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Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital

BACKGROUND: Home hospitalization at the end of life can sometimes be perturbed by unplanned hospital admissions (UHAs, defined as any admission that is not part of a preplanned care procedure), which increase the likelihood of death in hospital. The objectives were to describe the occurrence and cau...

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Autores principales: Gamblin, Vincent, Prod’homme, Chloé, Lecoeuvre, Adrien, Bimbai, André -Michel, Luu, Joël, Hazard, Pierre-Alexandre, Da Silva, Arlette, Villet, Stéphanie, Le Deley, Marie-Cécile, Penel, Nicolas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839201/
https://www.ncbi.nlm.nih.gov/pubmed/33499835
http://dx.doi.org/10.1186/s12904-021-00720-7
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author Gamblin, Vincent
Prod’homme, Chloé
Lecoeuvre, Adrien
Bimbai, André -Michel
Luu, Joël
Hazard, Pierre-Alexandre
Da Silva, Arlette
Villet, Stéphanie
Le Deley, Marie-Cécile
Penel, Nicolas
author_facet Gamblin, Vincent
Prod’homme, Chloé
Lecoeuvre, Adrien
Bimbai, André -Michel
Luu, Joël
Hazard, Pierre-Alexandre
Da Silva, Arlette
Villet, Stéphanie
Le Deley, Marie-Cécile
Penel, Nicolas
author_sort Gamblin, Vincent
collection PubMed
description BACKGROUND: Home hospitalization at the end of life can sometimes be perturbed by unplanned hospital admissions (UHAs, defined as any admission that is not part of a preplanned care procedure), which increase the likelihood of death in hospital. The objectives were to describe the occurrence and causes of UHAs in cancer patients receiving end-of-life care at home, and to identify factors associated with UHAs and death in hospital. METHODS: A retrospective, single-center study (performed at a regional cancer center in the city of Lille, northern France) of advanced cancer patients discharged to home hospitalization between January 2014 and December 2017. We estimated the incidence of UHA over time using Kaplan-Meier method and Kalbfleish and Prentice method. We investigated factors associated with the risk UHA in cause-specific Cox models. We evaluated factors associated with death in hospital in logistic regressions. RESULTS: One hundred and forty-two patients were included in the study. Eighty-two patients (57.7 %) experienced one or more UHAs, a high proportion of which occurred within 1 month after discharge to home. Most UHAs were related to physical symptoms and were initiated by the patient’s family physician. A post-discharge palliative care consultation was associated with a significantly lower incidence of UHAs. Sixty-five patients (47.8 % of the deaths) died in hospital. In a multivariate analysis, living alone and the presence of one or more children at home were associated with death in hospital. CONCLUSIONS: More than 40 % of cancer patients receiving end of life home hospitalization were not readmitted to hospital, reflecting the effectiveness of this type of palliative care setting. However, over half of the UHAs were due to an acute intercurrent event. Our results suggest that more efforts should be focused on anticipating these events at home – primarily via better upstream coordination between hospital physicians and family physicians.
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spelling pubmed-78392012021-01-27 Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital Gamblin, Vincent Prod’homme, Chloé Lecoeuvre, Adrien Bimbai, André -Michel Luu, Joël Hazard, Pierre-Alexandre Da Silva, Arlette Villet, Stéphanie Le Deley, Marie-Cécile Penel, Nicolas BMC Palliat Care Research Article BACKGROUND: Home hospitalization at the end of life can sometimes be perturbed by unplanned hospital admissions (UHAs, defined as any admission that is not part of a preplanned care procedure), which increase the likelihood of death in hospital. The objectives were to describe the occurrence and causes of UHAs in cancer patients receiving end-of-life care at home, and to identify factors associated with UHAs and death in hospital. METHODS: A retrospective, single-center study (performed at a regional cancer center in the city of Lille, northern France) of advanced cancer patients discharged to home hospitalization between January 2014 and December 2017. We estimated the incidence of UHA over time using Kaplan-Meier method and Kalbfleish and Prentice method. We investigated factors associated with the risk UHA in cause-specific Cox models. We evaluated factors associated with death in hospital in logistic regressions. RESULTS: One hundred and forty-two patients were included in the study. Eighty-two patients (57.7 %) experienced one or more UHAs, a high proportion of which occurred within 1 month after discharge to home. Most UHAs were related to physical symptoms and were initiated by the patient’s family physician. A post-discharge palliative care consultation was associated with a significantly lower incidence of UHAs. Sixty-five patients (47.8 % of the deaths) died in hospital. In a multivariate analysis, living alone and the presence of one or more children at home were associated with death in hospital. CONCLUSIONS: More than 40 % of cancer patients receiving end of life home hospitalization were not readmitted to hospital, reflecting the effectiveness of this type of palliative care setting. However, over half of the UHAs were due to an acute intercurrent event. Our results suggest that more efforts should be focused on anticipating these events at home – primarily via better upstream coordination between hospital physicians and family physicians. BioMed Central 2021-01-26 /pmc/articles/PMC7839201/ /pubmed/33499835 http://dx.doi.org/10.1186/s12904-021-00720-7 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Gamblin, Vincent
Prod’homme, Chloé
Lecoeuvre, Adrien
Bimbai, André -Michel
Luu, Joël
Hazard, Pierre-Alexandre
Da Silva, Arlette
Villet, Stéphanie
Le Deley, Marie-Cécile
Penel, Nicolas
Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital
title Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital
title_full Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital
title_fullStr Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital
title_full_unstemmed Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital
title_short Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital
title_sort home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839201/
https://www.ncbi.nlm.nih.gov/pubmed/33499835
http://dx.doi.org/10.1186/s12904-021-00720-7
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