Factors associated with discharge disposition on an acute palliative care unit

Purpose Acute palliative care units (APCUs) admit patients with cancer for symptom control, transition to community palliative care units or hospice (CPCU/H), or end-of-life care. Prognostication early in the course of admission is crucial for decision-making. We retrospectively evaluated factors as...

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Bibliographic Details
Published in:Supportive care in cancer 2018-11, Vol.26 (11), p.3951-3958
Main Authors: Hausner, David, Kevork, Nanor, Pope, Ashley, Hannon, Breffni, Bryson, John, Lau, Jenny, Rodin, Gary, Le, Lisa W., Zimmermann, Camilla
Format: Article
Language:English
Subjects:
Analysis
Cancer
Cancer screening
Clinical decision making
Composers
Decision making
Discharge
Hospice care
Hospices
Medical research
Medicine
Medicine & Public Health
Nursing
Nursing Research
Oncology
Original Article
Pain Medicine
Palliative care
Patient care planning
Rehabilitation Medicine
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Summary:Purpose Acute palliative care units (APCUs) admit patients with cancer for symptom control, transition to community palliative care units or hospice (CPCU/H), or end-of-life care. Prognostication early in the course of admission is crucial for decision-making. We retrospectively evaluated factors associated with patients’ discharge disposition on an APCU in a cancer center. Methods We evaluated demographic, administrative, and clinical data for all patients admitted to the APCU in 2015. Clinical data included cancer diagnosis, delirium screening, and Edmonton Symptom Assessment System (ESAS) symptoms. An ESAS sub-score composed of fatigue, drowsiness, shortness of breath, and appetite (FDSA) was also investigated. Factors associated with patients’ discharge disposition (home, CPCU/H, died on APCU) were identified using three-level multinomial logistic regression. Results Among 280 patients, the median age was 65.5 and median length of stay was 10 days; 155 (55.4%) were admitted for symptom control, 65 (23.2%) for transition to CPCU/H, and 60 (21.4%) for terminal care. Discharge dispositions were as follows: 156 (55.7%) died, 63 (22.5%) returned home, and 61 (21.8%) were transferred to CPCU/H. On multivariable analysis, patients who died were less likely to be older (OR 0.97, p  = 0.01), or to be admitted for symptom control (OR 0.06, p  
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-018-4274-2