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Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy
Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. To explore the characteristics of non-cancer...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222892/ https://www.ncbi.nlm.nih.gov/pubmed/35742082 http://dx.doi.org/10.3390/healthcare10061031 |
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author | Romanò, Massimo Oldani, Sabina Reina, Valter Sofia, Michele Castiglioni, Claudia |
author_facet | Romanò, Massimo Oldani, Sabina Reina, Valter Sofia, Michele Castiglioni, Claudia |
author_sort | Romanò, Massimo |
collection | PubMed |
description | Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. To explore the characteristics of non-cancer patients receiving PC in northern Italy, as well as the features and outcomes of their care, we retrospectively analyzed the charts of all non-cancer patients initiating PC regimens during 2019 in three publicly funded PC departments in Italy’s populous Lombardy region. We recorded the baseline variables (including data collected with the NECPAL CCOMS-ICO-derived questionnaire used since 2018 to evaluate all admissions to the region’s PC network), as well as treatment features (setting and duration) and outcomes (including time and setting of death). Of the 2043 patients admitted in 2019, only 12% (243 patients—131 females; mean age 83.5 years) had non-oncological primary diagnoses (mainly dementia [n = 78], heart disease [n = 55], and lung disease [n = 30]). All 243 had Karnofsky performance statuses ≤ 40% (10–20% in 64%); most (82%) were malnourished, 92% had ≥2 comorbidities, and 61% reported 2–3 severe symptoms (pain, dyspnea, and fatigue). Fifteen withdrew or were discharged from the study PCN; the other 228 remained in the PCN and died in hospice (n = 133), at home (n = 9), or after family-requested transfer to an emergency department (n = 1). Most deaths (172/228, 75%) occurred <3 weeks after PC initiation. These findings indicate that the PCN network we studied cares for few patients with life-limiting non-malignant diseases. Those admitted have advanced-stage illness, heavy symptom burdens, low performance statuses, and poor survival. Additional efforts are needed to improve PCN accessibility for non-cancer patients. |
format | Online Article Text |
id | pubmed-9222892 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-92228922022-06-24 Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy Romanò, Massimo Oldani, Sabina Reina, Valter Sofia, Michele Castiglioni, Claudia Healthcare (Basel) Article Patients with irreversible malignant and non-malignant diseases have comparable mortality rates, symptom burdens, and quality of life issues; however, non-cancer patients seldom receive palliative care (PC) or receive it late in their disease trajectory. To explore the characteristics of non-cancer patients receiving PC in northern Italy, as well as the features and outcomes of their care, we retrospectively analyzed the charts of all non-cancer patients initiating PC regimens during 2019 in three publicly funded PC departments in Italy’s populous Lombardy region. We recorded the baseline variables (including data collected with the NECPAL CCOMS-ICO-derived questionnaire used since 2018 to evaluate all admissions to the region’s PC network), as well as treatment features (setting and duration) and outcomes (including time and setting of death). Of the 2043 patients admitted in 2019, only 12% (243 patients—131 females; mean age 83.5 years) had non-oncological primary diagnoses (mainly dementia [n = 78], heart disease [n = 55], and lung disease [n = 30]). All 243 had Karnofsky performance statuses ≤ 40% (10–20% in 64%); most (82%) were malnourished, 92% had ≥2 comorbidities, and 61% reported 2–3 severe symptoms (pain, dyspnea, and fatigue). Fifteen withdrew or were discharged from the study PCN; the other 228 remained in the PCN and died in hospice (n = 133), at home (n = 9), or after family-requested transfer to an emergency department (n = 1). Most deaths (172/228, 75%) occurred <3 weeks after PC initiation. These findings indicate that the PCN network we studied cares for few patients with life-limiting non-malignant diseases. Those admitted have advanced-stage illness, heavy symptom burdens, low performance statuses, and poor survival. Additional efforts are needed to improve PCN accessibility for non-cancer patients. MDPI 2022-06-02 /pmc/articles/PMC9222892/ /pubmed/35742082 http://dx.doi.org/10.3390/healthcare10061031 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Romanò, Massimo Oldani, Sabina Reina, Valter Sofia, Michele Castiglioni, Claudia Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy |
title | Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy |
title_full | Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy |
title_fullStr | Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy |
title_full_unstemmed | Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy |
title_short | Palliative Care for Patients with End-Stage, Non-Oncologic Diseases—A Retrospective Study in Three Public Palliative Care Departments in Northern Italy |
title_sort | palliative care for patients with end-stage, non-oncologic diseases—a retrospective study in three public palliative care departments in northern italy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222892/ https://www.ncbi.nlm.nih.gov/pubmed/35742082 http://dx.doi.org/10.3390/healthcare10061031 |
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