Abstract：
Background: National clinical guidelines have been developed internationally to reduce variations in clinical practices and promote the quality of palliative care. In The Netherlands, there is considerable variability in the organisation and care processes of inpatient palliative care, with three types of hospices - Volunteer-Driven Hospices (VDH), Stand-Alone Hospices (SAH), and nursing home Hospice Units (HU). Aim: This study aims to examine clinical practices in palliative care through different hospice types and identify variations in care. Methods: Retrospective cohort study utilising clinical documentation review, including patients who received inpatient palliative care at 51 different hospices and died in 2017 or 2018. Care provision for each patient for the management of pain, delirium and palliative sedation were analysed according to the Dutch national guidelines. Results: 412 patients were included: 112 patients who received treatment for pain, 53 for delirium, and 116 patients underwent palliative sedation therapy. Care was provided in accordance with guidelines for pain in 32%, 61% and 47% (P = .047), delirium in 29%, 78% and 79% (P = .0016), and palliative sedation in 35%, 63% and 42% (P = .067) of patients who received care in VDHs, SAHs and HUs respectively. When all clinical practices were considered, patient care was conducted according to the guidelines for 33% of patients in VDHs, 65% in SAHs, and 50% in HUs (P < .001). Conclusions: The data demonstrate that care practices are not standardised throughout Dutch hospices and exhibit significant variations between type of hospice.
摘要：
背景：国际上已经制定了国家临床指南，以减少临床实践的差异并提高姑息治疗的质量。在荷兰,住院姑息治疗的组织和护理过程存在相当大的差异，有三种类型的临终关怀医院-志愿者驱动的临终关怀医院(VDH)，独立收容所（SAH），和疗养院临终关怀单位(HU)。目的：本研究旨在通过不同的临终关怀类型来检查姑息治疗的临床实践，并确定护理中的差异。方法：回顾性队列研究利用临床文献回顾，包括在51个不同的收容所接受住院姑息治疗并在2017年或2018年死亡的患者。为每位患者提供疼痛管理的护理，根据荷兰国家指南对谵妄和姑息性镇静进行了分析.结果：包括412例患者：112例接受疼痛治疗的患者，53为谵妄，116例患者接受了姑息性镇静治疗。根据32%的疼痛指南提供护理，61%和47%（P=0.047），29％的谵妄，78%和79%(P=0.0016)，以及35%的姑息镇静,63%和42%(P=.067)接受VDHs护理的患者，分别为SAHs和HU。当考虑所有临床实践时，根据33%的VDHs患者的指南进行患者护理，65%的SAHs，和50%的HU（P<.001）。结论：数据表明，整个荷兰临终关怀医院的护理实践并未标准化，并且在临终关怀类型之间表现出显着差异。
