Characteristics of patients with an unplanned admission to an acute palliative care unit
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The aim of this cohort study is to compare the symptom burden of patients who have an unplanned admission to an acute palliative care unit (APCU) with patients who have a regular planned admission. A consecutive sample of advanced cancer patients who were admitted to an APCU was prospectively assessed. The reasons and the kind of admission were recorded (unplanned, UP, or planned, P). Anticancer treatments, whether patients were on/off treatment or uncertain, previous care setting, and who referred the patient to the unit were also recorded. The Edmonton Symptom Assessment Scale (ESAS) was used at admission and at time of discharge, as well as the Memorial Delirium Assessment Scale. Analgesics and their doses at admission and discharge were recorded. Hospital staying was also recorded. At the time of discharge, subsequent referral to other care settings, and the pathway of oncologic treatment were re-considered. Fifty-five (17.5%) of 314 consecutive admissions recorded in a period of 10 months were UP. UP-patients are more frequently referred from other hospitals (P = 0.0005), and are reported by physicians of other units (P = 0.05). UP-patients have a longer hospital admission (P = 0.032), a higher hospital death rate (P = 0.025), and are less frequently discharged home (P = 0.031). A significant decrease in intensity of ESAS items was observed in both groups, with no differences in symptom burden either at admission and time for discharge. At discharge, opioid doses are higher in UP-patients. An APCU may admit UP-patients at any stage of disease, providing effective treatment outcomes, as reported with P-patients. This study suggests that patients referred from other settings or hospitals may provide specialist advice and rapid symptom control. Although symptom burden is similar, these patients have longer hospital admission, higher hospital death rate, and are less frequently discharged home, suggesting the need for more complex treatments. Such units in a comprehensive cancer center might improve symptom control and pose as referral centers for non-cancer hospitals, emergency departments, or the territory.
KeywordsCancer Early palliative care Symptom control Emergency Unplanned admission
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human and animal rights
Procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national). This was not an experimental study, and animals were not used. Ethical approval from the ethical committees was obtained and reported for the primary study (this is a secondary analysis).
Informed consent was obtained and reported for the primary study (this is a secondary analysis).
- 13.Maltoni M, Scarpi E, Dall’Agata M, Schiavon S, Biasini C, Codecà C, Broglia CM, Sansoni E, Bortolussi R, Garetto F, Fioretto L, Cattaneo MT, Giacobino A, Luzzani M, Luchena G, Alquati S, Quadrini S, Zagonel V, Cavanna L, Ferrari D, Pedrazzoli P, Frassineti GL, Galiano A, Casadei Gardini A, Monti M, Nanni Nanni, Early Palliative Care Italian Study Group (EPCISG) (2016) Systematic versus on-demand early palliative care: a randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life. Eur J Cancer 69:110–118CrossRefPubMedGoogle Scholar
- 26.Delgado-Guay MO, Rodriguez-Nunez A, Shin SH, Chisholm G, Williams J, Frisbee-Hume S, Bruera E (2016) Characteristics and outcomes of patients with advanced cancer evaluated by a palliative care team at an emergency center: a retrospective study. Support Care Cancer 24:2287–2295CrossRefPubMedGoogle Scholar
- 31.Hjermstad MJ, Kolflaath J, Løkken AO, Hanssen SB, Normann AP, Aass N (2013) Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study. BMJ Open 3(5). doi: 10.1136/bmjopen-2012-002515