Clinical Outcomes in Terminally Ill Patients Admitted to Hospice Care: Diagnostic and Therapeutic Interventions

Abstract

This study's aim was to determine the impact of medical technologies on patient comfort and survival time, through retrospective review of the clinical course, symptom profile, and illness trajectory in 102 consecutive patients (50 males and 52 females), and of diagnostic and therapeutic interventions delivered to them. The average age of males was 72.3 years and of females 73.1 years. Ninety-four patients were admitted for palliation of symptoms due to malignant disease and eight other patients for non-malignant diseases. The median survival time was 12 days. On admission, higher univariate hazard risks for survival were significantly associated with male gender, metastatic disease, and dyspnea. Higher adjusted Charlson comorbidity scores were associated with significantly decreased survival time, while de novo symptoms and diagnostic interventions were associated with lower univariate risk rates and increased survival times. Palliative therapeutic interventions were not significantly associated with increased patient survival. A multivariate analysis showed that pain, dyspnea, immobility, and adjusted Charlson comorbidity scores were independent risks for shorter patient survival times. Diagnostic interventions were significant for increased patient survival. No requests for euthanasia had been recorded, which may, in part, reflect the significant family support most of these patients had received. Resume I Cette etude visait adeterminer !'impact des technologies rnedlcales sur Ie confort des patients et sur leur temps de survie. Ainsi nous avons passe en revue les dossiers de 102 patients admis consecutivement (50 hommes, 52 femmes) afin de connaitre leur histoire clinique tels Ie profil des sympt6mes, la trajectoire de la maladie, Ie diagnostic et les interventions therapeutiques. L'age moyen des hommes etaient 72,3 ans et celui des femmes de 73,1. Des patients admis, 94 Ie furent pour Ie traitement palliatif des sympt6mes attribuables a une affection maligne et 8 autres pour des affections non-malignes. Le temps de survie en moyenne etalt de 12 jours. AI'admission, les risques univariables sieves de survie etalent pour une large part assocles aux hommes, aux maladies metastatlques et ala dyspnee, Les indices Charlson de comorbidite slevee etaient associes a une diminution significative du temps de survie; alors que les nouveaux symptomes et les interventions diagnostiques etaient assocles a des risques univariables bas de survie et une augmentation du temps de survie. Les interventions therapeutiques de nature palliative n'etalent pas associees aune augmentation du taux de survie des patients. Une analyse des multivariables a dernontre que la douleur, la dyspnee, l'lrnmobilite et les indices corriqes de cornorbidites de Charlson sont des risques qui n'ont aucun rapport avec un temps de survie plus court chez les patients. Les interventions diagnostiques ont un effet significatif sur Ie temps de survie des patients. Les dossiers n'indiquent aucune demande d'euthanasie, ce qui s'expliquerait par Ie fait que ce...

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