Interdisciplinary Palliative Care for Patients With Lung Cancer
Interdisciplinary Palliative Care for Patients With Lung Cancer
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DOI：
10.1016/j.jpainsymman.2015.07.005
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发表时间：
2015-12-01
影响因子：
4.7
通讯作者：
Koczywas, Marianna
中科院分区：
文献类型：
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作者：
Ferrell, Betty;Sun, Virginia;Koczywas, Marianna
语境。应在肺癌等严重疾病的整个发展过程中解决姑息治疗，包括症状管理和对生活质量 (QOL) 的关注。目标。本研究测试了跨学科姑息治疗干预对 I-IV 期非小细胞肺癌 (NSCLC) 患者的有效性。方法。接受非小细胞肺癌治疗的患者被纳入一项前瞻性、准实验性研究，首先是常规护理组，然后是干预组。干预组的患者参加了跨学科护理会议，并进行了适当的支持性护理转诊。他们还接受了四次教育课程。在基线和 12 周时，对两组患者的生活质量、症状和心理困扰进行了评估，调查包括癌症治疗肺功能评估和肺癌子量表、慢性病治疗精神健康的 12 项功能评估和痛苦温度计。结果。主要分析共纳入 491 名患者。接受干预的患者在 12 周时的生活质量得分（109.1 vs. 101.4；P < 0.001）、症状得分（25.8 vs. 23.9；P < 0.001）、精神健康得分（38.1 vs. 36.2；P = 0.001）和较低的心理困扰（2.2 vs. 3.3；P < 0.001）得分显着提高。在控制基线评分后，与常规护理组的患者进行比较。干预组中的患者完成预先护理指示的数量也显着增加（44% vs. 9%；P < 0.001），并且总体支持性护理转诊数量也显着增加（61% vs. 28%；P < 0.001）。与 IV 期患者相比，这些益处主要体现在早期患者身上。结论。门诊护理环境中的跨学科姑息治疗显着改善了 NSCLC 患者的生活质量、症状和痛苦。 (C) 2015 年美国临终关怀和姑息医学学会。由爱思唯尔公司出版。保留所有权利。
Context. Palliative care, including symptom management and attention to quality of life (QOL) concerns, should be addressed throughout the trajectory of a serious illness such as lung cancer.Objectives. This study tested the effectiveness of an interdisciplinary palliative care intervention for patients with Stage I-IV non-small cell lung cancer (NSCLC).Methods. Patients undergoing treatments for NSCLC were enrolled in a prospective, quasi-experimental study whereby the usual care group was accrued first followed by the intervention group. Patients in the intervention group were presented at interdisciplinary care meetings, and appropriate supportive care referrals were made. They also received four educational sessions. In both groups, QOL, symptoms, and psychological distress were assessed at baseline and 12 weeks using surveys which included the Functional Assessment of Cancer Therapy-Lung and the Lung Cancer Subscale, the 12-item Functional Assessment of Chronic Illness TherapyeSpiritual Well-Being, and the Distress Thermometer.Results. A total of 491 patients were included in the primary analysis. Patients who received the intervention had significantly better scores for QOL (109.1 vs. 101.4; P < 0.001), symptoms (25.8 vs. 23.9; P < 0.001) spiritual well-being (38.1 vs. 36.2; P = 0.001), and lower psychological distress (2.2 vs. 3.3; P < 0.001) at 12 weeks, after controlling for baseline scores, compared to patients in the usual care group. Patients in the intervention group also had significantly higher numbers of completed advance care directives (44% vs. 9%; P < 0.001), and overall supportive care referrals (61% vs. 28%; P < 0.001). The benefits were seen primarily in the earlier stage patients vs. those with Stage IV disease.Conclusion. Interdisciplinary palliative care in the ambulatory care setting resulted in significant improvements in QOL, symptoms, and distress for NSCLC patients. (C) 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.