緩和ケアと医学

抽象的な

Inpatient Palliative Care Consultation for Women with Gynecologic Malignancies

Nicole S Nevadunsky, Zahava Brodt, SerifeEti, Peter A Selwyn, Ann Van Arsdale, Bruce Rapkin and Gary L Goldberg

Objective: Recommendations to improve end-of-life cancer care include integration of palliative care into standard cancer care. There is limited information regarding palliative care for ethnic and racial minority women with gynecologic malignancies. The purpose of this study was to determine the impact of clinical, socio-demographic, and provider factors on palliative medicineconsultation.

Methods: After IRB approval, patients with gynecologic malignancies who received a palliative medicine consultation from January 1, 2008 until June 1, 2010 were identified. Abstracted data included demographics, reason/s for consultation, and outcomes. Results were described and comparison made using Fisher’s Exact Test, Student’s T analysis, and Kaplan-Meier time to event analysis with SPSS software.

Results: 84 patients were referred for palliative medicine consultation. Ethnic/racial distribution was Black (37%), White (39%), and Hispanic (16%). The reason/s for consultation included pain (45%), goals of care (46%), and bowel obstruction (4%), dyspnea (4%). Median number of days from the initial consultation until death by Kaplan-Meier time to event analysis, which is a proxy metric for timely consultation was 35 days [Range 0-1005 days].Younger patients (<60) were less likely to be DNR (p=0.03, 60% verses 79.5%) or referred to hospice (p=0.02, 9% versus 33%). “Goals of care” was the consultation reason in 61% of patients of medical sub-specialists vs. 26% of Gynecologic Oncologists (p=0.003). 28% of patients from medical sub-specialists died in the hospital verses 8% of gynecologic oncologist referred patients (p=0.02).

Conclusions: These data suggest that there may be barriers to the implementation of palliative medicine for women with gynecologic malignancies. Providers may be influenced by patient age as well as their own specialty background. Reasons for the barriers to access in these women need to be further explored.