Symptom Burden and Performance Status among Community-Dwelling Patients with Serious Illness.
Symptom Burden and Performance Status among Community-Dwelling Patients with Serious Illness.
复制标题
社区居住的重病患者的症状负担和表现状态。
DOI：
10.1089/jpm.2014.0381
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发表时间：
2015
影响因子：
2.8
通讯作者：
Abernethy,AmyP
中科院分区：
文献类型：
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作者：
Kamal,ArifH;Nipp,RyanD;Bull,Janet;Stinson,CharlesS;Abernethy,AmyP
背景：预测负担性症状何时出现或恶化对保持严重疾病患者的生活质量非常重要。目的：我们探讨了症状的患病率和严重程度与潜在的表现状态之间的关系。方法：我们对接受社区姑息治疗的患者进行了回顾性队列分析，调查了症状负担与表现状态之间的关系。患者数据来自Palliative Care Consortium数据库，这是一个用于研究和质量改进的社区咨询数据中心登记处。我们测量症状的患病率和严重程度使用McCorkle症状困扰量表和性能状态使用姑息性能Scale.Results：我们分析了4994例患者的数据，大多数（90%）与非癌症，严重的疾病。30%的人有一个或多个中度或重度症状。除了确定疲劳和疼痛的高患病率外，我们还发现了与不同水平的表现状态相关的高负担症状的不同分组。这包括在高性能患者中疲劳、厌食和呼吸困难的高患病率。然而，低体力状态的患者报告更多的疼痛、抑郁和便秘。使用性能状态作为一种共同的语言，医疗专业人员和非正式的照顾者可以监测即将发生的变化，症状负担。这应该告知发展以社区为基础的服务系统，以发现和管理病人的痛苦与姑息治疗的需要。
Background:Predicting when burdensome symptoms will arise or worsen is important to preserving quality of life in patients with serious illness.Objectives:We explored the relationship between prevalence and severity of symptoms and underlying performance status.Methods:We performed a retrospective cohort analysis of patients receiving community palliative care, investigating relationships between symptom burden and performance status. Patient data were obtained from the Carolinas Palliative Care Consortium Database, a central registry of community consultation data for research and quality improvement. We measured symptom prevalence and severity using the McCorkle Symptom Distress Scale and performance status using the Palliative Performance Scale.Results:We analyzed data of 4994 patients, most (90%) with noncancer, serious illnesses. Thirty percent had one or more moderate/severe symptoms. In addition to identifying the high prevalence of fatigue and pain, we found distinct groupings of symptoms with high burden associated with different levels of performance status. This includes high prevalence of fatigue, anorexia, and dyspnea in patients with high performance. Patients with low performance status, however, reported more pain, depression, and constipation.Conclusion:Bothersome symptoms change as patients' performance status worsens. Using performance status as a common language, both medical professionals and informal caregivers can monitor impending changes in symptom burden. This should inform development of community-based delivery systems to detect and manage distress in patients with palliative care needs.