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Title:
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Identifying patients with advanced chronic conditions for a progressive palliative care approach: a crosssectional study of prognostic indicators related to end-of-life trajectories
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Author:
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Amblàs-Novellas, Jordi; Murray, Scott A.; Espaulella Panicot, Joan; Martori, Joan Carles; Oller, Ramon; Martínez-Muñoz, Marisa; Molist Brunet, Núria; Blay Pueyo, Carles; Gómez Batiste, Xavier
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Other authors:
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Universitat de Vic - Universitat Central de Catalunya. Departament d'Economia i Empresa; Universitat de Vic - Universitat Central de Catalunya. Càtedra de Cures Pal·liatives |
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Notes:
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Objectives: 2 innovative concepts have lately been
developed to radically improve the care of patients with
advanced chronic conditions (PACC): early
identification of palliative care (PC) needs and the 3
end-of-life trajectories in chronic illnesses (acute,
intermittent and gradual dwindling). It is not clear (1)
what indicators work best for this early identification
and (2) if specific clinical indicators exist for each of
these trajectories. The objectives of this study are to
explore these 2 issues.
Setting: 3 primary care services, an acute care
hospital, an intermediate care centre and 4 nursing
homes in a mixed urban–rural district in Barcelona,
Spain.
Participants: 782 patients (61.5% women) with a
positive NECPAL CCOMS-ICO test, indicating they
might benefit from a PC approach.
Outcome measures: The characteristics and
distribution of the indicators of the NECPAL CCOMSICO
tool are analysed with respect to the 3 trajectories
and have been arranged by domain (functional,
nutritional and cognitive status, emotional problems,
geriatric syndromes, social vulnerability and others)
and according to their static (severity) and dynamic
(progression) properties.
Results: The common indicators associated with early
end-of-life identification are functional (44.3%) and
nutritional (30.7%) progression, emotional distress
(21.9%) and geriatric syndromes (15.7% delirium,
11.2% falls). The rest of the indicators showed
differences in the associations per illness trajectories
(p<0.05). 48.2% of the total cohort was identified as
advanced frailty patients with no advanced disease
criteria.
Conclusions: Dynamic indicators are present in the 3
trajectories and are especially useful to identify PACC
for a progressive PC approach purpose. Most of the
other indicators are typically associated with a specific
trajectory. These findings can help clinicians improve
the identification of patients for a palliative approach. |
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Subject(s):
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-Càncer -- Tractament pal·liatiu
-Càncer -- Pacients
-Tractament pal·liatiu
-Malalts crònics |
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Rights:
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Aquest document està subjecte a aquesta llicència Creative Commons
http://creativecommons.org/licenses/by-nc/4.0/
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Document type:
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Article
info:eu-repo/publishedVersion |
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Published by:
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BMJ Publishing
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Share:
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