title: Discharge from a palliative care unit: prevalence and related factors from a retrospective study in Japan.
abstract: OBJECTIVE
  Selecting a place for end-of-life care is an important issue for patients with cancer. In this study we conducted a retrospective analysis on the prevalence of discharge from a palliative care unit (PCU) and explored factors related to discharge based on individual-level data from 5 years of experience at the Tokyo Metropolitan Toshima Hospital PCU.
  
  
  METHODS
  We retrospectively collected information on patients and families from the admission database of the PCU. We calculated the prevalence of patients discharged from the PCU and explored the factors related to discharge using bivariate and multivariate analysis.
  
  
  RESULTS
  The subjects were 498 terminal patients with cancer. The overall discharge rate was 33%. For subjects who were admitted for symptom control, the discharge rate was 54%. The duration of the period from referral to death (odds ratio [OR] = 4.98, p < 0.001), Eastern Cooperative Oncology Group Performance States [ECOG PS]_OR = 0.51, p = 0.003), problems with oral intake (OR = 0.41, p = 0048), presence of nausea (OR = 0.41, p = 0.046), experience of radiation therapy (OR = 0.27, p = 0.003), and patient's anxiety for family (OR = 0.35, p = 0.029) were independent related factors for discharge from the PCU, according to logistic regression.
  
  
  CONCLUSIONS
  Early referral to the PCU and development of alleviation methods for symptoms such as nausea and anxiety and depression are important for promoting discharge and would contribute to the patient's quality of life at the end of life.
authors.affiliation: Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. miyasita-tky@umin.net
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Kazuko
authors.initials: K
authors.lastname: Arai
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yamada
authors.forename: Machiko
authors.initials: M
authors.lastname: Owada
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Sasahara
authors.forename: Masako
authors.initials: M
authors.lastname: Kawa
authors.forename: Taketo
authors.initials: T
authors.lastname: Mukaiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care