Clinical indicators that identify risk of deteriorating and dying in people with a hematological malignancy : a case-control study with multivariable analysis

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BUTTON, Elise | GAVIN, Nicole C. | CHAN, Raymond J. | CHAMBERS, Shirley | BUTLER, Jason | YATES, Patsy

BACKGROUND: Identifying people who are at risk of deteriorating and dying is essential to inform goals of care, appropriate treatment decisions, patient autonomy, and effective end-of-life care. Limited literature exists on predicting survival near the end of life for people with a hematological malignancy. OBJECTIVE: To identify the key clinical indicators that signal a person with a hematological malignancy is at high risk of deteriorating and dying. DESIGN, SETTING, PARTICIPANTS: Eleven clinical indicators identified in a Delphi approach were tested via a retrospective case–control study. Each indicator was assessed for at each in-patient admission between living (n = 236) and deceased (n = 120) people with a hematological malignancy who were admitted to a large tertiary hospital between 1st July 2014 and 31st December 2015. RESULTS: Six clinical indicators were independently associated with mortality in the final three months of life: declining performance status (Odds Ratio [OR] 7.153, 95% Confidence Intervals [CI] 3.281–15.597, p = < 0.001); treatment limitations of the hematological malignancy (OR 7.855, 95% CI 3.528–17.489, p = < 0.001); relapse, refractory or persistent disease (OR 3.749, 95% CI 1.749–8.039, p = 0.001); presence of two or more comorbidities (OR 2.991, 95% CI 1.319–6.781, p = 0.009); invasive fungal infections (OR 4.887, 95% CI 1.197–19.949, p = 0.027); and persistent infections (OR 6.072, 95% CI 2.551–14.457, p = < 0.001). CONCLUSIONS: This study has identified six clinical indicators that signal a person with a hematological malignancy is at high risk of deteriorating and dying and may benefit from an assessment of palliative needs and proactive planning, along-side appropriate treatment.

http://dx.doi.org/10.1089/jpm.2018.0033

Voir la revue «JOURNAL OF PALLIATIVE MEDICINE, 21»

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