Pain, dyspnea, and the quality of dying in long-term care
Pain, dyspnea, and the quality of dying in long-term care
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DOI：
10.1111/j.1532-5415.2007.01613.x
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发表时间：
2008-04-01
影响因子：
6.3
通讯作者：
Zimmerman, Sheryl
中科院分区：
文献类型：
--
作者：
Caprio, Anthony J.;Hanson, Laura C.;Zimmerman, Sheryl
目的：评估长期护理中疼痛、呼吸困难和家人对死亡质量的看法之间的关系。设计：死后访谈。背景：对四个州的 111 家疗养院、住宿护理和辅助生活设施进行分层随机抽样。参与者：对 325 名已故居民进行设施工作人员和家庭护理人员的配对访谈。测量：结果变量是死亡质量长期护理（QOD-LTC）是一种心理测量学上合理的回顾性量表，代表死亡质量的社会心理方面，通过对家庭护理人员的访谈获得。设施工作人员报告了疼痛和呼吸困难的存在情况、频率和严重程度。结果：在生命的最后一个月，近一半的居民经历了疼痛或呼吸困难。有疼痛和无疼痛的居民的 QOD-LTC 评分没有差异（4.15 vs 4.02，P=.16）。总体而言，有呼吸困难的居民比没有呼吸困难的居民有更好的 QOD-LTC 评分（4.20 vs 3.99，P=.006）。呼吸困难与更好的 QOD-LTC 评分之间的关联在认知障碍居民以及在住院护理和辅助生活设施中死亡的居民中最为明显。结论：对于在长期护理中死亡的居民来说，疼痛和呼吸困难与已故居民家属认为的较差的死亡质量无关。相反，呼吸困难可能会提醒工作人员需要护理。提高长期护理中临终质量的举措不仅应关注身体症状，还应关注减轻临终时非身体痛苦。
OBJECTIVES: To evaluate the relationship between pain, dyspnea, and family perceptions of the quality of dying in long-term care.DESIGN: After-death interviews.SETTING: Stratified random sample of 111 nursing homes and residential care and assisted living facilities in four states.PARTICIPANTS: Paired interviews from facility staff and family caregivers for 325 deceased residents.MEASUREMENTS: The outcome variable was the Quality of Dying in Long-Term Care (QOD-LTC), a psychometrically sound, retrospective scale representing psychosocial aspects of the quality of dying, obtained from interviews with family caregivers. Facility staff reported the presence, frequency, and severity of pain and dyspnea.RESULTS: During the last month of life, nearly half of residents experienced pain or dyspnea. QOD-LTC scores did not differ for residents with and without pain (4.15 vs 4.02, P=.16). Overall, residents with dyspnea had better QOD-LTC scores than those without dyspnea (4.20 vs 3.99, P=.006). The association between dyspnea and a better QOD-LTC score was strongest in cognitively impaired residents and for those dying in residential care and assisted living facilities.CONCLUSION: For residents dying in long-term care, pain and dyspnea were not associated with a poorer quality of dying as perceived by families of deceased residents. Instead, dyspnea may alert staff to the need for care. Initiatives to improve the quality of dying in long-term care should focus not only on physical symptoms, but also on the alleviation of nonphysical sources of suffering at the end of life.