Discrepancies between Reasons of Palliative Care Team Consultation and Palliative Care Team Activities
Discrepancies between Reasons of Palliative Care Team Consultation and Palliative Care Team Activities
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DOI：
10.1089/jpm.2018.0086
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发表时间：
2018-06-05
影响因子：
2.8
通讯作者：
Kawaguchi, Akinori
中科院分区：
文献类型：
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作者：
Hatano, Yutaka;Shikata, Yuko;Kawaguchi, Akinori
背景：姑息治疗团队（PCT）是姑息治疗服务的常见类型。然而，医院工作人员可能低估了癌症患者的痛苦。 PCT会诊的原因可能与患者的实际需求不符。目的：我们旨在检查 PCT 咨询原因与实际 PCT 活动之间的差异比例。设计和方法：我们根据近代大学医院的 PCT 活动数据集进行了一项观察性研究。计算了PCT咨询原因与实际PCT活动之间的比例差异。结果：对 PCT 进行干预的 368 名住院癌症患者的数据集进行了分析。患者的平均年龄为 61 岁。肝胆癌和胰腺癌是最常见的原发部位（20%），其次是血液癌（12%）和肺癌（11%）。疼痛管理是 PCT 咨询 (67%) 和 PCT 活动 (65%) 的最常见原因。谵妄更有可能通过 PCT 治疗，但不太可能被列为咨询原因。医院工作人员很少意识到对家庭支持和决策的需要。癌症相关疲劳（CRF）和抑郁更有可能被列为咨询原因，但接受 PCT 干预的可能性较小。结论：医院工作人员没有充分认识到谵妄以及对家庭和决策支持的需求。由于转诊太晚，针对 CRF 和抑郁症的 PCT 干预常常被拒绝。 PCT 磋商的适当时机非常重要。需要为医院工作人员提供教育机会，以全面评估患者的多维痛苦。
Background: Palliative care team (PCT) is a common type of palliative care services. However, distress in cancer patients may be underestimated by hospital staff. Reasons for PCT consultation may be inconsistent with patients' actual needs. Objective: We aimed to examine the proportions of discrepancy between the reasons for PCT consultation and actual PCT activities. Design and Methods: We performed an observational study based on datasets of PCT activities at Kindai University Hospital. Differences in the proportion between reasons for PCT consultation and actual PCT activities were calculated. Results: Datasets of 368 hospitalized cancer patients for whom the PCT performed interventions were analyzed. The average patient age was 61 years. Hepatobiliary and pancreatic cancer were the most common primary sites (20%) followed by blood (12%) and lung (11%). Pain management was the most frequent reason for PCT consultation (67%) and PCT activities (65%). Delirium was more likely to be treated by the PCT, but less likely to be listed as a reason for consultation. The need for support for family and for decision making was less often recognized by hospital staff. Cancer-related fatigue (CRF) and depression were more likely listed as reasons for consultation, but less likely to receive PCT intervention. Conclusions: Delirium and the need for family and decision-making support were underrecognized by hospital staff. PCT intervention for CRF and depression was often withheld because of very late referral. Appropriate timing of PCT consultations is important. Providing educational opportunities for hospital staff to comprehensively assess patient's multidimensional distress is needed.