TY - JOUR
T1 - Clinical Indicators That Identify Risk of Deteriorating and Dying in People with a Hematological Malignancy
T2 - A Case-Control Study with Multivariable Analysis
AU - Button, Elise
AU - Gavin, Nicole C.
AU - Chan, Raymond J.
AU - Chambers, Shirley
AU - Butler, Jason
AU - Yates, Patsy
PY - 2018/12
Y1 - 2018/12
N2 - 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.
AB - 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.
KW - case-control
KW - clinical indicators
KW - deteriorating and dying
KW - end-of-life care
KW - hematologic neoplasms
KW - predicting survival
UR - http://www.scopus.com/inward/record.url?scp=85058739487&partnerID=8YFLogxK
U2 - 10.1089/jpm.2018.0033
DO - 10.1089/jpm.2018.0033
M3 - Article
C2 - 30334690
AN - SCOPUS:85058739487
SN - 1096-6218
VL - 21
SP - 1729
EP - 1740
JO - Journal of Palliative Medicine
JF - Journal of Palliative Medicine
IS - 12
ER -