Background
Methods
Study design
Eligibility criteria
Study objectives and endpoints
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Acute intercurrent event : any acute pathology, which may be due to a sudden decompensation of an underlying medical condition, or an unexpected occurrence of an acute medical condition.
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Uncontrolled or refractory symptoms : main symptoms of discomfort already present at the time of initial hospitalization, and which showed a gradual worsening, rapid or not, requiring the patient’s unplanned hospitalization.
Statistical analysis
Results
Study population
Parameters | Categories | n | % |
---|---|---|---|
Sex | Men | 54 | 38.0 |
Age | < 50 [50–65] > 65 | 27 60 55 | 19.0 42.3 38.7 |
Karnofsky Index at the time of initial hospital discharge | 10%20%30%40%50%60% | 1186041175 | 0.712.742.328.912.03.5 |
Primary tumor site (MD = 3) | Breast Head and neck Digestive Gynecological Lung Urological Sarcoma / other | 41 28 21 16 14 11 8 | 28.9 19.7 14.8 11.3 9.9 7.7 5.6 |
Current home (MD = 4) | Patient’s own home Relatives’ home Nursing home/other | 122 14 2 | 88.4 10.1 1.5 |
Marital status (MD = 8) | Married Divorced Widow(er) Single Living together | 85 16 14 11 8 | 63.4 11.9 10.4 8.2 6.0 |
Patient living alone (MD = 1) | Yes | 28 | 19.9 |
Caregiver at home (MD = 21) | Yes | 103 | 85.1 |
One or more children at home (MD = 2) | Yes | 25 | 17.9 |
Initial discharge from | Medical oncology department Hospital palliative care unit | 88 54 | 62.0 38.0 |
Length of hospital stay before discharge | < 8 days [8-21] > 21 | 46 68 28 | 32.4 47.9 19.7 |
Assessment by the mobile hospital’s palliative care team before discharge (MD = 54) | Yes | 38 | 43.2 |
Psycho-oncology consultation (MD = 1) | Yes | 38 | 27.0 |
Written advance directives | Yes | 7 | 4.9 |
Pre-emptive prescription of sedation | Yes | 24 | 16.9 |
First UHA
Variables | Categories | n | % |
---|---|---|---|
Number of UHAs | 0 1 >=2 | 60 54 28 | 42.3 38.0 19.7 |
Admission to (MD = 1) | Palliative care unit Emergency room Medical oncology department Another unit | 33 31 15 2 | 40.7 38.3 18.5 2.5 |
Admission requested by (MD = 23) | A family physician Hospital staff A nurse The patient’s family A home hospitalization coordinating physician | 21 18 13 5 2 | 35.6 30.5 22.0 8.5 3.4 |
Causes (MD = 2) | Acute intercurrent or new event: o Cardiovascular event o Digestive event o Pain o Hemorrhage o Infection o Delirium o Dyspnea o Iatrogenic event Uncontrolled or refractory symptoms: o Pain o Dyspnea Intervention requiring technical expertise: o Blood transfusion o Other Decline in general condition Caregiver burnout Other causes | 45 1 8 3 1 10 7 13 2 9 5 4 9 2 7 5 5 7 | 56.3 11.3 11.3 6.3 6.3 8.7 |
Outcome of hospital stay after the UHA | Home hospitalization Death Transfer to another hospital | 40 40 2 | 48.8 48.8 2.4 |
Parameters | Categories | n | Univariate analysis of the risk of UHA | Multivariate analysis of the risk of UHA(1) | ||
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Crude cs-HR (95 %-CI) | p | Adjusted cs-HR (95 %-CI) | p | |||
At the time of initial hospital discharge | ||||||
Sex | Women Men | 88 54 | 1 1.28 (0.82–2.03) | 0.28 | - | |
Age (/10 years) | 142 | 0.98 (0.83–1.18) | 0.90 | - | ||
Karnofsky index | ≤ 30 % > 30 % | 79 63 | 1 0.97 (0.63–1.51) | 0.91 | - | |
Primary tumor site | Breast Head and neck Digestive Gynecological Lung Urological Sarcoma / other | 41 28 21 16 14 11 8 | 1 1.24 (0.60–2.34) 2.70 (1.33–5.49) 1.61 (0.78–3.33) 1.35 (0.55–3.35) 1.78 (0.71–4.45) 1.88 (0.71–4.98) | 0.20 | - | |
Home | Patient’s home Other | 122 16 | 1.25 (0.54–2.88) 1 | 0.61 | - | |
Marital status | Single Married/Living together | 41 93 | 1 0.91 (0.56–1.45) | 0.68 | - | |
Patient living alone | No Yes | 113 28 | 1 1.30 (0.78–2.19) | 0.32 | - | |
Caregiver at home | No Yes | 18 103 | 1 1.11 (0.58–2.13) | 0.75 | - | |
One or more children at home | No Yes | 115 25 | 1 0.93 (0.54–1.61) | 0.79 | - | |
Initial discharge from | Medical oncology dept. Palliative care unit | 88 54 | 1 1.35 (0.86–2.12) | 0.19 | 1 1.99 (1.21–3.27) | 0.006 |
Length of hospital stay before discharge | Per 10-day increment | 142 | 1.09 (0.93–1.27) | 0.30 | - | |
Psycho-oncology consultation | No Yes | 103 38 | 1 0.85 (0.53–1.37) | 0.51 | - | |
Written advance directives | No Yes | 135 7 | 1 0.93 (0.34–2.55) | 0.89 | - | |
Preemptive prescription of end-life sedation | No Yes | 118 24 | 1 0.82 (0.42–1.60) | 0.57 | - | |
After initial hospital discharge | ||||||
Palliative care consultation | No Yes | 124 15 | 1 0.46 (0.23–0.92) | 0.03 | 1 0.35 (0.16–0.75) | 0.007 |
Frequency of visits by a family physician | 1 per 10-day increment | 142 | 1.36 (1.23–1.50) | < 0.001 | 1.37 (1.24–1.52) | < 0.001 |
Multiple UHAs and total duration of home hospitalization
Place of death and overall survival duration
Parameters | Categories | n | Crude OR (95 %CI) | p | Adjusted OR1 (95 %-CI) | p |
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Sex | Women Men | 83 53 | 1 0.96 (0.48–1.91) | 0.91 | ||
Age (/10 years) | 136 | 0.82 (0.63–1.07) | 0.15 | 0.89 (0.63–1.26) | 0.51 | |
Karnofsky index | ≤ 30 % > 30 % | 79 57 | 1 2.02 (1.01–4.03) | 0.046 | 1 2.04 (0.92–4.56) | 0.08 |
Primary tumor site | Breast Head and neck Digestive Gynecological Lung Urological Sarcoma / other | 40 26 20 15 14 11 8 | 1 0.78 (0.29–2.09) 0.74 (0.25–2.17) 0.79 (0.24–2.60) 0.90 (0.27–3.06) 0.75 (0.19–2.88) 0.54 (0.11–2.58) | 1.0 | ||
Home | Patient home Other | 117 14 | 3.86 (1.02–14.6) 1 | 0.046 | 2.66 (0.64–11.1) 1 | 0.18 |
Marital status | Single Other | 40 89 | 1 0.66 (0.31–1.41) | 0.29 | ||
Patient living alone | No Yes | 108 27 | 1 2.59 (1.07–6.29) | 0.035 | 1 2.70 (1.01–7.2) | 0.047 |
Caregiver at home | No Yes | 15 100 | 1 1.01 (0.34-3.00) | 0.98 | ||
One or more children at home | No Yes | 112 22 | 1 3.55 (1.29–9.76) | 0.014 | 1 3.86 (1.14–13.1) | 0.003 |
Initial discharge from | Medical oncology dept. Palliative care unit | 82 54 | 1 1.03 (0.51–2.03) | 0.95 | ||
Length of hospital stay before discharge | Per 10-day increment | 136 | 1.20 (0.92–1.57) | 0.17 | 1.19 (0.86–1.64) | 0.30 |
Psycho-oncology consultation | No Yes | 99 36 | 1 2.04 (0.94–4.46) | 0.07 | 1 1.80 (0.75–4.32) | 0.19 |
Written advance directives | No Yes | 129 7 | 1 1.48 (0.32–6.90) | 0.61 | ||
Preemptive prescription of end-life sedation | No Yes | 112 24 | 1 0.60 (0.24–1.48) | 0.27 |