Diagnostic accuracy of a predictive scoring tool for patients who are eligible for home discharge from a palliative care unit

Abstract

Background: Staying at a preferred place, principally at home, is of great value for dying patients, and palliative care units (PCUs) have an important role in providing adequate support so that patients can be discharged and go home. We attempted to create and validate a scoring tool to predict whether a cancer patient admitted to a PCU will be discharged home.Methods: All 369 cancer patients admitted to the PCU of a 533-bed general hospital in Japan from October 2016 to October 2019 were enrolled. As outcomes, we recorded whether patients were discharged to home, died in hospitals, or were discharged to other hospitals. Attending physicians recorded 22 potential scale items at admission, including (I) demographic variables, (II) patient general conditions, (III) vital signs, (IV) medications, and (V) patient symptoms. Training-testing procedure to develop a screening score was performed.Results: Among 369 cancer patients admitted to the PCU, we excluded 10 cases for whom a death location could not be identified. Among the remaining 359 patients, 180 were analyzed in the development phase and 179 in the validation phase. Multivariate logistic regression analysis identified five items as independent factors associated with discharge to home, and a prediction equation was created using the regression coefficients: sex (female, 4 points), calorie intake (520 kcal or more, 19 points), availability of daytime caregivers (11 points), family's preferred place of care (home, 139 points), and symptoms that resulted in hospitalization (not fatigue, 7 points). Using a cutoff point of 155, the area under the curve (AUC) value was 0.949 with 95% confidence intervals of 0.918 to 0.981. In the validation sample, the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and error rate were 75.3%, 86.3%, 82.2%, 80.6%, and 18.4%, respectively.Conclusions: Whether a patient admitted to a PCU can discharge to home could be predicted using the simple clinical tool. Further validation and outcome studies are warranted.

Discharge to home from a palliative care unit: impact on survival and factors associated with home death after the discharge: a cohort study

“…The ability to care for the patient at home could also have a signi cant impact on supporting home care. These ndings are consistent with previous studies, [19][20][21][22][23] and con rm that opinions of family members and availability of a daytime caregiving service are important factors in uencing home death for patients who were discharged to home. The average performance status was 2.67 and PPI was 3.48 for the patients at the time of admission to the PCU.…”

“…On the basis of literature reviews, [13][14][15][16][19][20][21][22] variables potentially associated with survival and place of death were extracted from the medical records: patient age, gender, primary tumor sites, length of hospital stay, presence or absence of metastases, Palliative Prognostic Index (PPI), 23 symptoms, vital signs (i.e., systolic blood pressure, pulse rate, and SpO ), opioid dose (oral morphine equivalent), marital status, the number of co-habiting family members (including patient), presence or absence of a daytime caregiver, whether the primary caregiver was a spouse, family members' preferred place of care, and family members' preferred location of death. Furthermore, calorie intake on the rst day and presence/absence of delirium within three days of admission were recorded.…”

Discharge to home from a palliative care unit: impact on survival and factors associated with home death after the discharge: a cohort study

“…On the basis of literature reviews [ 12 – 15 , 18 – 21 ], variables potentially associated with survival and place of death were extracted from the medical records: patient age, sex, primary tumor sites, length of hospital stay, presence or absence of metastases, Palliative Prognostic Index (PPI) [ 22 ], symptoms, vital signs (i.e., systolic blood pressure, pulse rate, and SpO 2 ), opioid dose (oral morphine equivalent), marital status, the number of co-habiting family members (including patient), presence or absence of a daytime caregiver, whether the primary caregiver was a spouse, family members’ preferred place of care, and family members’ preferred location of death. Further, calorie intake on the first day and presence/absence of delirium within three days of admission were recorded.…”