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Utilization of Palliative Care for Patients Undergoing Hematopoietic Stem Cell Transplantation During Hospitalization: A Population-Based National Study
Department of Health Statistics, Second Military Medical University, Shanghai, China.
Mount Sinai St Luke's and West Medical Center, New York, NY, USA.
Department of Health Statistics, Second Military Medical University, Shanghai, China.
Department of Health Statistics, Second Military Medical University, Shanghai, China.
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2019 (English)In: The American Journal of Hospice and Palliative Medicine, ISSN 1049-9091, Vol. 36, no 10, p. 900-906Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Patients undergoing hematopoietic stem cell transplantation (HSCT) have substantial physical and psychological symptoms. This study aimed to investigate the utilization of palliative care (PC) in patients undergoing HSCT during hospitalization.

METHODS: The 2008-2014 National Inpatient Sample was queried for eligible participants. Demographics, hospital characteristics, comorbidities, posttransplantation complications, and inpatient procedures were compared between patients with and without PC. Multivariate logistic regression was performed to identify predictors associated with PC use.

RESULTS: Among 21 458 patients undergoing HSCT during hospitalization, 278 (1.30%) received PC. The rate of PC use has significantly increased from 0.64% in 2008 to 1.95% in 2014. Patients receiving PC had more co-comorbidities, posttransplantation complications, inpatient procedures, and were more likely to carry a diagnosis of leukemia. In allogeneic HSCT, large bed size (odds ratio [OR] =2.80; 95% confidence interval [CI]: 1.17-6.70), stem cell source from cord blood (OR = 1.93; 95% CI: 1.15-3.24), and graft-versus-host disease (OR = 2.04; 95% CI: 1.36-3.06) were predictors of PC use. In a subset analysis of 783 patients who died during hospitalization, 166 (21.20%) received PC. Among the decedents, Hispanic race had lower odds of PC use (OR = 0.20; 95% CI: 0.05-0.82) in allogeneic HSCT and women had higher odds of PC (OR = 2.70; 95% CI: 1.35-5.41) in autologous HSCT.

CONCLUSIONS: The rate of PC use has significantly increased among patients undergoing HSCT during hospitalization from 2008 to 2014 but still remains very low. Further investigation is warranted to verify and better understand the barriers toward PC use for HSCT patients.

Place, publisher, year, edition, pages
Sage Publications, 2019. Vol. 36, no 10, p. 900-906
Keywords [en]
National Inpatient Sample, barrier, graft-versus-host disease, hematopoietic stem cell transplantation, palliative care, trends
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-73424DOI: 10.1177/1049909119838975ISI: 000482969800009PubMedID: 30922064Scopus ID: 2-s2.0-85071714129OAI: oai:DiVA.org:oru-73424DiVA, id: diva2:1302412
Note

Funding Agency:

Fourth Round of Shanghai Three-year Action Plan on Public Health Discipline and Talent Program: EvidenceBased Public Health and Health Economics  15GWZK0901

Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2019-09-16Bibliographically approved

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Cao, Yang

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