Purpose Patients with advanced cancer experience potentially burdensome transitions of care after hospitalizations. We examined predictors of discharge location and assessed the relationship between discharge location and survival in this population. Methods We conducted a prospective study of 932 patients with advanced cancer who experienced an unplanned hospitalization between September 2014 and March 2016. Upon admission, we assessed patients' physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire-4). The primary outcome was discharge location (home without hospice, postacute care [PAC], or hospice [any setting]). The secondary outcome was survival. Results Of 932 patients, 726 (77.9%) were discharged home without hospice, 118 (12.7%) were discharged to PAC, and 88 (9.4%) to hospice. Those discharged to PAC and hospice reported high rates of severe symptoms, including dyspnea, constipation, low appetite, fatigue, depression, and anxiety. Using logistic regression, patients discharged to PAC or hospice versus home without hospice were more likely to be older (odds ratio [OR], 1.03; 95% CI, 1.02 to 1.05; P < .001), live alone (OR, 1.95; 95% CI, 1.25 to 3.02; P < .003), have impaired mobility (OR, 5.08; 95% CI, 3.46 to 7.45; P < .001), longer hospital stays (OR, 1.15; 95% CI, 1.11 to 1.20; P < .001), higher Edmonton Symptom Assessment System physical symptoms (OR, 1.02; 95% CI, 1.003 to 1.032; P < .017), and higher Patient Health Questionnaire-4 depression symptoms (OR, 1.13; 95% CI, 1.01 to 1.25; P < .027). Patients discharged to hospice rather than PAC were more likely to receive palliative care consultation (OR, 4.44; 95% CI, 2.12 to 9.29; P < .001) and have shorter hospital stays (OR, 0.84; 95% CI, 0.77 to 0.91; P < .001). Patients discharged to PAC versus home had lower survival (hazard ratio, 1.53; 95% CI, 1.22 to 1.93; P < .001). Conclusion Patients with advanced cancer who were discharged to PAC facilities and hospice had substantial physical and psychological symptom burden, impaired physical function, and inferior survival compared with those discharged to home. These patients may benefit from interventions to enhance their quality of life and care.

中文翻译：

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晚期癌症患者院后护理过渡的预测因素


目的 晚期癌症患者住院后可能会经历繁重的护理转变。我们检查了出院地点的预测因素，并评估了出院地点与该人群生存率之间的关系。方法 我们对 2014 年 9 月至 2016 年 3 月期间经历过计划外住院的 932 名晚期癌症患者进行了一项前瞻性研究。入院后，我们评估了患者的身体症状（埃德蒙顿症状评估系统）和心理困扰（患者健康问卷-4）。主要结局是出院地点（没有临终关怀的家、急性后期护理 [PAC] 或临终关怀 [任何环境]）。次要结果是生存。结果 932 例患者中，726 例（77.9%）出院回家，没有接受临终关怀，118 例（12.7%）出院接受 PAC，88 例（9.4%）接受临终关怀。出院到 PAC 和临终关怀医院的人报告严重症状的比例很高，包括呼吸困难、便秘、食欲不振、疲劳、抑郁和焦虑。使用逻辑回归，出院到 PAC 或临终关怀中心的患者与没有临终关怀中心的家庭相比，年龄更大（比值比 [OR]，1.03；95% CI，1.02 至 1.05；P < .001）、独居（OR，1.95） ；95% CI，1.25 至 3.02；P < .003），活动能力受损（OR，5.08；95% CI，3.46 至 7.45；P < .001），住院时间较长（OR，1.15；95% CI） ，1.11 至 1.20；P < .001），埃德蒙顿症状评估系统身体症状较高（OR，1.02；95% CI，1.003 至 1.032；P < .017），以及患者健康问卷 4 抑郁症状较高（OR，1.02；95% CI，1.003 至 1.032） ，1.13；95% CI，1.01 至 1.25；P < .027）。出院到临终关怀医院而不是 PAC 的患者更有可能接受姑息治疗咨询（OR，4.44；95% CI，2.12 至 9.29；P < .001）并且住院时间更短（OR，0.84； 95% CI，0.77 至 0.91； P < .001)。出院到 PAC 的患者与回家的患者相比，生存率较低（风险比，1.53；95% CI，1.22 至 1.93；P < .001）。结论 与出院回家的患者相比，出院到 PAC 设施和临终关怀中心的晚期癌症患者有严重的身体和心理症状负担、身体功能受损、生存率较差。这些患者可能会受益于提高生活质量和护理质量的干预措施。