Palliative care phases (stable, unstable, deteriorating, terminal and bereavement) are useful in describing the palliative care situation of patients/relatives and their care needs as well as the suitability of care plans. Little is known about care setting-specific differences of the phases and their association with burden of symptoms/problems and functional status. We aimed to describe the presence and association of symptom/problem burden and functional status with the palliative care phase at the beginning of care episodes in specialist palliative care units, specialist home care teams and advisory services.
This study is a secondary analysis of a prospective, cross-sectional, multicentre study collecting data on patients’ complexity in Germany. Analyses using the palliative care phase, symptom/problem burden measured by the Integrated Palliative care Outcome Scale (IPOS), functional status measured by the Australian-modified Karnofsky Performance Status (AKPS), severity of confusion and agitation, age and gender were conducted, including descriptive statistics, non-parametric tests and multinomial logistic regression.
3115 phases from three settings were included, with an average age of 72 years (SD±13.3) and 49% male. The distribution of phases at episode start varied among settings: data showed in palliative care units 20.3% stable, 43.4% unstable, 31.5% deteriorating and 4.8% terminal; in palliative care advisory, 26% stable, 33.9% unstable, 32.8% deteriorating and 7.3% terminal; and in specialist palliative home care, 42.4% stable, 21.3% unstable, 29.1% deteriorating and 7.2% terminal phases. Multinomial logistic regression showed that besides functional status, in palliative care units and specialist palliative home care, high physical symptom burden and palliative care advisory, high emotional burden increased the odds of being in an unstable phase.
Setting-specific differences in patient characteristics and symptom and problem burden associated with palliative care phases lead towards different demands on the teams providing patient care.