ACMJ

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
Clinical characteristics of patients discharged from a palliative care center to home care: a retrospective cross-sectional study
Aims: The aim of this study was to establish the clinical characteristics and their impact on the length of stay (LOS) of patients discharged from a palliative care center (PCC) to home care (HC).
Methods: Our cross-sectional study retrospectively analysed 314 patients who were discharged from PCC to HC between 1 January 2015 and 30 September 2018. The patients were divided into two groups based on their LOS in the PCC. Prolonged hospitalisation was defined as hospitalisation for more than 30 days. Clinical characteristics associated with prolonged hospitalization were analyzed.
Results: The study included 314 patients, with 129 (41.08%) female and 185 (58.92%) male. The mean age was 68.41±18.91 years and the LOS in PCC was 36.27±40.34 days. Of the patients, 186 were hospitalized for 30 days or less, while 128 were hospitalized for more than 30 days. The most frequent diagnosis was cerebrovascular event (CVE) (37.57%). The most common accompanying chronic systemic diseases were hypertension (20.70%), followed by diabetes mellitus and heart failure (9.87%; 6.68%, respectively). Out of the total number of patients, 9.87% (n=31) were mobilized. Among them, 55.09% (n=173) were able to receive oral nutrition, 42.03% (n=132) had percutaneous endoscopic gastrostomy (PEG), 23.88% (n=75) had pressure ulcer (PU), and 27.07% (n=85) had tracheostomy. Additionally, 6.68% (n=24) of the patients were receiving respiratory support with a home ventilator. It was observed that the LOS of patients who were mobile, able to feed orally, and diagnosed with cancer was shorter. The presence of CVE (p=0.001), head trauma (p=0.013), hypoxic brain diagnosis (p=0.001), PEG (p<0.001), tracheostomy (p<0.001), PU (p=0.011), and home ventilator (p=0.024) were identified as predictors of long LOS. Hypoxic brain diagnosis was found to be the clinical feature most strongly associated with long-term hospitalization (OR:6.8), followed by PEG feeding (OR:6.6) and the presence of tracheostomy (OR:5.2).
Conclusion: In our study we observed that time to discharge is extended due to training on care and nutrition for patients undergoing tracheostomy, PEG and PU.


1. Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageingpopulations: the challenges ahead. Lancet. 2009;374(9696):1196-208.
2. Radbruch L, Payne S. White paper on standards and norms forhospice and palliative care in Europe: part 1. Eur J Palliat Care.2009;16(6):278-289.
3. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness.Am J Respir Crit Care Med. 2010;182(4):446-454.
4. Parpucu &Uuml;M, K&uuml;&ccedil;&uuml;k O, Sağ F, et al. Pre-assessment criteria for theneeds of patients in palliative care: the role of palliative care by agegroups. Turkish J Geriatr. 2023;26(3):334-346.
5. Ibrahim JE, Anderson LJ, MacPhail A, Lovell JJ, Davis MC, WinboltM. Chronic disease self-management support for persons withdementia, in a clinical setting. J Multidiscip Healthc. 2017;10:49-58.
6. Wiencek C, Coyne P. Palliative care delivery models. Semin OncolNurs. 2014;30(4):227-233.
7. Reymond L, Parker G, Gilles L, Cooper K. Home-based palliativecare. Aust J Gen Pract. 2018;47(11):747-752.
8. Ozgul N, Koc O, Gultekin M, et al. Opioids for cancer pain:availability, accessibility, and regulatory barriers in Turkiye andPallia-Turk Project. J Pediatr Hematol Oncol. 2011;33:S29-S32.
9. Ozgul N, Gultekin M, Koc O, et al. Turkish community-based palliative care model: a unique design. Ann Oncol.2012;23(Supplement 3):iii76-iii78.
10. Mergen H, Unluoglu I, Elcioglu O. Contemporary home careservice and family medicine in Turkiye. Home Health Care ManagPract. 2013;25(3):104-109.
11. Emuk Y, Naz I. The current situation of palliative care in Turkiye. JCancer Policy. 2017;13:33-37.
12. Radbruch L, Maier BO, Bausewein C. Palliative home care: whichtype for whom and when? Schmerz. 2019;33(4):285-286.
13. Brumley R, Enguidanos S, Jamison P, et al. Increased satisfactionwith care and lower costs: results of a randomized trial of in-homepalliative care. J Am Geriatr Soc. 2007;55(7):993-1000.
14. Ciemins EL, Stuart B, Gerber R, Newman J, Bauman M. Anevaluation of the advanced illness management (AIM) program:increasing hospice utilization in the San Francisco Bay area. JPalliat Med. 2006;9(6):1401-1411.
15. Hughes MT, Smith TJ. The growth of palliative care in the UnitedStates. Annu Rev Public Health. 2014;35(1):459-475.
16. Labson MC, Sacco MM, Weissman DE, Gornet B, Stuart B.Innovative models of home-based palliative care. Cleve Clin J Med.2013;80(E-Supplement 1):30-35.
17. Maida V, Ennis M, Kuziemsky C, Corban J. Wounds and survivalin cancer patients. Eur J Cancer. 2009;45(18):3237-3244.
18. Artico M, Dante A, D&rsquo;Angelo D, et al. Prevalence, incidenceand associated factors of pressure ulcers in home palliative carepatients: a retrospective chart review. Palliat Med. 2018;32(1):299-307.
19. Brian Cassel J, Kerr KM, McClish DK, et al. Effect of a home-basedpalliative care program on healthcare use and costs. J Am GeriatrSoc. 2016;64(11):2288-2295.
20. Bosel J, Schiller P, Hook Y, et al. Stroke-related early tracheostomyversus prolonged orotracheal intubation in neurocritical care trial(SETPOINT): a randomized pilot trial. Stroke. 2013;44(1):21-28.
21. Spataro R, Bono V, Marchese S, La Bella V. Tracheostomy mechanicalventilation in patients with amyotrophic lateral sclerosis: clinicalfeatures and survival analysis. J Neurol Sci. 2012;323(1-2):66-70.
22. Pan CX, Gutierrez C, Maw MM, et al. Impact of a palliative careprogram on tracheostomy utilization in a community hospital. JPalliat Med. 2015;18(12):1070-1073.
23. Glover TL, Kluger BM. Palliative medicine and end-of-life care.Handb Clin Neurol. 2019;167:545-561.
24. Robinson MT, Holloway RG. Palliative care in neurology. MayoClin Proc. 2017;92(10):1592-1601.
25. Taylor BL, O&rsquo;Riordan DL, Pantilat SZ, Creutzfeldt CJ. Inpatientswith neurologic disease referred for palliative care consultation.Neurol. 2019;92(17):e1975-e1981.
26. Newman III AJ, Kvale EA, Williams BR, Bailey FA. What about thetrach? Tracheotomy removal as a palliative care maneuver. Am JHosp Palliat Care. 2007;24(5):371-375.
27. Chan T, Devaiah AK. Tracheostomy in palliative care. OtolaryngolClin North Am. 2009;42(1):133-141.
28. Sherlock ZV, Wilson JA, Exley C. Tracheostomy in the acutesetting: patient experience and information needs. J Crit Care.2009;24(4):501-507.
29. Cameron JI, Chu LM, Matte A, et al. One-year outcomes incaregivers of critically ill patients. N Engl J Med. 2016;374(19):1831-1841.
30. Nakarada-Kordic I, Patterson N, Wrapson J, Reay SD. A Systematicreview of patient and caregiver experiences with a tracheostomy.Patient. 2018;11(2):175-191.
31. Nagi M, Kapoor S, Kaur S, Gupta S. Effect of an intervention onperformance regarding change of tracheostomy tube among thecaregivers of the patient. Indian J Neurosurg. 2014;3(1):31-35.
32. World Health Organization. Strengthening of palliative care as acomponent of integrated treatment throughout the life course. JPain Palliat Care Pharmacother. 2014;28(2):130-134.
33. Langemo DK, Black J. Pressure ulcers in individuals receivingpalliative care: a National Pressure Ulcer Advisory Panel whitepaper. Adv Skin Wound Care. 2010;23(2):59-72.
34. Lyder CH, Wang Y, Metersky M, et al. Hospital-acquiredpressure ulcers: results from the national Medicare Patient SafetyMonitoring System study. J Am Geriatr Soc. 2012;60(9):1603-1608.
35. Allman RM. The impact of pressure ulcers on health care costs andmortality. Adv Wound Care. 1998;11:2.
36. Hudson P. Improving support for family carers: key implicationsfor research, policy and practice. Palliat Med. 2013;27(7):581-582.
37. Chellappan S, Ezhilarasu P, Gnanadurai A, George R, ChristopherS. Can symptom relief be provided in the home to palliative carecancer patients by the primary caregivers? An Indian study. CancerNurs. 2014;37(5):E40-E47.
Volume 6, Issue 2, 2024
Page : 155-160
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