034 Background: Dying in a hospital, particularly on an intensive care unit (ICU), can be traumatic for patients and families. Palliative care services (PCS) and a palliative care unit (PCU) improve severe physical and psychosocial symptoms, but they are not available in the majority of cancer centers and tertiary hospitals. The purpose of this paper is to review the impact of a PCS/PCU on overall hospital mortality at the University of Texas M.D. Anderson Cancer Center. Methods: We reviewed inpatient hospital deaths (including number of deaths, hospital location of death, and medical service), hospital discharges, and medical service information from the years 1999–2003. We determined the number of patients who accessed PCS before death (via consults or PCU admission). The Cochran-Armitage Trend Test was used to test for trends over time. Results: See table below. Conclusions: Establishment of PCS and PCU resulted in no significant increase in hospital mortality or length of stay. Coordinated efforts between PCS, ICU, and an ethics consult service resulted in a decrease in ICU deaths. By 2003, PCS had increased significantly. No significant financial relationships to disclose.

Major Depression, Adjustment Disorders, and Post-Traumatic Stress Disorder in Terminally Ill Cancer Patients: Associated and Predictive Factors

Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally. Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated. The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up. The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.