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End-of-life decisions guiding the palliative care of cancer patients visiting emergency department in South Western Finland: a retrospective cohort study

机译：终身决定指导南部芬兰南部急诊部的癌症患者的姑息治疗：回顾性队列研究

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Abstract Background Until recently, palliative care (PC) resources in Finland have been sparse. To meet the increasing need for PC an end-of-life (EOL) care project has been ongoing in South Western Finland since 2012, and in 2015, a weekday palliative outpatient clinic was established in Turku University Hospital (TUH). The aim of this study was to explore the effect of the project and the PC clinic on the management practices of EOL cancer patients attending the Emergency Department (ED) of TUH from 2013 to 2016. Methods The medical records of all cancer patients (ICD-10 codes C00–97) admitted to the ED of TUH between August 1–December 31, in 2013 and 2016, were analyzed: n = 529, n = 432 respectively (2013 and 2016). The analysis focused on those patients in EOL care; n = 77, n = 63, respectively. The late palliative patients were defined by PC decision, thus termination of life-prolonging cancer-specific treatments. The EOL patients were in the imminently dying phase of their illness. The site of referral after an ED visit was also verified together with the documentation on advance care plans (ACP), and the impact of palliative outpatient visits. Results In 2016, the number of late palliative and EOL patients admitted to the ED has shown a tendency to decrease. The quality of the documentation for treatment goals, do-not-resuscitate (DNR) orders, living wills and connections to primary care providers has improved since 2013. Prior visits to palliative outpatient clinic correlated well with the more comprehensive ACP information: i) DNR order (p = 0.0001); ii) connection to primary care (p = 0.003); iii) documented ICD-10 code Z51.5 (p = 0.0001). Conclusions Even modest investments in resources for PC can induce an objective change in the allocation of health care resources, and improve the ACP for the cancer patients at their EOL. A visit to a palliative outpatient clinic may offer one approach for improving the quality and completion of ACP documentation.
机译：抽象背景直到最近，芬兰的姑息治疗（PC）资源稀疏。为了满足PC的需求越来越多，自2012年以来，芬兰南芬兰南部的寿命终端（EOL）护理项目一直在努力，在土库市大学医院（TUH）建立了平日姑息的门诊诊所。本研究的目的是探讨项目和PC诊所对2013至2016年犹太州犹太州急诊部门（ED）的EOL癌症患者的管理实践的影响。方法所有癌症患者的病程（ICD- 10码C00-97）分析了2013年和2016年12月1日至12月31日之间Tuh的Zhed，分析：N = 529，分别（2013年和2016年）。分析专注于eol care中的那些患者; n = 77，n = 63分别。晚期姑息患者由PC决策定义，从而终止延长癌症的癌症特异性治疗方法。 EOL患者患有他们疾病的令人垂死的阶段。 ED访问后转介现场也与提前护理计划（ACP）的文件进行核实，以及姑息门诊访问的影响。结果2016年，允许达到ED的后期姑息和EOL患者的数量表现出降低的趋势。自2013年以来，治疗目标的文档质量，DO-NOT-RESCATED（DNR）订单，生活意愿和与初级护理提供者的联系提高了。之前访问姑息门诊诊所的临床良好与更全面的ACP信息相关：i）DNR订单（p = 0.0001）; ii）与初级保健的连接（p = 0.003）; III）记录ICD-10代码Z51.5（P = 0.0001）。结论甚至适度投资PC的资源可以促进卫生保健资源分配的客观变化，并改善其EOL癌症患者的ACP。访问姑息门诊诊所可以提供一种提高ACP文档的质量和完成的一种方法。

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