ABSTRACT
OBJECTIVE: Knowledge of symptom prevalence and adequate assessment of such symptoms at the end of life is important in clinical practice. We determined the frequency and severity of symptom distress and delirium using the Edmonton Assessment Scale (ESAS) and the Memorial Delirium Assessment Scale (MDAS) and evaluated the clinical utility of the Nursing Delirium Screening Scale (Nu-DESC) as scored by a caregiver as a screening tool for delirium. METHOD: We conducted a secondary analysis of the data from a previous randomized controlled trial on parenteral hydration at the end of life of patients admitted to home hospice. Only patients that had assessments within the last week of life were included. We collected the ESAS, MDAS, Nu-DESC, and Richmond Agitation Sedation Scale (RASS) results. The sensitivity and specificity of the Nu-DESC were then calculated. RESULTS: Some 78 of 261 patients were included in our study, 62 (80%) of which had moderate-to-severe symptoms corresponding to an ESAS score >4. These symptoms include: 73 (94%) anorexia, 63 (81%) fatigue, 56 (73%) drowsiness, 58 (75%) decreased well-being, and 39 (51%) pain. Delirium was diagnosed in 34 (44%) of patients using the MDAS. The Nu-DESC was found to have a sensitivity of 35%, a specificity of 80%, a positive predictive value (PPV) of 58%, and an negative predictive value (NPV) of 61% when used by caregivers. SIGNIFICANCE OF RESULTS: Hospice patients at the end of life have a high rate of symptom distress and delirium. The Nu-DESC is not a reliable tool for screening delirium when scoring is conducted by a caregiver. Our study illustrates the need for routine use of assessment tools to improve care.
Subject(s)
Delirium/epidemiology , Hospice Care , Neoplasms/nursing , Psychomotor Agitation/epidemiology , Stress, Psychological/epidemiology , Terminal Care , Aged , Aged, 80 and over , Female , Home Nursing , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
BACKGROUND: Missed appointments (MA) are frequent, but there are no studies on the effects of the first MA at supportive care outpatient clinics on clinical outcomes. METHODS: We determined the frequency of MA among all patients referred to our clinic from January-December 2011 and recorded the clinical and demographic data and outcomes of 218 MA patients and 217 consecutive patients who kept their first appointments (KA). RESULTS: Of 1,352 advanced-cancer patients referred to our clinic, 218 (16 %) had an MA. The MA patients' median age was 57 years (interquartile range, 49-67). The mean time between referral and appointment was 7.4 days (range, 0-71) for KA patients vs. 9.1 days (range, 0-89) for MA patients (P = 0.006). Reasons for missing included admission to the hospital (17/218 [8 %]), death (4/218 [2 %]), appointments with primary oncologists (37/218 [18 %]), other appointments (19/218 [9 %]), visits to the emergency room (ER) (9/218 [9 %]), and unknown (111/218 [54 %]). MA patients visited the ER more at 2 weeks (16/214 [7 %] vs. 5/217 [2 %], P = 0.010) and 4 weeks (17/205 [8 %] vs. 8/217 [4 %], P = 0.060). Median-survival duration for MA patients was 177 days (range, 127-215) vs. 253 days (range, 192-347) for KA patients (P = 0.013). Multivariate analysis showed that MAs were associated with longer time between referral and scheduled appointment (odds ratio [OR], 1.026/day, P = 0.030), referral from targeted therapy services (OR, 2.177, P = 0.004), living in Texas/Louisiana regions (OR, 2.345, P = 0.002), having an advanced directive (OR, 0.154, P < 0.0001), and being referred for symptom control (OR, 0.024, P = 0.0003). CONCLUSION: MA patients with advanced cancer have worse survival and increased ER utilization than KA patients. Patients at higher risk for MA should undergo more aggressive follow-up. More research is needed.
Subject(s)
Ambulatory Care/statistics & numerical data , Appointments and Schedules , Neoplasms/therapy , Palliative Care/statistics & numerical data , Patient Compliance/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
La astenia en el paciente con cáncer es definida como una sensación abrumadora y persistente de cansancio o agotamiento relacionado con el cáncer o el tratamiento de este, que disminuye o impide la capacidad para el trabajo mental o físico en el contexto de su actividad diaria y a pesar de un buen descanso. Es uno de los primeros síntomas que puede presentarse en el paciente con cáncer, afectando de manera importante a la calidad de vida. El objetivo de esta revisión es detallar las diferentes causas que influyen en la astenia y describir las escalas de medida que más frecuentemente se utilizan para estudiarla. La metodología empleada en esta revisión es narrativa. En esta revisión describimos cómo la astenia es un concepto multidimensional, ya que casi siempre está provocada o influenciada por múltiples causas. Esta multidimensionalidad interviene también en la comprensión de la fisiopatología. Por esta razón en esta revisión diferenciaremos entre astenia primaria y secundaria definiendo y detallando cada una de ellas. Por otro lado, también analizamos el tipo de escalas empleadas para medir la astenia diferenciando entren las que miden la astenia de forma primaria o las que la miden desde un punto de vista multidimensional
Fatigue in cancer patients is defined as an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning, despite good rest. Fatigue is one of the first symptoms that can appear in patients with cancer and quality of life is severely impacted by it. The main goal of this review is to describe the different causes that influence fatigue and the different ways to asses this symptom. The methodology we have used for this review is narrative. In this work we describe fatigue as a multidimensional concept that it is caused by multiple mechanisms. This multidimensionality is also involved in understanding the pathophysiologyFor that reason we are going to define fatigue as primary and secondary, and we are going to describe each of them. We are also going to analyse the type of scales used to measure fatigue; describing the differences between the ones that measure only fatigue and the ones that are used to asses fatigue from a multidimensional perspective
