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Abstract：
BACKGROUND: The role of palliative care for end-stage renal disease (ESRD) patients have been proven in some developed countries, but it is still unclear in the mainland of China. In fact, patients with ESRD experience many unmet palliative care needs, such as physical, psychological, social and spiritual needs, but the factors influencing these needs have not investigated.
METHODS: A cross-sectional study was conducted at two hemodialysis centers in the mainland of China from January to September 2022. Convenience sampling was used to collect data on the participants\' socio-demographics, clinical characteristics, the Palliative Care Outcome Scale (POS), the Dialysis Symptom Index (DSI), the Karnofsky Performance Status Scale (KPS), the Patient Health Questionnaire-9 item (PHQ-9), and the Social Support Rate Scale (SSRS). Data were analyzed using latent profile analysis, Kruskal-Wallis test, one-way analysis of variance (ANOVA), the chi-square test and multinomial logistic regression analysis.
RESULTS: Three hundred five participants were included in this study, and divided palliative care needs into three categories: Class 1, mild palliative care needs (n = 154, 50.5%); Class 2, moderate palliative care needs (n = 89, 29.2%); Class 3, severe palliative care needs (n = 62, 20.3%). Based on the analysis of three profiles, the influencing factors of unmet needs were further analyzed. Compared with Class 3, senior high school education, the household per capita monthly income < 2,000, low KPS scores, high PHQ-9 scores, and low SSRS scores were less likely to be in Class 1 (OR = 0.03, P = 0.012; OR = 0.003, P < 0.001; OR = 1.15, P < 0.001; OR = 0.55, P < 0.001; OR = 1.35, P = 0.002; respectively) and Class 2 (OR = 0.03, P = 0.007; OR = 0.05, P = 0.011; OR = 1.10, P = 0.001; OR = 0.60, P = 0.001; OR = 1.32, P = 0.003; respectively), and high symptom severity were less likely to be in Class 1 (OR = 0.82, P = 0.001). Moreover, compared with Class 1, the household per capita monthly income < 2,000 (OR = 16.41, P < 0.001), high symptom severity scores (OR = 1.12, P = 0.002) and low KPS scores (OR = 0.95, P = 0.002) were more likely to be in Class 2.
CONCLUSIONS: This study showed that almost half of ESRD patients receiving MHD presented moderate to severe palliative care needs, and the unmet needs were mainly affected by education level, financial pressure, functional status, symptom burden and social support. In the future, it is important to identify the populations with the greatest need for palliative care and consider the influencing factors of unmet needs from a comprehensive perspective, so as to help them improve health-related quality of life.
METHODS: A cross-sectional study was conducted at two hemodialysis centers in the mainland of China from January to September 2022. Convenience sampling was used to collect data on the participants\' socio-demographics, clinical characteristics, the Palliative Care Outcome Scale (POS), the Dialysis Symptom Index (DSI), the Karnofsky Performance Status Scale (KPS), the Patient Health Questionnaire-9 item (PHQ-9), and the Social Support Rate Scale (SSRS). Data were analyzed using latent profile analysis, Kruskal-Wallis test, one-way analysis of variance (ANOVA), the chi-square test and multinomial logistic regression analysis.
RESULTS: Three hundred five participants were included in this study, and divided palliative care needs into three categories: Class 1, mild palliative care needs (n = 154, 50.5%); Class 2, moderate palliative care needs (n = 89, 29.2%); Class 3, severe palliative care needs (n = 62, 20.3%). Based on the analysis of three profiles, the influencing factors of unmet needs were further analyzed. Compared with Class 3, senior high school education, the household per capita monthly income < 2,000, low KPS scores, high PHQ-9 scores, and low SSRS scores were less likely to be in Class 1 (OR = 0.03, P = 0.012; OR = 0.003, P < 0.001; OR = 1.15, P < 0.001; OR = 0.55, P < 0.001; OR = 1.35, P = 0.002; respectively) and Class 2 (OR = 0.03, P = 0.007; OR = 0.05, P = 0.011; OR = 1.10, P = 0.001; OR = 0.60, P = 0.001; OR = 1.32, P = 0.003; respectively), and high symptom severity were less likely to be in Class 1 (OR = 0.82, P = 0.001). Moreover, compared with Class 1, the household per capita monthly income < 2,000 (OR = 16.41, P < 0.001), high symptom severity scores (OR = 1.12, P = 0.002) and low KPS scores (OR = 0.95, P = 0.002) were more likely to be in Class 2.
CONCLUSIONS: This study showed that almost half of ESRD patients receiving MHD presented moderate to severe palliative care needs, and the unmet needs were mainly affected by education level, financial pressure, functional status, symptom burden and social support. In the future, it is important to identify the populations with the greatest need for palliative care and consider the influencing factors of unmet needs from a comprehensive perspective, so as to help them improve health-related quality of life.
摘要：
背景：姑息治疗对终末期肾病（ESRD）患者的作用已在一些发达国家得到证实，但在中国大陆仍不清楚。事实上,ESRD患者经历了许多未满足的姑息治疗需求，如物理，心理,社会和精神需求，但是影响这些需求的因素还没有调查。
方法：于2022年1月至9月在中国大陆的两个血液透析中心进行了横断面研究。便利抽样用于收集参与者的社会人口统计数据，临床特征,姑息治疗结果量表(POS)，透析症状指数（DSI），Karnofsky绩效状态量表(KPS)，患者健康问卷-9项目(PHQ-9)，和社会支持率量表(SSRS)。使用潜在剖面分析对数据进行分析，Kruskal-Wallis测试,单向方差分析(ANOVA)，卡方检验和多项logistic回归分析。
结果：本研究纳入了三百五个参与者，并将姑息治疗需求分为三类：第1类，轻度姑息治疗需求（n=154，50.5%）；第2类，中度姑息治疗需求（n=89，29.2%）；第3类，重度姑息治疗需求（n=62，20.3%）。基于对三个剖面的分析，进一步分析了未满足需求的影响因素。与高中三班相比，家庭人均月收入<2000，KPS得分低，PHQ-9得分高,1级(OR=0.03,P=0.012;OR=0.003,P<0.001;OR=1.15,P<0.001;OR=0.55,P<0.001;OR=1.35,P=0.002;分别)和2级(OR=0.03,P=0.007;OR=0.05,P=0.011;OR=1.10,P=0.001;OR=0.60,P=0.001,P=3)症状严重程度较高的患者在1级中的可能性较小（OR=0.82，P=0.001）。此外，与1级相比，家庭人均月收入<2,000（OR=16.41，P<0.001），高症状严重程度评分(OR=1.12,P=0.002)和低KPS评分(OR=0.95,P=0.002)更可能属于2级.
结论：这项研究表明，接受MHD的ESRD患者几乎有一半存在中度至重度姑息治疗需求，未满足的需求主要受到教育水平的影响，财政压力,功能状态，症状负担和社会支持。在未来,重要的是确定最需要姑息治疗的人群，并从全面的角度考虑未满足需求的影响因素，从而帮助他们改善与健康相关的生活质量。
方法：于2022年1月至9月在中国大陆的两个血液透析中心进行了横断面研究。便利抽样用于收集参与者的社会人口统计数据，临床特征,姑息治疗结果量表(POS)，透析症状指数（DSI），Karnofsky绩效状态量表(KPS)，患者健康问卷-9项目(PHQ-9)，和社会支持率量表(SSRS)。使用潜在剖面分析对数据进行分析，Kruskal-Wallis测试,单向方差分析(ANOVA)，卡方检验和多项logistic回归分析。
结果：本研究纳入了三百五个参与者，并将姑息治疗需求分为三类：第1类，轻度姑息治疗需求（n=154，50.5%）；第2类，中度姑息治疗需求（n=89，29.2%）；第3类，重度姑息治疗需求（n=62，20.3%）。基于对三个剖面的分析，进一步分析了未满足需求的影响因素。与高中三班相比，家庭人均月收入<2000，KPS得分低，PHQ-9得分高,1级(OR=0.03,P=0.012;OR=0.003,P<0.001;OR=1.15,P<0.001;OR=0.55,P<0.001;OR=1.35,P=0.002;分别)和2级(OR=0.03,P=0.007;OR=0.05,P=0.011;OR=1.10,P=0.001;OR=0.60,P=0.001,P=3)症状严重程度较高的患者在1级中的可能性较小（OR=0.82，P=0.001）。此外，与1级相比，家庭人均月收入<2,000（OR=16.41，P<0.001），高症状严重程度评分(OR=1.12,P=0.002)和低KPS评分(OR=0.95,P=0.002)更可能属于2级.
结论：这项研究表明，接受MHD的ESRD患者几乎有一半存在中度至重度姑息治疗需求，未满足的需求主要受到教育水平的影响，财政压力,功能状态，症状负担和社会支持。在未来,重要的是确定最需要姑息治疗的人群，并从全面的角度考虑未满足需求的影响因素，从而帮助他们改善与健康相关的生活质量。
