Late Referrals to Palliative Care Units in Japan: Nationwide Follow-Up Survey and Effects of Palliative Care Team Involvement After the Cancer Control Act
Late Referrals to Palliative Care Units in Japan: Nationwide Follow-Up Survey and Effects of Palliative Care Team Involvement After the Cancer Control Act
复制标题
DOI：
10.1016/j.jpainsymman.2008.09.011
复制
发表时间：
2009-08-01
影响因子：
4.7
通讯作者：
Shima, Yasuo
中科院分区：
文献类型：
--
作者：
Morita, Tatsuya;Miyashita, Mitsunori;Shima, Yasuo
转诊到姑息治疗单位的时间往往会推迟。在日本，2006年制定了《癌症控制法》，旨在通过促进更多人获得专门的姑息治疗服务来提高癌症患者的生活质量。这项研究的主要目的是澄清在《癌症控制法案》之后转诊到姑息治疗单元的家庭感知的适当性，并确定姑息治疗团队的参与对家庭感知的转诊时机的影响。这项研究的另一个目的是阐明姑息治疗团队在家庭中的有用性。一项多中心问卷调查对661名住在日本姑息治疗病房的癌症患者家属进行了抽样调查。共分析了451份回复(应答率：68%)。一半的家属认为转介到姑息治疗病房的时间太晚或太晚：太晚(25%，n=114)、故事(22%，n=97)、合适(4.7%，n=212)、早(2.4%，n=11)和非常早(1.8%，n=8)。在228个家庭中，约一半的家庭表示患者表示转介的时间太晚或太晚：太晚(23%，n=52)、晚(21%，n=49)、合适(48%，n=110)、早(4.4%，n=10)和非常早(3.1%，n=7)。有姑息治疗团队的患者的家属倾向于较少报告他们认为转诊时机太晚或太晚(43%对51%，P=0.073)；他们也较少报告患者说转诊时机太晚或太晚(36%对52%，P=0.037)。评价姑息关怀团队有用或非常有用的家庭比例分别为：93%(症状控制)、90%(情感支持)、92%(家庭支持)和8.7%(护理协调)。在入住姑息治疗病房的日本患者家属中，有一半的人认为转诊的时机太晚或太晚，调查中确定的转诊比例与《癌症控制法案》之前的记录相似。然而，姑息治疗团队的参与与较低的家庭和患者感知的延迟转诊显著相关，并且姑息治疗团队的活动通常被失去亲人的家庭成员视为有用。进一步传播姑息治疗小组可有助于更好地获得全国各地的姑息治疗单位和高质量的姑息治疗。J疼痛症状管理2009；38：191-196。(C)2009年美国癌症疼痛缓解委员会。爱思唯尔公司出版，版权所有。
Referral to palliative care units tends to be delayed. In Japan, the Cancer Control Act was established in 2006 to improve the quality of life of cancer patients by facilitating greater access to specialized palliative care services. The primary aims of this study were to clarify the family-perceived appropriateness of the timing of referral to palliative care units after the Cancer Control Act, and to determine the effects of the involvement of the palliative care team on the family-perceived referral timing. An additional aim of this study was to clarify the family-perceived usefulness of the palliative care team. A multicenter questionnaire survey was conducted on a sample of 661 bereaved family members of cancer patents who were admitted to palliative care units in Japan. A total of 451 responses were analyzed (response rate: 68 %). Half of the bereaved family members regarded the timing of referrals to palliative, care units as late or too late: too late (25%, n = 114), tale (22%, n = 97), appropriate (4 7 %, n = 212), early (2.4 %, n = 11), and very early (1.8 %, n = 8). Among 228 families who reported that patients had commented on the timing of referrals, about half reported that the patients said the timing of referral was late or too late: too late (23 %, n = 52), late (21 %, n = 49), appropriate (48 %, n = 110), early (4.4 %, n = 10), and very early (3.1%, n = 7). The families of patients with a palliative care team (n = 191) tended to report less frequently that, they believed the referral timing to be late or too late (43 % vs. 51 %, P = 0.073); they also reported significantly less frequently that the patients said that the referral timing was tale or too late (36 % vs. 52 %, P = 0.037). The percentages of families who evaluated the palliative care team as useful or very useful were: 93 % (symptom control), 90 % (emotional support), 92 % (family support), and 8 7 % (care coordination). Half of the Japanese bereaved families of Patients admitted to palliative care units regarded the timing of referrals as late or too late, and the rates identified in the survey were similar to those recorded before the Cancer Control Act. Involvement of the palliative care team, however, significantly correlated with lower family- and patient-perceived late referrals, and palliative care team activity was generally perceived as useful by the bereaved family members. Further dissemination of palliative care team could contribute to better access to palliative care units and quality palliative care throughout the country. J Pain Symptom Manage 2009;38:191-196. (C) 2009 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.