Blood:临终关怀医院,若允许缓解性输血,可很大限度的提高为白血病患者提供的服务质量

2018-06-01 MedSci MedSci原创

临终医院提供高质量的临终关怀,但白血病患者享受临终服务的频率低于实体肿瘤患者。输血依赖(TD)或许会阻碍或推迟登记,因为临终关怀组织通常不允许输血。Thomas W. LeBlanc等人在享有医疗保险的白血病患者中评估TD和临终结局的关系。研究人员从监察、流行病学和临终医疗数据库中检索死于2001-2011年的医疗受益的急慢性白血病患者。TD定义:死亡或临终关怀登记前30天内输血两次及以上。评估指

临终医院提供高质量的临终关怀,但白血病患者享受临终服务的频率低于实体肿瘤患者。输血依赖(TD)或许会阻碍或推迟登记,因为临终关怀组织通常不允许输血。Thomas W. LeBlanc等人在享有医疗保险的白血病患者中评估TD和临终结局的关系。

研究人员从监察、流行病学和临终医疗数据库中检索死于2001-2011年的医疗受益的急慢性白血病患者。TD定义:死亡或临终关怀登记前30天内输血两次及以上。评估指标:临终登记和临终弥留时间,根据关键协变量校准报告相关风险(RR)。

本分析共纳入21033位患者,中位年龄79岁,其中20%在死亡/临终登记前为输血依赖。临床关怀的应用率从2001年的35%增加至2011年的49%。临终医院住院中位时间9天,输血依赖的患者会更短一些(6天 vs 11天,p<0.001)。根据基线特征校准后,TD与临终关怀应用更多相关(RR 1.08;95% CI 1.04-1.12),但同样与临终医院住院时间短51%相关(RR 0.49;95% CI 0.44-0.54)。无论TD状态如何,临终住院患者死亡、化疗药物应用的可能性更低,而且临终医疗花费中位值更低。

总而言之,临终关怀的应用相对增加,加上输血依赖患者的住院时间明显缩短,提示该类患者人群对临终关怀服务有很高的不完全满足的需求,而且他们还面临不能及时转诊的问题。允许缓解性输血或可最大限度的提高临终关怀针对白血病患者的服务质量。

原始出处:

Thomas W. LeBlanc, Pamela C. Egan, and Adam J. Olszewski.Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia. Blood  2018  :blood-2018-03-842575;  doi: https://doi.org/10.1182/blood-2018-03-842575

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    2018-06-02 wzb521zf

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