Frequency of symptom distress and poor prognostic indicators in palliativecancer patients admitted to a tertiary palliative care unit, hospices, andacute care hospitals

The Edmonton Regional Palliative Care Program was established to increase a ccess to palliative care for terminal cancer patients in the region. Inpati ent care is delivered, in decreasing order of distress, at the tertiary pal liative care unit, by consult teams in acute care facilities, and in hospic es. We reviewed the admission data for all patients discharged from the pro gram between November 1, 1997, and October 31, 1998, in order to determine ii demographical and clinical variables suggested appropriate use of the th ree levels of care. Patients admitted to the tertiary palliative care unit were significantly younger than those admitted to acute care of hospices (6 1 years versus 68 years and 71 years respectively, p<0.0007), had a higher frequency of positive screening for alcoholism in the CAGE questionnaire (2 7% versus 16% and 14% respectively, p<0.0001), and a higher frequency of po or prognostic pain syndromes as compared to acute care admissions (87% vers us 65%, p<0.0001). Overall, frequency of symptoms and severe symptoms was s ignificantly higher in patients admitted to the palliative care unit than t hose admitted to the other two settings. Our results suggest that patients with demographic and clinical indications of higher distress are more frequ ently admitted to the tertiary palliative care unit. The clinical tools are useful predictors of utilization that can be used for monitoring health ca re delivery.