Palliative care outcomes research: the next steps.
Palliative care outcomes research: the next steps.
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姑息治疗结果研究：下一步。
DOI：
10.1089/jpm.2005.8.13
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发表时间：
2005
影响因子：
2.8
通讯作者：
Morrison,RSean
中科院分区：
文献类型：
--
作者：
Morrison,RSean
很明显，医院对晚期病人及其家属的护理需要改进。研究继续表明疼痛和症状困扰的高患病率1 -5;大量使用繁琐的无益技术6，7;护理人员负担的高患病率8，9;患者、家属和医生之间关于护理目标和应遵循的医疗决策的沟通问题10;过渡管理不善11;以及对住院重病患者的总体护理质量普遍不满。12，13对病人及其家属的调查表明，减轻痛苦、实际支持需求、开放式沟通以及减轻家庭负担和加强与家庭关系的机会是医疗保健系统的首要需求。13-15住院的慢性病患者的数量和需求的增长，谁不是明确的绝症导致了医院为基础的姑息治疗的快速增长。虽然专家级姑息治疗是通过一系列临床模式提供的，但在美国（临终关怀以外），主要的提供模式是住院姑息治疗咨询团队。16.医院是提供姑息治疗服务的重要场所，因为几乎所有重病患者在其疾病或病情发展过程中至少都要在医院住一段时间，通常是多次住院。17 2002年，有120万美国人因癌症住院，18随着老年人癌症和其他慢性病患者人数和需求的增加，这一数字预计还会增加。到2030年，慢性病患者人数将超过1.57亿。超过75%的成人死亡发生在医院或疗养院，约50%的成人死亡发生在医院。20医院里有大量的病人没有死亡，但患有慢性病和使人衰弱的疾病，他们也需要专家的症状管理、沟通和决策支持以及护理协调。这些力量促进了姑息治疗咨询团队项目的发展，为患有严重和复杂疾病的患者提供高效和有效的医院护理。在过去的二十年里，以医院为基础的姑息治疗咨询团队的数量急剧增加，但我们对姑息治疗计划有效性的了解大多来自对医院单位、独立临终关怀机构和家庭提供的姑息治疗的小型研究。关于采用不同模式和方法的姑息治疗专家服务的报告提出了一系列益处，包括减轻疼痛21和其他症状21;改善与健康相关的生活质量22，23以及患者和家庭对护理和医生沟通的高度满意度12，13，24。23，25几项小型研究将姑息治疗和伦理咨询与减少急诊室就诊和住院、住院费用以及住院和重症监护室（ICU）住院时间相关联，22，24，26-31结果与支持讨论护理目标和促进患者/家属决定未来护理类型和设置有关。其他团体报告说，由于医院和疗养院的姑息治疗计划，临终关怀转诊率和临终关怀住院时间有所增加。32，33观察性研究表明，接受姑息治疗的患者和接受常规治疗的患者之间的死亡率没有差异。二十七、三十三、三十四
IT HAS BECOME abundantly clear that hospital care for patients with advanced illness and their families needs improvement. Studies continue to demonstrate a high prevalence of pain and symptom distress1–5; high use of burdensome nonbeneficial technologies6, 7; high prevalence of caregiver burden8, 9; communication problems between patients, families, and physicians about goals of care and medical decisions that should follow10; poor transition management11; and broad dissatisfaction with general quality of care for the hospitalized seriously ill. 12, 13 Surveys of patients and their families have identified relief of suffering, practical support needs, open communication, and opportunities to relieve burdens on and strengthen relationships with family, as the top priority needs from the healthcare system. 13–15 The growth in the number and needs of hospitalized chronically ill patients who are not clearly terminally ill has led to the rapid growth of hospital based palliative care. While specialistlevel palliative care is delivered through a range of clinical models, the predominant delivery model in the United States (outside of hospice) is the inpatient palliative care consultation team. 16 Hospitals are an important setting for palliative care services because virtually all persons with serious illness spend at least some time in a hospital, usually on multiple occasions, in the course of their disease or condition. 17 In 2002, 1.2 million Americans were hospitalized with cancer, 18 a figure expected to increase in association with the growth in numbers and needs of the elderly with cancer and other chronic conditions. By 2030, the number of persons with chronic conditions will exceed 157 million. 19 More than 75% of adult deaths occur in hospitals or nursing homes, with approximately 50% of adult deaths occurring in hospitals. 20 The much larger number of patients in hospitals who are not dying, but are living with chronic and debilitating illness also need expert symptom management, communication and decision-making support, and care coordination. These forces have contributed to the development of palliative care consultation team programs for the efficient and effective hospital care of patients with serious and complex illness. The number of hospital-based palliative care consultation teams has increased dramatically over the last two decades, yet most of what we know about the effectiveness of palliative care programs comes from small studies of palliative care provided in hospital units, free-standing hospices, and at home. Reports on palliative care specialist services utilizing diverse models and approaches have suggested a range of benefits including reduced pain21 and other symptom distress21; improved health-related quality of life22, 23 and high patient and family satisfaction12, 13, 24 with care and with physician communication. 23, 25 Several small studies have associated palliative care and ethics consultation with reductions in emergency department visits and hospitalizations, hospital costs, and hospital and intensive care unit (ICU) length of stay, 22, 24, 26–31 outcomes linked to support for discussions about the goals of care and facilitation of patient/family decisions about types and settings of future care. Other groups have reported increases in hospice referral rates and hospice length of stay resulting from hospital and nursing-home-based palliative care programs. 32, 33 Observational studies have yielded no differences in mortality between patients receiving palliative care and those receiving usual care. 27, 33, 34