End-of-Life Care Preferences and Needs: Perceptions of Patients with Chronic Kidney Disease
End-of-Life Care Preferences and Needs: Perceptions of Patients with Chronic Kidney Disease
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DOI：
10.2215/cjn.05960809
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发表时间：
2010-02-01
影响因子：
9.8
通讯作者：
Davison, Sara N.
中科院分区：
文献类型：
--
作者：
Davison, Sara N.
背景与目的：尽管慢性肾脏病（CKD）患者死亡率较高，但令人惊讶的是，针对此类患者临终关怀偏好的研究却少之又少。本研究旨在评估CKD患者的临终关怀偏好，以明确当前临终关怀实践与患者偏好之间的差距，并为临终关怀政策的未来创新确定重点及提供指导。
设计、环境、参与者及评估指标：2008年1月至4月期间，在加拿大一个大学附属的肾脏项目中，对584名4期和5期CKD患者在其前往透析、移植或透析前门诊就诊时进行了调查。
结果：参与者表示，他们在诸如疼痛和症状管理、预先护理计划以及心理社会和精神支持等目前尚未系统纳入其肾脏护理的广泛临终关怀需求方面依赖肾病科工作人员。参与者自述对姑息治疗选择及其疾病发展轨迹了解甚少。共有61%的患者后悔开始透析的决定。与在医院（27.4%）相比，更多患者希望在家中（36.1%）或住院临终关怀机构（28.8%）离世。在过去12个月中，不到10%的患者表示曾与肾病医生讨论过临终关怀问题。
结论：当前的临终临床实践无法满足晚期CKD患者的需求。《美国临床肾脏病学会杂志》2010年5卷195 - 204页。doi:10.2215/CJN.05960809
Background and objectives: Despite high mortality rates, surprisingly little research has been done to study chronic kidney disease (CKD) patients' preferences for end-of-life care. The objective of this study was to evaluate end-of-life care preferences of CKD patients to help identify gaps between current end-of-life care practice and patients' preferences and to help prioritize and guide future innovation in end-of-life care policy.Design, setting, participants, & measurements: A total of 584 stage 4 and stage 5 CKD patients were surveyed as they presented to dialysis, transplantation, or predialysis clinics in a Canadian, university-based renal program between January and April 2008.Results: Participants reported relying on the nephrology staff for extensive end-of-life care needs not currently systematically integrated into their renal care, such as pain and symptom management, advance care planning, and psychosocial and spiritual support. Participants also had poor self-reported knowledge of palliative care options and of their illness trajectory. A total of 61% of patients regretted their decision to start dialysis. More patients wanted to die at home (36.1%) or in an inpatient hospice (28.8%) compared with in a hospital (27.4%). Less than 10% of patients reported having had a discussion about end-of-life care issues with their nephrologist in the past 12 months.Conclusions: Current end-of-life clinical practices do not meet the needs of patients with advanced CKD. Clin J Ain Soc Nephrol 5: 195-204, 2010. doi: 10.2215/CJN.05960809