Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.

<h4>Introduction</h4>The end-of-life symptom prevalence of non-cancer patients have been described mostly in hospital and institutional settings. This study aims to describe the average symptom trajectories among non-cancer patients who are community-dwelling and used home care services...

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Autores principales:	Katrin Conen, Dawn M Guthrie, Tara Stevens, Samantha Winemaker, Hsien Seow
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/29ec6654beb84786825bb355cb7ebcbf
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spelling	oai:doaj.org-article:29ec6654beb84786825bb355cb7ebcbf2021-12-02T20:10:37ZSymptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.1932-620310.1371/journal.pone.0252814https://doaj.org/article/29ec6654beb84786825bb355cb7ebcbf2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252814https://doaj.org/toc/1932-6203<h4>Introduction</h4>The end-of-life symptom prevalence of non-cancer patients have been described mostly in hospital and institutional settings. This study aims to describe the average symptom trajectories among non-cancer patients who are community-dwelling and used home care services at the end of life.<h4>Materials and methods</h4>This is a retrospective, population-based cohort study of non-cancer patients who used home care services in the last 6 months of life in Ontario, Canada, between 2007 and 2014. We linked the Resident Assessment Instrument for Home Care (RAI-HC) (standardized home care assessment tool) and the Discharge Abstract Databases (for hospital deaths). Patients were grouped into four non-cancer disease groups: cardiovascular, neurological, respiratory, and renal (not mutually exclusive). Our outcomes were the average prevalence of these outcomes, each week, across the last 6 months of life: uncontrolled moderate-severe pain as per the Pain Scale, presence of shortness of breath, mild-severe cognitive impairment as per the Cognitive Performance Scale, and presence of caregiver distress. We conducted a multivariate logistic regression to identify factors associated with having each outcome respectively, in the last 6 months.<h4>Results</h4>A total of 20,773 non-cancer patient were included in our study, which were analyzed by disease groups: cardiovascular (n = 12,923); neurological (n = 6,935); respiratory (n = 6,357); and renal (n = 3,062). Roughly 80% of patients were > 75 years and half were female. In the last 6 months of life, moderate to severe pain was frequent in the cardiovascular (57.2%), neurological (42.7%), renal (61.0%) and respiratory (58.3%) patients. Patients with renal disease had significantly higher odds for reporting uncontrolled moderate to severe pain (odds ratio [OR] = 1.21; 95% CI: 1.08 to 1.34) than those who did not. Patients with respiratory disease reported significantly higher odds for shortness of breath (5.37; 95% CI, 5.00 to 5.80) versus those who did not. Patients with neurological disease compared to those without were 9.65 times more likely to experience impaired cognitive performance and had 56% higher odds of caregiver distress (OR = 1.56; 95% CI: 1.43 to 1.71).<h4>Discussion</h4>In our cohort of non-cancer patients dying in the community, pain, shortness of breath, impaired cognitive function and caregiver distress are important symptoms to manage near the end of life even in non-institutional settings.Katrin ConenDawn M GuthrieTara StevensSamantha WinemakerHsien SeowPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252814 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Katrin Conen Dawn M Guthrie Tara Stevens Samantha Winemaker Hsien Seow Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.
description	<h4>Introduction</h4>The end-of-life symptom prevalence of non-cancer patients have been described mostly in hospital and institutional settings. This study aims to describe the average symptom trajectories among non-cancer patients who are community-dwelling and used home care services at the end of life.<h4>Materials and methods</h4>This is a retrospective, population-based cohort study of non-cancer patients who used home care services in the last 6 months of life in Ontario, Canada, between 2007 and 2014. We linked the Resident Assessment Instrument for Home Care (RAI-HC) (standardized home care assessment tool) and the Discharge Abstract Databases (for hospital deaths). Patients were grouped into four non-cancer disease groups: cardiovascular, neurological, respiratory, and renal (not mutually exclusive). Our outcomes were the average prevalence of these outcomes, each week, across the last 6 months of life: uncontrolled moderate-severe pain as per the Pain Scale, presence of shortness of breath, mild-severe cognitive impairment as per the Cognitive Performance Scale, and presence of caregiver distress. We conducted a multivariate logistic regression to identify factors associated with having each outcome respectively, in the last 6 months.<h4>Results</h4>A total of 20,773 non-cancer patient were included in our study, which were analyzed by disease groups: cardiovascular (n = 12,923); neurological (n = 6,935); respiratory (n = 6,357); and renal (n = 3,062). Roughly 80% of patients were > 75 years and half were female. In the last 6 months of life, moderate to severe pain was frequent in the cardiovascular (57.2%), neurological (42.7%), renal (61.0%) and respiratory (58.3%) patients. Patients with renal disease had significantly higher odds for reporting uncontrolled moderate to severe pain (odds ratio [OR] = 1.21; 95% CI: 1.08 to 1.34) than those who did not. Patients with respiratory disease reported significantly higher odds for shortness of breath (5.37; 95% CI, 5.00 to 5.80) versus those who did not. Patients with neurological disease compared to those without were 9.65 times more likely to experience impaired cognitive performance and had 56% higher odds of caregiver distress (OR = 1.56; 95% CI: 1.43 to 1.71).<h4>Discussion</h4>In our cohort of non-cancer patients dying in the community, pain, shortness of breath, impaired cognitive function and caregiver distress are important symptoms to manage near the end of life even in non-institutional settings.
format	article
author	Katrin Conen Dawn M Guthrie Tara Stevens Samantha Winemaker Hsien Seow
author_facet	Katrin Conen Dawn M Guthrie Tara Stevens Samantha Winemaker Hsien Seow
author_sort	Katrin Conen
title	Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.
title_short	Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.
title_full	Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.
title_fullStr	Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.
title_full_unstemmed	Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.
title_sort	symptom trajectories of non-cancer patients in the last six months of life: identifying needs in a population-based home care cohort.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/29ec6654beb84786825bb355cb7ebcbf
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Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort.

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