Clinical Outcomes of Operating an Acute Palliative Care Unit at a Comprehensive Cancer Center.

PURPOSE: Acute palliative care units (APCUs) are inpatient services in tertiary hospitals that provide intensive symptom management and assist in hospital discharge for transitions to hospice care. We aimed to analyze the clinical outcomes of operating an APCU at a comprehensive cancer center. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 1,440 consecutive patients admitted to the APCU and analyzed demographic and clinical information, discharge outcomes, symptom assessments using the Edmonton Symptom Assessment System, spiritual distress, and financial distress. RESULTS: The median age of patients was 67.0 (range, 23-97) years, and 41% were female. The most common primary cancer types were lung (21.9%), hepatopancreatobiliary (14.1%), and colorectal cancers (12.9%). The median length of stay was 8.0 days (range, 1-60 days), and 31.0% of patients died in the APCU. Death in the APCU showed a significant decrease over time, and overall inpatient death in oncology wards did not increase after APCU opening. In total, 44.7% of patients were discharged to government-certified hospice centers. The proportion of patients discharged to certified hospice centers increased from 32.2% in 2015 to 62.4% in 2018. Among 715 patients with a follow-up evaluation 1 week after admission, Edmonton Symptom Assessment System symptom scores, spiritual distress, and financial distress showed statistically significant improvements compared with the baseline symptom scores (P < .001). This improvement was limited to patients who did not die in the APCU. CONCLUSION: Patients with advanced cancer admitted to the APCU may experience significant improvements in distressing symptoms. The majority of patients requiring transition to hospice were successfully transferred to certified hospice centers. The percentage discharged alive improved over time.

Symptom burden and characteristics of patients who die in the acute palliative care unit of a tertiary cancer center.

BACKGROUND: Acute palliative care unit (APCU) is a novel inpatient program in a tertiary cancer center that provides aggressive symptom management and assists with the transition to hospice. However, patients often die in the APCU before successfully transferring to hospice. The aim of this study was to evaluate the symptom burden and characteristics of advanced cancer patients who died in the APCU. METHODS: We retrospectively reviewed the medical records of all advanced cancer patients admitted to the APCU between April 2015 and March 2016 at a tertiary cancer center in Korea. Basic characteristics and symptom burden assessed by the Edmonton Symptom Assessment System (ESAS) were retrieved. Statistical analyses were conducted to compare patients who died in the APCU with those who were discharged alive. RESULTS: Of the 267 patients, 87 patients (33%) died in the APCU. The median age of the patients was 66 years (range, 23-97 years). The most common primary cancer types were lung (21%), stomach (17%), and colorectal cancer (15%). Patients who died in the APCU had higher ESAS scores for drowsiness (6 vs. 5, P=0.002), dyspnea (4 vs. 2, P=0.001), anorexia (8 vs. 6, P=0.014) and insomnia (6 vs. 4, P=0.002) compared to patients who were discharged alive. The total symptom distress score (SDS) was also significantly higher (47 vs. 40, P=0.001) in patients who died in the APCU. In the multivariate analysis, patients who died in the APCU were more likely to be male [odds ratio (OR) 2.63, 95% confidence interval (CI): 1.49-4.64, P=0.001] and have higher ESAS scores for drowsiness (OR 2.08, 95% CI: 1.08-3.99, P=0.029) and dyspnea (OR 2.19, 95% CI: 1.26-3.80, P=0.005). Patients who died in the APCU showed significantly shorter survival after APCU admission (7 vs. 31 days, P<0.001). CONCLUSIONS: Advanced cancer patients who die in the APCU were more likely to be male and have significantly higher symptom burden including drowsiness and dyspnea. These patients showed rapid clinical deterioration after APCU admission. More proactive and timely end-of-life care is needed for these patients.

Phenomenological Study on Aging of Women in 40's and 50's: Applying the Parse's Theory.

PURPOSE: This study was done to explore the essence and meaning of the experience of 'aging,' as a process of 40's and 50's women in Korea by applying the Parse's Human Becoming theory (2002). METHODS: Data was collected from February to April, 2013, using the phenomenological research method. Data was collected through in-depth informal interview and analyzed following Colaizzi method. After IRB permission and informed consent from the participants, all interviews were recorded with MP3 recorder and transcribed for analysis. RESULTS: Data analysis revealed 112 of meanings, 33 key subject words, 8 subject phrases, and 4 categories. The main themes were elaborated as 'going down' ('Being changed of body and mind', 'Being considered on my identity'), 'going up' ('Being expanded of productive role', 'Being transcendent multi-dimensionally'), 'pausing' ('Becoming more thoughtful about family', 'Looking back'), 'going forward again' ('Age is just a number, 'Contemplating of life and death'). Experiences in aging among women in 40's and 50's enlightened with Parse's theory of Human Becoming in terms of 'going down', 'going up', 'pausing', 'going forward again' appeared simultaneously, rather than consecutively. CONCLUSION: Women in 40's and 50's require holistic nursing intervention with physical, psychological, socio-economical, and spiritual aspects, rather than focusing on problematic physical symptom relief and prevention of further conditions. It is recommended to develop various nursing intervention considering on different environment, type of experience, and level of human becoming, individually.