Abstract
Purpose
Discharging a patient admitted to an inpatient palliative care unit (PCU) is a major challenge. A predictor of the feasibility of home discharge at the time of admission would be very useful. We tried to identify such predictors in a prospective observational study.
Methods
Sixty patients with advanced cancer admitted to a PCU were enrolled. Sociodemographic data were recorded and a panel of laboratory tests performed. The Karnofsky performance status scale (KPS) and the palliative performance scale (PPS) were determined. A palliative care physician and nurse independently predicted whether the patient would die at the ward. The association of these variables with home discharge or death at the PCU was determined.
Results
Sixty patients (26 men and 34 women) with advanced cancer were included in the study. Discharge was achieved in 45 % of patients, while 55 % of patients died at the PCU. The median stay of discharged patients was 15.2 days, and the median stay of deceased patients 13.6 days. Median KPS and PPS on admission was 56.2 % for the entire group and significantly higher for discharged patients (60.7 %) compared to deceased patients (52.4 %). Median BMI on admission was 22.8 in the entire group and was similar in discharged and deceased patients. No correlation was found between a panel of sociodemographic variables and laboratory tests with regard to discharge or death. In a binary logistic regression model, the probability of discharge as estimated by the nurse/physician and the KPS and PPS were highly significant (p = 0.008).
Conclusion
Estimation by a nurse and a physician were highly significant predictors of the likelihood of discharge and remained significant in a multivariate logistic regression model including KPS and PPS. Other variables, such as a panel of laboratory tests or sociodemographic variables, were not associated with discharge or death.
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References
Alonso-Babarro A, Bruera E, Varela-Cerdeira M, Boya-Cristia MJ, Madero R, Torres-Vigil I, De Castro J, Gonzalez-Baron M (2011) Can this patient be discharged home? Factors associated with at-home death among patients with cancer. J Clin Oncol 29:1159–1167
Anderson F, Downing GM, Hill J, Casorso L, Lerch N (1996) Palliative performance scale (PPS): a new tool. J Palliat Care 12:5–11
Burki TK (2012) End-of-life discussions are being left too late. Lancet Oncol 13:e94
Fainsinger RL, Demoissac D, Cole J, Mead-Wood K, Lee E (2000) Home versus hospice inpatient care: discharge characteristics of palliative care patients in an acute care hospital. J Palliat Care 16:29–34
Fairchild A, Debenham B, Danielson B, Huang F, Ghosh S (2013) Comparative multidisciplinary prediction of survival in patients with advanced cancer. Support Care Cancer 18:18
Glare P, Sinclair C, Downing M, Stone P, Maltoni M, Vigano A (2008) Predicting survival in patients with advanced disease. Eur J Cancer (Oxford, England : 1990) 44:1146–1156
Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ (2013) Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 6
Harrold J, Rickerson E, Carroll JT, McGrath J, Morales K, Kapo J, Casarett D (2005) Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population? J Palliat Med 8:503–509
Hladschik-Kermer B, Kierner KA, Heck U, Miksovsky A, Reiter B, Zoidl H, Medicus E, Masel EK, Watzke HH (2013) Patients and staff perceptions of cancer patients’ quality of life. Eur J Oncol Nurs 17:70–74
Kutner JS, Blake M, Meyer SA (2002) Predictors of live hospice discharge: data from the National Home and Hospice Care Survey (NHHCS). Am J Hosp Palliat Care 19:331–337
Kutner JS, Meyer SA, Beaty BL, Kassner CT, Nowels DE, Beehler C (2004) Outcomes and characteristics of patients discharged alive from hospice. J Am Geriatr Soc 52:1337–1342
Lusardi P, Jodka P, Stambovsky M, Stadnicki B, Babb B, Plouffe D, Doubleday N, Pizlak Z, Walles K, Montonye M (2011) The going home initiative: getting critical care patients home with hospice. Crit Care Nurse 31:46–57
McManus W, Khodabukus A, Hayle C, Ahmad F, Lewis-Jones C (2014) Is the specialist palliative care multidisciplinary team (mdt) able to provide more accurate prognostication than non-specialist medical professionals? BMJ Support Palliat Care 4:2014–000654
Morita T, Tsunoda J, Inoue S, Chihara S (1999) Validity of the palliative performance scale from a survival perspective. J Pain Symptom Manage 18(1):2–3
Narducci F, Grande R, Mentuccia L, Trapasso T, Sperduti I, Magnolfi E, Fariello AM, Gemma D, Gamucci T (2012) Symptom improvement as prognostic factor for survival in cancer patients undergoing palliative care: a pilot study. Support Care Cancer 20:1221–1226
Pleschberger S (2012) Zu Hause Sterben zwischen Wunsch und Wirklichkeit (German). In: Wegleitner K, Heimerl K, Heller A (eds) Der Tod haelt sich nicht an Dienstplaene. Sterben zu Hause. Der Hospiz Verlag, Wuppertal, pp 106–118
Sampson C, Finlay I, Byrne A, Snow V, Nelson A (2014) The practice of palliative care from the perspective of patients and carers. BMJ Support Palliat Care 16:2013–000551
Sasahara T, Watakabe A, Aruga E, Fujimoto K, Higashi K, Hisahara K, Hori N, Ikenaga M, Izawa T, Kanai Y, Kinoshita H, Kobayakawa M, Kobayashi K, Kohara H, Namba M, Nozaki-Taguchi N, Osaka I, Saito M, Sekine R, Shinjo T, Suga A, Tokuno Y, Yamamoto R, Yomiya K, Morita T (2013) Assessment of reasons for referral and activities of hospital palliative care teams using a standard format: a multicenter 1000 case description. J Pain Symptom Manage 21:00337–00330
Schag CC, Heinrich RL, Ganz PA (1984) Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 2:187–193
Solano JP, Gomes B, Higginson IJ (2006) A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 31:58–69
Sonoda H, Yamaguchi T, Matsumoto M, Hisahara K (2013) Validation of the Palliative prognostic index and palliative prognostic score in a palliative care consultation team setting for patients with advanced cancers in an acute care hospital in Japan. Am J Hosp Palliat Care 26:26
Stone CA, Tiernan E, Dooley BA (2008) Prospective validation of the palliative prognostic index in patients with cancer. J Pain Symptom Manage 35:617–622
Stone P, Gwilliam B, Keeley V, Todd C, Gittins M, Kelly L, Barclay S, Roberts C (2012) Patients’ reports or clinicians’ assessments: which are better for prognosticating? BMJ Support Palliat Care 2:219–223
Virik K, Glare P (2002) Validation of the palliative performance scale for inpatients admitted to a palliative care unit in Sydney. Australia. J Pain Symptom Manage 23(6):455–457
Vries K, Wells J, Plaskota M (2012) Evaluation of an admission and discharge programme at a UK specialist palliative day hospice. Int J Palliat Nurs 18:275–281
Yates JW, Chalmer B, McKegney FP (1980) Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 45:2220–2224
Zulehner PM, Becker B (1991) Sterben und Sterben zulassen (German). Patmos, Duesseldorf
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Masel, E.K., Huber, P., Schur, S. et al. Coming and going: predicting the discharge of cancer patients admitted to a palliative care unit: easier than thought?. Support Care Cancer 23, 2335–2339 (2015). https://doi.org/10.1007/s00520-015-2601-4
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DOI: https://doi.org/10.1007/s00520-015-2601-4