One size does not fit all : disease profiles of serious illness patients receiving specialty palliative care

Article

KAMAL, Arif H. | TAYLOR, Donald H. | NEELY, Benjamin | HARKER, Matthew | BHULLAR, Parampal | MORRIS, John N. | BONSIGNORE, Lindsay | BULL, Janet

INTRODUCTION: Understanding the symptom profiles of seriously ill patients who receive palliative care, especially non-cancer diagnoses where the data is sparse, is critical to better targeting our resources to the needs of patients. METHODS: We performed a retrospective, multi-cohort study of patients evaluated during their first consultative palliative care visit in a community-based palliative care registry. We placed into one of seven major disease categories based on clinician-reported primary diagnosis for consultation. Our primary aim of this analysis was to determine the univariate association between several patient-specific characteristics (e.g. demographics, care of setting, initial screening score) and the primary diagnosis. RESULTS: We evaluated the first visit consultation records of 1615 patients. Most prevalent diagnosis was Neurologic (564; 35%), followed by Cardiovascular (266; 16%), Pulmonary (229; 14%), and Cancer (208; 13%). Patients in the study with the highest symptom burden were those diagnosed with cancer or pulmonary disease, with 45% and 37% of cancer and pulmonary patients, respectively having two or more moderate to severe symptoms. 26% of cardiovascular disease patients reported two or more moderate to severe symptoms while 11% reported three or more. Patients with a neurologic or infectious diagnosis had less symptom burden, but a large percentage of neurologic patients were unable to respond. DISCUSSION: This study is one of the first to describe symptom burden and functional scores by diagnostic categories and care settings across a community-based interdisciplinary specialty palliative care program. Results demonstrated statistically significant and clinically relevant differences among settings of care, functional status, and symptom profiles between patients with various serious illnesses.

http://dx.doi.org/10.1016/j.jpainsymman.2017.07.035

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 54»

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