Authors (including presenting author) :
Chan KY(1), Li CW(1), Au HY(1), Wong CY(1), Tsang KW(1), Chan TSY(2), Gill H(2)(3), So WL(1), Hung DSM(4), Wong HH(4), Ng SS(4), Cheung KC(5), Choi CM(5), Leung SM(5), Pang KK(5)
Affiliation :
(1)Palliative Medical Unit, Grantham Hospital, (2)Department of Medicine. Queen Mary Hospital, (3)The University of Hong Kong, (4)Department of Clinical Psychology, Queen Mary hospital, (5)Medical Social Service Department, Grantham Hospital
Introduction :
Providing aggressive medical care to patients with advanced hematological malignancy prolongs patient suffering and increases healthcare burden. Our palliative care team pioneered integrated palliative care (IPC) program for patients with advanced hematological malignancies in HKWC since 2018.
Objectives :
To evaluate the impact of IPC on: 1) the use of chemotherapy within 14 days before death; 2) multiple (>1) emergency department (ED) visits 90 days before death; 3) multiple (>1) hospitalization 90 days before death; and 4) intensive care unit (ICU) admission within 90 days before death.
Methodology :
We retrospectively reviewed the outcomes of patients with advanced hematological malignancies and received IPC during the period of January 2017 to December 2020. Patient who died within the same day of PC referral or < 18 years of age were excluded. Our IPC program comprised: 1) early palliative care referral and advance care planning discussions; 2) baseline and regular assessment of patient’s physical and psycho-spiritual distress, and family concerns; 3) consensus for symptom management and supportive services, and 4) regular meetings with hematologists to review and modify care plans for their patients and community providers. Patients matched for disease status and patient characteristics but did not receive IPC were selected as control in 1:2 ratio. Multivariate analyses were used to assess the impact of IPC on the outcomes of interest. The effect of the duration of IPC on patient outcomes was also investigated.
Result & Outcome :
317 patients with advanced hematological malignancies (of which 105 received IPC services) were included for analysis. The use of IPC service was associated with less multiple ED visits [odds ratio (OR) 0.19, 95% CI 0.16-0.23, p=0.019], reduced multiple unplanned hospitalizations (OR = 0.24, 95% CI 0.19-0.31, p=0.002), lower risk of ICU admission (OR=0.12, 95% CI 0.08-0.18, p=0.003) and decreased use of chemotherapy/disease treatment near death (OR=0.34, 95% CI 0.25-0.46, p=0.001) before death. The use of IPC service for >90 days was associated with less multiple emergency department visits, multiple unplanned hospitalizations, ICU admissions and use of chemotherapy/disease treatment near death. In conclusion, use of IPC service was associated with reduced use of acute and aggressive medical services in patients with advanced hematological malignancies.
