Trajectories of Illness in Stage 5 Chronic Kidney Disease: A Longitudinal Study of Patient Symptoms and Concerns in the Last Year of Life
Trajectories of Illness in Stage 5 Chronic Kidney Disease: A Longitudinal Study of Patient Symptoms and Concerns in the Last Year of Life
复制标题
DOI：
10.2215/cjn.09021010
复制
发表时间：
2011-07-01
影响因子：
9.8
通讯作者：
Higginson, Irene J.
中科院分区：
文献类型：
--
作者：
Murtagh, Fliss E. M.;Sheerin, Neil S.;Higginson, Irene J.
背景与目的对于晚期（5期）慢性肾脏病患者生命最后一年的疾病轨迹了解甚少。绘制以患者为中心的结果轨迹可以促进更好的护理。本研究的目的是确定无透析治疗的5期慢性肾脏疾病患者生命最后一年的症状轨迹和更广泛的健康相关问题。设计、设置、参与者和测量在三个英国肾脏单位进行了纵向症状调查，使用了纪念症状评估量表-简短形式和核心姑息治疗结果量表。绘制了平均（使用随时间推移的平均分数）和个体（使用随时间推移的个体分数，并进行了可视化图形分析）轨迹。结果共纳入74例患者，平均年龄81±6.8岁；49人在随访期间死亡。平均轨迹显示中度症状窘迫和健康相关问题，在生命的最后2个月显著增加。可视化图形分析可以识别出稳定、增加或波动的个体轨迹。遵循这些轨迹的比例因结果测量而异；在症状方面，50%的人遵循稳定模式，24%的人增加，21%的人波动，而与健康相关的问题分别为26%，57%和21%。分组轨迹的评分间一致性较高（kappa统计值分别为0.80和0.86）。在死亡前2个月，患者报告症状窘迫和健康相关问题急剧增加。卫生保健应预见并处理这种增加，这可能表明患者正在接近死亡。相当大的个体差异和护理的灵活性/响应性是重要的：一种规模的服务不适合所有人。中华临床医学杂志，2011,31(6):980 - 990。doi: 10.2215 / CJN.09021010
Background and objectives The illness trajectory in the last year of life in advanced (stage 5) chronic kidney disease is poorly understood. Mapping the trajectory of patient-centered outcomes could facilitate better care. The objectives of this study were to determine trajectories of symptoms and wider health-related concerns in the last year of life in stage 5 chronic kidney disease, managed without dialysis.Design, setting, participants, & measurements A longitudinal symptom survey in three UK renal units was used, using the Memorial Symptom Assessment Scale-Short Form and core Palliative Care Outcome Scale. Average (using mean scores over time) and individual (using individual scores over time, with visual graphical analysis) trajectories were mapped.Results Seventy-four patients (mean age, 81 +/- 6.8 years) were recruited; 49 died during follow-up. Average trajectories showed moderate symptom distress and health-related concerns, with marked increase in the last 2 months of life. Visual graphical analysis enabled stable, increasing, or fluctuant individual trajectories to be identified. The proportion following these trajectories varied between outcome measures; regarding symptoms, 50% followed a stable pattern, 24% increased, and 21% fluctuated compared with 26%, 57%, and 21%, respectively, for health-related concerns. Inter-rater agreement in grouping trajectories was high (kappa statistic, 0.80 and 0.86, respectively).Conclusions In the 2 months before death, patients reported a sharp increase in symptom distress and health-related concerns. Health care should anticipate and address this increase, which may indicate the patients is approaching death. Considerable individual variation and flexibility/responsiveness of care is important: one size of service does not fit all. Clin J Am Soc Nephrol 6: 1580-1590, 2011. doi: 10.2215/CJN.09021010