|Tipo di tesi||Tesi di laurea magistrale|
|Titolo||Studio dei fattori associati a conversazioni riguardanti gli obiettivi del percorso di cura (Goals-of-Care discussions) in pazienti affetti da leucemia acuta|
|Titolo in inglese||Study of factors associated to goals of care discussions in patients with acute leukemia|
|Struttura||Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze|
|Corso di studi||MEDICINA E CHIRURGIA (D.M.270/04)|
|Data inizio appello||2021-10-14|
|Disponibilità||Accesso limitato: si può decidere quali file della tesi rendere accessibili. Disponibilità mixed (scegli questa opzione se vuoi rendere inaccessibili tutti i file della tesi o parte di essi)|
|Data di rilascio||2061-10-14|
INTRODUZIONE: Le neoplasie ematologiche ad alto rischio si associano ad un’alta mortalità e ad un’elevata aggressività delle cure nel fine vita. Molti studi sui tumori solidi hanno dimostrato i vantaggi associati alla discussione dei GOC che, tuttavia, resta ancora troppo poco applicata e studiata in ematologia.
BACKGROUND: High-risk blood cancers are associated to high mortality rates and high-intensity medical care near the end-of-life. Several studies about solid tumors demonstrated the advantages of discussing goals of care (GOC) but it remains too little applied and studied in hematology. METHODS: This is an observational retrospective study based on AML, ALL or high-risk MDS patients aiming to study clinical and demographic factors associated with GOC discussion and if discussing GOC improves cares quality and/or reduces end of life care intensity. RESULTS: 390 patients were enrolled in this study, of which 67.2% with AML, 20.0% with ALL and 12.8% with high-risk MDS. Patients that discussed GOC are 44.4%. Factors associated with GOC discussion are age ≥ 60, comorbidities ≥ 2, allogenic transplantation and especially ePSC integration. All patients that discussed GOC received better quality cares with greater psychological support, more frequent pain assessment and management, greater discussion of ACP and higher activation of home care services. GOC discussion is also associated with less end-of-life care aggressiveness, especially a reduced probability of death in a hospital setting. In addition, ePSC also demonstrated a statistically significant association with most of the indicators of end-of-life care aggressiveness. CONCLUSIONS: This study represents the largest case history in literature of patients suffering from high-risk hemopathy on which the topic of the GOC discussion is deepened and, for the first time, it describes clinical and demographic factors associated with these discussions. The main factor appears to be ePSC and this study supports the relevance of early palliative care integration in hematological patients, at least in those with high-risk hemopathy. In fact, ePSC, through GOC discussion, is associated with a high quality of care received and less end-of-life care aggressiveness.