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Table 4 Multivariate odds ratios for the association of under-diagnosis of pain by primary physicians and independent variables

From: Under-diagnosis of pain by primary physicians and late referral to a palliative care team

Variables

Crude OR (95% CI)

Adjusted OR†(95% CI)

Age

0.99 (0.96-1.03)

0.98 (0.96-1.01)

Gender

 Male

0.79 (0.31-1.94)

0.94 (0.49-1.83)

 Female

1.00 (Reference)

1.00 (Reference)

KPS < 40

1.35 (0.53-3.39)

1.10 (0.51-2.34)

   ≧ 40

1.00 (Reference)

1.00 (Reference)

Primary cancer site

 Respiratory tract

0.83 (0.18-3.74)

0.58 (0.19-1.66)

 Gastrointestinal tract and Liver/Gallbladder/Pancreas

0.91 (0.26-3.18)

0.70 (0.25-2.01)

 Genitourinary

0.80 (0.24-2.69)

0.43 (0.13-1.40)

 Others

1.00 (Reference)

1.00 (Reference)

Treatment status at initial PCT consultation

 Chemotherapy/Radiotherapy/Surgery/Diagnosis

0.63 (0.25-1.58)

1.47 (0.69-3.14)

 Only symptom management

1.00 (Reference)

1.00 (Reference)

Purpose of admission

 Chemotherapy/Radiotherapy/Surgery/Diagnosis

1.39 (0.56-3.43)

1.17 (0.56-2.45)

 Only symptom management

1.00 (Reference)

1.00 (Reference)

Coexistence of delirium

 Yes

1.92 (0.59-6.23)

2.92 (1.23-6.94)**

 No

1.00 (Reference)

1.00 (Reference)

Current opioid use at initial PCT consultation

 Yes

0.98 (0.39-2.45)

0.84 (0.43-1.63)

 No

1.00 (Reference)

1.00 (Reference)

Duration of hospitalization (Number of days)

 

1.01 (0.99-1.02)

0.99 (0.98-1.01)

Interval between admission and initial PCT consultation (Days)

 > 20 days

3.06 (1.65-5.69)**

2.91 (1.27-6.71)**

 ≦ 20 days

1.00 (Reference)

1.00 (Reference)

Clinical department of primary physician 1)

 Internal medicine less-experienced oncology 2), 5)

1.21 (0.13-11.06)

1.51 (0.38-5.97)

 Internal medicine more-experienced oncology 3), 5)

1.33 (0.16-11.37)

1.81 (0.42-7.76)

 Surgery 4) and Urology/Obstetrics and Gynecology

1.00 (Reference)

1.00 (Reference)

Experience of primary physician

 < 6 years

3.45 (1.42-8.36)*

3.51 (1.32-9.35)*

 6−10 years

1.00 (Reference)

1.00 (Reference)

 > 10 years

1.93 (1.01-3.69)*

1.96 (0.94-4.08)

  1. Under-diagnosis of pain by primary physicians = 1, accurate pain assessment = 0.
  2. † Adjusted for age, gender, KPS, primary cancer site, treatment status at initial PCT consultation, purpose of admission, coexistince of delirium, current opioid use at initial PCTconsultation, duration of hospitalization, interval between admission and initial PCT consultation, clinical department, experience of primary physician.
  3. 1) Others was deleted as it was the minority. Others were Orthopedic surgery, Otorhinolaryngology, Dermatology, and Oral surgery.
  4. 2) General medicine, Internal medicine specialized Renal and Cardiovascular.
  5. 3) Internal medicine specialized Gastroenterological, Respiratory, Hematology, and Oncology.
  6. 4) Surgery specialized Upper and Lower gastroenterological, Hepato-Biliary-Pancreatic Surgery, Respiratory, Mammary gland, and Thyroid.
  7. 5) Less-experienced and more-experienced oncology was defined by cancer patient data from the hospital register.
  8. OR; Odds Ratio.
  9. CI; Confidence Interval.
  10. KPS; Karnofsy Performance Status.
  11. PCT; Palliative Care Team.
  12. *p < 0.05.
  13. **p < 0.01.
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BMC Palliative Care

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