Comparing Severe Symptom Distress of Inpatients and People Cared for in the Community in Their Last Week of Life: A National, Consecutive Cohort Study.
Background: Understanding how symptom outcomes vary by care setting helps optimize care. Aim: To compare trajectories of severe symptom distress in the final week of life across community and hospital settings. Design: This retrospective consecutive cohort study used point-of-care data from the Aust...
| Publicado en: | Journal of Palliative Medicine Vol. 29; no. 6; pp. 781 - 790 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Jun2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194357001&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194357001 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10966218 C1U jtl: Journal of Palliative Medicine issn: 10966218 maglogo: N pubinfo: dt: Jun2026 vid: 29 iid: 6 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 194357001 194357001 194357001 10.1177/10966218261426903 194357001 ppf: 781 ppct: 9 formats: tig: atl: Comparing Severe Symptom Distress of Inpatients and People Cared for in the Community in Their Last Week of Life: A National, Consecutive Cohort Study. aug: au: Clapham, Sabina Ayalew, Animut Alebel Redwood, Lisa Yates, Patsy Auret, Kirsten Clark, Katy Currow, David affil: Australian National Palliative Care Outcomes Collaboration, Wollongong, New South Wales, Australia. sug: subj: Community Health Services Terminal Care Terminally Ill Patients Symptom Distress Evaluation Medical Care Evaluation Human Comparative Studies Inpatients Prospective Studies Male Female Middle Age Aged Aged, 80 and Over Hospitals Retrospective Design Record Review Scales Patient Attitudes Logistic Regression Australia Odds Ratio Confidence Intervals Pain Respiration Disorders Respiratory Distress Syndrome, Acute Fatigue Insomnia Quality of Health Care Funding Source Multicenter Studies Descriptive Statistics Data Analysis Software Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: Background: Understanding how symptom outcomes vary by care setting helps optimize care. Aim: To compare trajectories of severe symptom distress in the final week of life across community and hospital settings. Design: This retrospective consecutive cohort study used point-of-care data from the Australian Palliative Care Outcomes Collaboration, which includes the Symptom Assessment Scale and Palliative Care Problem Severity Score. Mixed-effects logistic regression models were adjusted for clinical, demographic and temporal factors. Setting/Participants: Australian palliative care services (n = 165) contributed data for people who died between July 1, 2019, and June 30, 2024. Results: Of 141,691 patients,73.6% were inpatients; 61.0% had a cancer diagnosis. Severe symptom prevalence was generally low (<5%). After adjusting important factors, inpatients had higher relative odds of severe pain-related (aOR: 1.20, 95% CI: 1.10, 1.30) and breathing-related distress (aOR: 1.55, 95% CI: 1.40, 1.70) compared with community patients; the corresponding absolute risk differences (ARDs) were minimal (pain: +0.36 percentage points; breathing: +0.79 percentage points). Conversely, inpatients had lower relative odds of severe fatigue (aOR: 0.86, 95% CI: 0.79, 0.94) and insomnia (aOR: 0.74, 95% CI: 0.66, 0.84), with small ARDs (fatigue: −0.32; insomnia: −0.26). Over time, severe breathing-related distress increased significantly as death approached, while pain-related distress increased slightly. Inpatients were also less likely to experience family/carer issues (aOR: 0.78, 95% CI: 0.72–0.84), or other symptoms (aOR: 0.57, 95% CI: 0.53–0.61), with small ARDs (family/carer: −0.56; other symptoms: −0.26). Conclusions: While some relative differences were noted between settings, absolute differences were minimal, suggesting clinically comparable outcomes. These national data show that severity of symptoms in the two care settings are similar, reassuring patients, families, and health care professionals. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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