PB2286 IMPACT OF THE JOINT ASSESSMENT BETWEEN THE HEMATOLOGY AND PALLIATIVE CARE SERVICES ON HOSPITAL ADMISSION IN ONCOHEMATOLOGICAL PATIENTS IN RURAL AREAS. EXPERIENCE IN A GENERAL HOSPITAL IN SPAIN
Authors: Jordan B. L. Diaz , Baz M. Torcal , Templado A. Valverde , Domínguez E. Marín , Espinosa J. Hueso , Fernández T. Cañizares , Espinales V. B. Yepez 
Published: June 2019

Background:

The figures of oncohematological cases are increasing due to the aging of the population. Patients diagnosed with hematological malignancies have fewer or more delayed access to early palliative care than those diagnosed with solid cancers. This reality is exacerbated in rural areas, where access to comprehensive health services is more complex.

Aims:

The objective of this work is to assess the impact of the joint assessment by the Clinical Hematology Service and the Palliative Care Unit on hospital admission and the quality of life of oncohematological patients in a regional hospital in rural Spain.

Methods:

This is a retrospective, analytical and unicentric study conducted between October 2017 and 2018 reviewing clinical records of patients who were jointly assessed between the Hematology and Palliative Care Services with subsequent descriptive and inferential statistical analysis comparing patients who needed hospital admission with those who only received outpatient follow‐up. The inclusion criteria of patients in said joint assessment consisted of clinical and sociosanitary criteria. The first included the diagnosis of an oncohematological disease (independent of the cell line) and the need for continuous hematological follow‐up due to the short‐medium‐term prognosis. Within the sociosanitary criteria were geographical variables (the distance between the patient's habitual residence and the hospital), the patient's baseline situation, family and social support and symptomatic control.

Results:

Palliative Care Unit assessed 70 patients, 15 of them met the inclusion criteria for dual follow‐up (Table 1). The median age was 82 years old (SD: 6.4, Interval: 72‐92 years), with a slight predominance of females (53.33%) and married marital status (46.67%); in 53.33% of the patients, one of their children was the main caregiver. The most frequent hematological diagnosis was monoclonal gammopathies (33.34%), followed by myelodysplastic syndromes (myelodysplastic syndromes / chronic myeloproliferative neoplasms included), acute leukemia and non‐Hodgkin's lymphoma. Only 26.67% of the analyzed population had as an established residence the urban nucleus where the hospital center was located (average of the sample: 28.7 km away, SD: 18.46, interval: 1‐49 km distance between the usual home and the hospital). 73.33% of the sample analyzed did not require hospital admission during the follow‐up of our study. The inferential study showed statistically significant differences between hospital admission and sex (p: 0.024), high transfusional dependence (p: 0.002) and the highest frequency of hematological evaluations (p: 0.024); the greater distance between the habitual residence and the hospital center showed a limit significance (p: 0.069).

Summary/Conclusion:

The joint assessment by the services of Hematology and Palliative Care was based on communication, collaboration and integration between the patient, their environment and the socio‐sanitary staff having a positive impact, being an important tool to decrease the hospital admission in rural areas and of great geographical dispersion.

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