Patients With Cirrhosis and Denied Liver Transplants Rarely Receive Adequate Palliative Care or Appropriate Management
Patients With Cirrhosis and Denied Liver Transplants Rarely Receive Adequate Palliative Care or Appropriate Management
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DOI：
10.1016/j.cgh.2013.08.027
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发表时间：
2014-04-01
影响因子：
12.6
通讯作者：
Karvellas, Constantine J.
中科院分区：
文献类型：
--
作者：
Poonja, Zafrina;Brisebois, Amanda;Karvellas, Constantine J.
背景与目的：正在接受姑息治疗且没有资格接受肝移植（LT）的肝硬化患者通常会多次住院，对死亡和垂死缺乏期望或了解。我们评估了这些患者接受适当的姑息治疗的频率。方法：我们对102例连续的成年患者（67%男性;平均年龄55岁）进行了回顾性研究，这些患者从2005年1月到2010年12月在加拿大的阿尔伯塔大学被从名单中删除或拒绝LT。患者的医疗记录进行了审查，以确定他们获得姑息治疗和缓解症状，适当的目标，为他们的护理，他们的要求急性护理service.Results：患者的中位模型为终末期肝病评分为20，和中位时间从拒绝LT死亡为52天（范围，10-332天）。患者从移植等待名单中删除的最常见原因是不依从或药物滥用（26%）和严重疾病或器官功能障碍（25%）。在患者从名单中删除后，17%的患者接受了肾脏替代治疗，48%的患者随后进入重症监护室。患者从移植等待名单中删除后，平均在医院度过了14天（范围为6-33天）。根据埃德蒙顿症状评估系统，65%的患者有疼痛的证据，58%有恶心的证据，10%有抑郁，36%有焦虑，48%有呼吸困难，49%有厌食症状。百分之二十八的所有患者的文件不复苏的状态在他们的图表，只有11%被称为姑息治疗。结论：肝硬化患者已被从等待名单LT被删除的姑息治疗（类似于10%的情况下），虽然有很高的百分比疼痛或恶心。护理目标和不复苏状态很少讨论。需要为这些患者改进护理目标和姑息治疗服务的规划。
BACKGROUND & AIMS: Patients with cirrhosis who are receiving palliative care and are not eligible for liver transplantation (LT) are often hospitalized multiple times, with lack of expectations or understanding of death and dying. We evaluated how frequently these patients received appropriate and palliative care.METHODS: We performed a retrospective study of 102 consecutive adult patients (67% men; mean age, 55 years) who were removed from the list for or declined LT from January 2005 through December 2010 at the University of Alberta, Canada. Patients' medical records were reviewed to determine their access to palliative care and relief of symptoms, the appropriateness of the goals for their care, and their requirements for acute care services.RESULTS: The patients' median Model for End-stage Liver Disease score was 20, and median time from denial of LT to death was 52 days (range, 10-332 days). The most common reasons that patients were removed from the transplant wait list were noncompliance or substance abuse (26%) and severe illness or organ dysfunction (25%). After patients were removed from the list, 17% received renal replacement therapy, and 48% were subsequently admitted to the intensive care unit. Patients spent a median of 14 days (range, 6-33 days) in the hospital after they were removed from the transplant wait list. On the basis of the Edmonton Symptom Assessment System, 65% of patients had evidence of pain, 58% had evidence of nausea, 10% had depression, 36% had anxiety, 48% had dyspnea, and 49% had symptoms of anorexia. Twenty-eight percent of all the patients had documentation of do not resuscitate status on their charts, and only 11% were referred for palliative care.CONCLUSIONS: Patients with cirrhosis who have been removed from the wait list for LT are infrequently referred for palliative care (similar to 10% of cases), although a high percentage have pain or nausea. Goals of care and do not resuscitate status are rarely discussed. Improved planning of goals of care and access to palliative services are required for these patients.