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Quality of transition to end-of-life care for cancer patients in the intensive care unit

BACKGROUND: There have been few studies that have evaluated the quality of end-of-life care (EOLC) for cancer patients in the ICU. The aim of this study was to explore the quality of transition to EOLC for cancer patients in ICU. METHODS: The study was undertaken on medical patients admitted to a sp...

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Autores principales: Miller, Sophie J, Desai, Nishita, Pattison, Natalie, Droney, Joanne M, King, Angela, Farquhar-Smith, Paul, Gruber, Pascale C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Paris 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513017/
https://www.ncbi.nlm.nih.gov/pubmed/26205668
http://dx.doi.org/10.1186/s13613-015-0059-7
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author Miller, Sophie J
Desai, Nishita
Pattison, Natalie
Droney, Joanne M
King, Angela
Farquhar-Smith, Paul
Gruber, Pascale C
author_facet Miller, Sophie J
Desai, Nishita
Pattison, Natalie
Droney, Joanne M
King, Angela
Farquhar-Smith, Paul
Gruber, Pascale C
author_sort Miller, Sophie J
collection PubMed
description BACKGROUND: There have been few studies that have evaluated the quality of end-of-life care (EOLC) for cancer patients in the ICU. The aim of this study was to explore the quality of transition to EOLC for cancer patients in ICU. METHODS: The study was undertaken on medical patients admitted to a specialist cancer hospital ICU over 6 months. Quantitative and qualitative methods were used to explore quality of transition to EOLC using documentary evidence. Clinical parameters on ICU admission were reviewed to determine if they could be used to identify patients who were likely to transition to EOLC during their ICU stay. RESULTS: Of 85 patients, 44.7% transitioned to EOLC during their ICU stay. Qualitative and quantitative analysis of the patients’ records demonstrated that there was collaborative decision-making between teams, patients and families during transition to EOLC. However, 51.4 and 40.5% of patients were too unwell to discuss transition to EOLC and DNACPR respectively. In the EOLC cohort, 76.3% died in ICU, but preferred place of death known in only 10%. Age, APACHE II score, and organ support, but not cancer diagnosis, were identified as associated with transition to EOLC (p = 0.017, p < 0.0001 and p = 0.001). CONCLUSIONS: Advanced EOLC planning in patients with progressive disease prior to acute deterioration is warranted to enable patients’ wishes to be fulfilled and ceiling of treatments agreed. Better documentation and development of validated tools to measure the quality EOLC transition on the ICU are needed.
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spelling pubmed-45130172015-07-27 Quality of transition to end-of-life care for cancer patients in the intensive care unit Miller, Sophie J Desai, Nishita Pattison, Natalie Droney, Joanne M King, Angela Farquhar-Smith, Paul Gruber, Pascale C Ann Intensive Care Research BACKGROUND: There have been few studies that have evaluated the quality of end-of-life care (EOLC) for cancer patients in the ICU. The aim of this study was to explore the quality of transition to EOLC for cancer patients in ICU. METHODS: The study was undertaken on medical patients admitted to a specialist cancer hospital ICU over 6 months. Quantitative and qualitative methods were used to explore quality of transition to EOLC using documentary evidence. Clinical parameters on ICU admission were reviewed to determine if they could be used to identify patients who were likely to transition to EOLC during their ICU stay. RESULTS: Of 85 patients, 44.7% transitioned to EOLC during their ICU stay. Qualitative and quantitative analysis of the patients’ records demonstrated that there was collaborative decision-making between teams, patients and families during transition to EOLC. However, 51.4 and 40.5% of patients were too unwell to discuss transition to EOLC and DNACPR respectively. In the EOLC cohort, 76.3% died in ICU, but preferred place of death known in only 10%. Age, APACHE II score, and organ support, but not cancer diagnosis, were identified as associated with transition to EOLC (p = 0.017, p < 0.0001 and p = 0.001). CONCLUSIONS: Advanced EOLC planning in patients with progressive disease prior to acute deterioration is warranted to enable patients’ wishes to be fulfilled and ceiling of treatments agreed. Better documentation and development of validated tools to measure the quality EOLC transition on the ICU are needed. Springer Paris 2015-07-25 /pmc/articles/PMC4513017/ /pubmed/26205668 http://dx.doi.org/10.1186/s13613-015-0059-7 Text en © Miller et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Miller, Sophie J
Desai, Nishita
Pattison, Natalie
Droney, Joanne M
King, Angela
Farquhar-Smith, Paul
Gruber, Pascale C
Quality of transition to end-of-life care for cancer patients in the intensive care unit
title Quality of transition to end-of-life care for cancer patients in the intensive care unit
title_full Quality of transition to end-of-life care for cancer patients in the intensive care unit
title_fullStr Quality of transition to end-of-life care for cancer patients in the intensive care unit
title_full_unstemmed Quality of transition to end-of-life care for cancer patients in the intensive care unit
title_short Quality of transition to end-of-life care for cancer patients in the intensive care unit
title_sort quality of transition to end-of-life care for cancer patients in the intensive care unit
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513017/
https://www.ncbi.nlm.nih.gov/pubmed/26205668
http://dx.doi.org/10.1186/s13613-015-0059-7
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