Prescribing in palliative care as death approaches
Prescribing in palliative care as death approaches
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DOI：
10.1111/j.1532-5415.2007.01124.x
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发表时间：
2007-04-01
影响因子：
6.3
通讯作者：
Shelby-James, Tania M.
中科院分区：
文献类型：
--
作者：
Currow, David C.;Stevenson, James P.;Shelby-James, Tania M.
目的：确定在末期疾病的姑息治疗阶段，对共存疾病的处方和症状控制如何变化。设计：这项前瞻性队列研究探讨了针对共存疾病开出针对症状的药物 (SSM) 和长期药物的相对贡献。地点：南澳大利亚阿德莱德区域咨询姑息治疗计划。参与者：连续 260 名患者， 其中 96% 患有癌症，他们参加了一项探索姑息服务提供的大型随机试验，并随后死亡。测量：从转诊到死亡，每月收集药物和表现数据（平均 107 天，中位数 93 天，标准差 (SD) 103 天，范围 11-752 天）。对年龄、体能状态和合并症药物的基线使用进行了预先指定的亚组分析。结果：基线时，平均药物总数 SD 为 4.9 +/- 2.8（范围 0-16），SSM 为 2.3 +/- 1.5（范围 0-7），共病药物为 2.6 +/- 2.4（范围 0-13）。随着死亡临近，由于 SSM 处方，药物总数增加（增加 2.5 种药物，95% 置信区间 (0) = 2.2-2.9；P
OBJECTIVES: To determine how prescribing for comorbid illnesses and symptom control changes during the palliative phase of a terminal illness.DESIGN: This prospective cohort study explores the relative contribution to prescribing of symptom-specific medications (SSMs) and long-term medications for comorbid medical conditions.SETTING: Regional consultative palliative care program, Adelaide, South Australia.PARTICIPANTS: Two hundred sixty consecutive patients, 96% of whom had cancer, who enrolled and subsequently died in a larger randomized trial exploring palliative service delivery.MEASUREMENTS: Medication and performance data were collected monthly from referral until death (mean 107 days, median 93 days, standard deviation (SD) 103 days, range 11-752 days). Prespecified subgroup analyses of age, performance status, and the baseline use of medications for comorbid medical conditions were performed. RESULTS: At baseline, the mean total number of medications SD was 4.9 +/- 2.8 (range 0-16), SSMs was 2.3 +/- 1.5 (range 0-7), and medications for comorbid medical conditions was 2.6 +/- 2.4 (range 0-13). As death approached the total number of medications increased because of SSM prescribing (2.5 more medications, 95% confidence interval (0) = 2.2-2.9; P