Improvements in end-of-life care with a protocol-based pathway for cancer patients dying in a Singapore hospital.
Improvements in end-of-life care with a protocol-based pathway for cancer patients dying in a Singapore hospital.
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通过基于协议的途径改善在新加坡医院死亡的癌症患者的临终关怀。
DOI：
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Alethea C P Yee
中科院分区：
文献类型：
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作者：
P. Neo;M. Poon;T. Peh;S. Ong;W. Koo;U. Santoso;C. Goh;Alethea C P Yee
介绍
新加坡半数以上的死亡发生在医院。对医院里垂死病人所接受的护理质量知之甚少。利物浦护理路径（LCP）提供了一个框架，为临终患者提供良好的临终护理，并已在英国（UK）成功使用。在这项研究中，我们调查了在新加坡医院采用改良LCP是否能为癌症患者提供更好的临终护理。
材料和方法
LCP作为试点项目在新加坡总医院的肿瘤病房进行了调整和实施。对30例连续死亡记录进行了基线审查，随后对30例使用改良LCP的连续患者进行了4个月的试点和实施后审计。
结果
分析了五种类型的临终症状。实施后组中死亡时只有1例不受控制的症状，而回顾性稽查组中有24例不受控制的症状。用于症状控制的突破性药物处方从回顾性审计组的21%增加到实施后组的79%。实施后组中有25例患者停止了不适当的监测，而回顾性审计组中没有。复苏状态和患者宗教信仰的记录得到改善，在实施后组中实现了完整的记录。
结论
这项研究显示，在新加坡一家医院，通过基于协议的途径改善癌症患者的临终护理取得了可喜的成果。应探索将这一护理途径扩展到其他环境，以最大限度地提高其对因各种原因在医院死亡的患者的益处。
INTRODUCTION
More than half of all deaths in Singapore occur in hospitals. Little is known about the quality of care received by dying patients in hospitals. The Liverpool Care Pathway (LCP) provides a framework of providing good end-of-life care for dying patients and has been used with success in the United Kingdom (UK). In this study, we investigate whether adoption of a modified LCP in a Singapore hospital translated to better end-of-life care for cancer patients.
MATERIALS AND METHODS
The LCP was adapted and implemented as a pilot project on an oncology ward in Singapore General Hospital. A baseline review of 30 consecutive death records was performed, followed by a 4-month pilot and post-implementation audit of 30 consecutive patients on the adapted LCP.
RESULTS
Five types of end-of-life symptoms were analysed. There was only 1 uncontrolled symptom at death in the post-implementation group compared to 24 uncontrolled symptoms in the retrospective audit group. The prescription of breakthrough medications for symptom control increased from 21% in the retrospective audit group to 79% in the post-implementation group. Inappropriate monitoring was discontinued in 25 patients in the post-implementation group compared to none in the retrospective audit group. The documentation of resuscitation status and religion of the patient was improved, achieving full documentation in the post-implementation group.
CONCLUSION
This study shows promising results for improving end-of-life care in cancer patients with a protocol-based pathway in a Singapore hospital. Extension of this care pathway to other settings should be explored to maximise its benefits to patients dying from all causes in hospital.