Abstract：
BACKGROUND: Hospital-based specialized palliative care teams (HSPC) are important for symptom management and ethics support, especially during complex decision-making, but the needs of patients with noncancer diseases and their families from the HSPC are unclear. This study aimed to (I) compare the prevalence of symptom between patients with and without cancer and explore changes in symptom intensity after HSPC consultation in patients with noncancer; (II) determine factors related to ethics support; and (III) compare the percentage of request contents from patients and their families when a certified nurse specialist in gerontological nursing (geriatric care nurse below) is present in the HSPC to that when a certified nurse specialist in palliative care (palliative care nurse below) is present in the HSPC.
METHODS: We utilized a retrospective cohort study to analyze 761 patients (360 with noncancer and 401 with cancer) referred to our HSPC at the National Center for Geriatrics and Gerontology using 10-year data (since 2011) available in an electronic medical record database. (I) Symptom scores of the Support Team Assessment Schedule were compared between noncancer and cancer groups and between initial and 1-week assessments for noncancer patients. (II) Ethics support was compared between noncancer (including dementia) and cancer. The presence or absence of ethics support requests, which was set as the objective variable, was examined using logistic regression analysis. (III) The percentage of request contents selected from nine items defaulted on the electronic medical record when a geriatric care nurse was present in our HSPC were compared to those when a palliative care nurse was present in our HSPC.
RESULTS: Compared to those with cancer, patients with noncancer suffered more from dyspnea and sputum accumulation. More than 10% of patients with noncancer had suffered from pain, dyspnea, sputum accumulation, and anorexia that required treatment, with symptom scores showing improvement after 1 week of HSPC involvement, except for the sputum accumulation. Moreover, for anorexia, symptom scores improved, but >10% of these patients continued to suffer. Patients with noncancer diseases, including dementia, received ethics support than those with cancer without dementia. More requests for ethics support were received when a geriatric care nurse was in the HSPC than when a palliative care nurse was in the HSPC. Logistic regression analysis revealed that requests for ethics support were more frequent from patients or families with impaired decision-making capacity or when the patient lacked an advocate.
CONCLUSIONS: The needs of patients with noncancer diseases and families from the HSPC in Japan included (I) symptom management for intractable conditions, such as sputum accumulation; (II) ethics support for patients with noncancer diseases, including dementia, with impaired decision-making capacity, and without advocates; and (III) advice on ethics issues from a geriatric care nurse.
METHODS: We utilized a retrospective cohort study to analyze 761 patients (360 with noncancer and 401 with cancer) referred to our HSPC at the National Center for Geriatrics and Gerontology using 10-year data (since 2011) available in an electronic medical record database. (I) Symptom scores of the Support Team Assessment Schedule were compared between noncancer and cancer groups and between initial and 1-week assessments for noncancer patients. (II) Ethics support was compared between noncancer (including dementia) and cancer. The presence or absence of ethics support requests, which was set as the objective variable, was examined using logistic regression analysis. (III) The percentage of request contents selected from nine items defaulted on the electronic medical record when a geriatric care nurse was present in our HSPC were compared to those when a palliative care nurse was present in our HSPC.
RESULTS: Compared to those with cancer, patients with noncancer suffered more from dyspnea and sputum accumulation. More than 10% of patients with noncancer had suffered from pain, dyspnea, sputum accumulation, and anorexia that required treatment, with symptom scores showing improvement after 1 week of HSPC involvement, except for the sputum accumulation. Moreover, for anorexia, symptom scores improved, but >10% of these patients continued to suffer. Patients with noncancer diseases, including dementia, received ethics support than those with cancer without dementia. More requests for ethics support were received when a geriatric care nurse was in the HSPC than when a palliative care nurse was in the HSPC. Logistic regression analysis revealed that requests for ethics support were more frequent from patients or families with impaired decision-making capacity or when the patient lacked an advocate.
CONCLUSIONS: The needs of patients with noncancer diseases and families from the HSPC in Japan included (I) symptom management for intractable conditions, such as sputum accumulation; (II) ethics support for patients with noncancer diseases, including dementia, with impaired decision-making capacity, and without advocates; and (III) advice on ethics issues from a geriatric care nurse.
摘要：
背景：基于医院的专业姑息治疗团队（HSPC）对于症状管理和道德支持很重要，尤其是在复杂的决策过程中，但HSPC非癌症患者及其家属的需求尚不清楚.这项研究旨在（I）比较有癌症和没有癌症的患者之间的症状患病率，并探讨非癌症患者在HSPC咨询后症状强度的变化；（II）确定与伦理支持相关的因素；（III）比较HSPC中存在经认证的老年护理专家（以下为老年护理护士）时患者及其家属的要求内容百分比，以及HSPC中存在经认证的姑息护理护士（以下为姑息护理）时的患者及其家属的
方法：我们利用一项回顾性队列研究，利用电子病历数据库中的10年数据（自2011年起），分析了在国家老年病和老年学中心转诊到HSPC的761名患者（360名非癌症患者和401名癌症患者）。（I）在非癌症和癌症组之间以及在非癌症患者的初始和1周评估之间，比较了支持团队评估计划的症状评分。（II）比较了非癌症（包括痴呆症）和癌症之间的伦理支持。是否存在道德支持请求，它被设置为目标变量，采用Logistic回归分析。（III）将当我们的HSPC中存在老年护理护士时，从电子病历中默认的9个项目中选择的请求内容的百分比与当HSPC中存在姑息护理护士时的百分比进行比较。
结果：与癌症患者相比，非癌症患者更容易出现呼吸困难和痰液积聚.超过10%的非癌症患者患有疼痛，呼吸困难,痰液积聚，需要治疗的厌食症，HSPC参与1周后症状评分显示改善，除了痰液积聚.此外，对于厌食症，症状评分改善，但仍有10%以上的患者继续遭受痛苦。患有非癌症疾病的患者，包括痴呆症,比那些没有痴呆症的癌症患者获得伦理支持。当老年护理护士在HSPC时，比姑息护理护士在HSPC时收到更多的道德支持请求。Logistic回归分析显示，决策能力受损的患者或家庭或患者缺乏倡导者时，对道德支持的请求更为频繁。
结论：日本非癌症疾病患者和HSPC家庭的需求包括（I）顽固性疾病的症状管理，例如痰液积聚；（II）对非癌症疾病患者的伦理支持，包括痴呆症,决策能力受损，并且没有倡导者；（III）老年护理护士关于道德问题的建议。
方法：我们利用一项回顾性队列研究，利用电子病历数据库中的10年数据（自2011年起），分析了在国家老年病和老年学中心转诊到HSPC的761名患者（360名非癌症患者和401名癌症患者）。（I）在非癌症和癌症组之间以及在非癌症患者的初始和1周评估之间，比较了支持团队评估计划的症状评分。（II）比较了非癌症（包括痴呆症）和癌症之间的伦理支持。是否存在道德支持请求，它被设置为目标变量，采用Logistic回归分析。（III）将当我们的HSPC中存在老年护理护士时，从电子病历中默认的9个项目中选择的请求内容的百分比与当HSPC中存在姑息护理护士时的百分比进行比较。
结果：与癌症患者相比，非癌症患者更容易出现呼吸困难和痰液积聚.超过10%的非癌症患者患有疼痛，呼吸困难,痰液积聚，需要治疗的厌食症，HSPC参与1周后症状评分显示改善，除了痰液积聚.此外，对于厌食症，症状评分改善，但仍有10%以上的患者继续遭受痛苦。患有非癌症疾病的患者，包括痴呆症,比那些没有痴呆症的癌症患者获得伦理支持。当老年护理护士在HSPC时，比姑息护理护士在HSPC时收到更多的道德支持请求。Logistic回归分析显示，决策能力受损的患者或家庭或患者缺乏倡导者时，对道德支持的请求更为频繁。
结论：日本非癌症疾病患者和HSPC家庭的需求包括（I）顽固性疾病的症状管理，例如痰液积聚；（II）对非癌症疾病患者的伦理支持，包括痴呆症,决策能力受损，并且没有倡导者；（III）老年护理护士关于道德问题的建议。
