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clinmed/2000040001v1 (October 29, 2000)
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Clinical Outcomes in Terminally Ill Patients Admitted to Hospice Care: Diagnostic and Therapeutic Interventions
Luis Vitetta, David Kenner, David Kissane, and Avni Sali
This study retrospectively reviewed the clinical course, symptom profile on admission and the diagnostic and therapeutic interventions delivered to 102 consecutive patients (50 males, and 52 females). The average age (SD) of males was 72.3 years (11.1) [range: 42.8-89.7] and of females 73.1 years (13.2) [range: 31.6-96.2]. Ninety-four patients (92.2%) were admitted for palliation of symptoms due to malignant disease and 8 other patients (7.8%) for non-malignant diseases. The overall median survival was 12 days [25%-75% inter-quartile range: 4-29 days]. On admission elevated univariate hazard risks for survival were significantly associated with male gender [6.5 to 18 days, (P=.03)], metastatic disease [62.8% (95%CI, 53.2-72.3% P=.002)], and dyspnea [23.5% (95%CI, 15.7-33.0% P=.005)]. Adjusted Charlson co-morbidity scores were associated with significantly decreased survival with increasing scores (P=.002). De novo symptoms (P=.04) and diagnostic interventions (P=.0001) were associated with decreased univariate risk rates and hence increased survival. Palliative therapeutic interventions were not significantly associated with increased patient survival (P = .9). The independent risks of decreased survival persisted with a multivariate model that showed that pain, dyspnea, immobility, and adjusted Charlson co-morbidity scores were significantly associated (P<.05) with decreased survival and diagnostic interventions with increased survival (P<.001).
Euthanasia was not recorded as a requested intervention by any patient in this cohort. This may be in part, be a reflection of the significant family support most of these patients received.