Appropriate referral timing to specialized palliative care service: survey of bereaved families of cancer patients who died in palliative care units
Appropriate referral timing to specialized palliative care service: survey of bereaved families of cancer patients who died in palliative care units
复制标题
DOI：
10.1007/s00520-021-06493-2
复制
发表时间：
2021-08-21
影响因子：
3.1
通讯作者：
Miyashita，Mitsunori
中科院分区：
文献类型：
--
作者：
Tagami，Keita;Masukawa，Kento;Miyashita，Mitsunori
很少有研究从癌症患者和家属的经验角度探讨专科姑息治疗（SPC）的适当转诊时机。我们的目的是为晚期癌症患者及其家属明确适当的SPC转诊时机。我们使用的数据来自日本全国范围内的丧亲家庭调查。我们向164家姑息治疗单位（PCUs）的999名癌症患者家属发送了一份调查问卷，分析了首次SPC转诊的时间以及患者对其的评价。我们将SPC定义为门诊或住院姑息治疗服务，包括经过认证的姑息治疗医生、高级执业护士和多学科从业人员。最后，对51.6% （n= 515）的应答进行分析。SPC转诊时间被评价为合适（26.1%），太晚或太迟（20.2%），太早或太早（1.2%），或没有这些（52.5%）。其中，32.3%的人在被诊断为晚期或无法治愈的癌症或在抗癌治疗期间被转诊到SPC， 62.6%的人在抗癌治疗后被转诊。患者认为SPC转诊时机的适当性与他们的良好死亡过程有关。在排除“这些都没有”的反应后，与那些报告在抗癌治疗后转诊的受访者相比，报告在诊断时和抗癌治疗期间转诊到SPC的受访者比例显着更高，评估了适当的反应时间。SPC转诊的适当时机关系到死亡质量；研究结果表明，适当的时间是在诊断时或抗癌治疗期间。
Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients’ and families’ experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questionnaire to 999 bereaved families of cancer patients who died in 164 palliative care units (PCUs) and analyzed the first SPC referral timing and how patients evaluated it. We defined SPC as outpatient or inpatient palliative care service comprising certified palliative care physicians, advanced-practice nurses, and multidisciplinary practitioners. Finally, 51.6% (n= 515) of all responses were analyzed. The SPC referral timing was evaluated as appropriate (26.1%), late or too late (20.2%), early or too early (1.2%), or none of these (52.5%). Of these, 32.3% reported that they were referred to an SPC when diagnosed with advanced or incurable cancer or during anti-cancer treatment, and 62.6% reported they were referred after anti-cancer treatment. Patient-perceived appropriateness of SPC referral timing was associated with their good death process. After excluding “none of these” responses, a significantly higher proportion of respondents who reported being referred to SPC at diagnosis and during anti-cancer treatment evaluated the response timing as appropriate, compared to those who reported being referred after anti-cancer treatment. Appropriate timing for SPC referrals relates to quality of death; findings suggest that appropriate timing is at the time of diagnosis or during anti-cancer treatment.