背景:姑息治疗(PC)相当于一种提高面临危及生命的疾病患者生活质量的方法,比如癌症,以及他们的家人。有各种模式提供姑息治疗。晚期癌症患者早期转诊PC对其生活质量有显著的积极影响。然而,早期转诊的标准仍然存在争议.
目的:评估患者入院时的症状强度和生活质量,并根据不同的方法(门诊和住院护理)分析这两个变量。
方法:横截面,描述性,描述性我们对60例患者进行了相关性研究,这些患者是在一家三级肿瘤医院的姑息性门诊咨询或其他住院服务中依次进入PC病房的患者.评估方案包括社会人口统计学和医学问卷,埃德蒙顿症状评估量表(ESAS),以及患者在入院后最初24小时内完成的姑息治疗结果量表(POS)。
结果:参与者大多为男性(61.7%),平均年龄为72岁。大多数患者(n=32;53.3%)正在接受门诊治疗,其余的人(n=28;46.7%)从其他医院服务(住院护理)转移。在门诊护理组中,疲劳和呼吸困难评分较高.相反,在住院护理组中,疼痛评分较高,抑郁症,和焦虑。两组在生命意义的POS维度上有显著差异,自我感受,失去了时间。在住院组,诊断和转诊至PC之间的时间较长;然而,在住院患者组中,PC转诊和首次PC评估之间的时间也较短,在PC转诊和PC单元录取之间,在电脑转诊和死亡之间。住院和门诊组的转诊时间和ESAS/POS评分之间没有显着相关性。
结论:进入姑息治疗室的患者表现出较高的症状负担和对生活质量的感知变化。然而,一种方法与另一种方法之间没有统计学上的显著差异。结果发现,较差的症状控制和生活质量与较短的PC转诊时间有关,因为这是在治疗暂停后才开始的,特别是在我们的体制背景下。早期转诊到PC团队不仅对于缓解症状相关的困扰,而且对于改善癌症患者的治疗结果和生活质量至关重要。
BACKGROUND: Palliative care (PC) corresponds to an approach that enhances the quality of life for patients facing life-threatening diseases, such as cancer, as well as for their families. There are various models for providing palliative care. Early referral to PC of patients with advanced cancer has a significant positive impact on their quality of life. However, the criteria for early referral still remain controversial.
OBJECTIVE: To evaluate patients\' symptomatic intensity and perception of quality of life on admission to a PC unit and to analyze these two variables according to different models of approach (outpatient and inpatient care).
METHODS: A cross-sectional, descriptive, and correlational study was conducted with a sample of 60 patients sequentially admitted to a PC unit from palliative outpatient consultations or other inpatient services in a tertiary hospital dedicated to oncology care. The evaluation protocol included a sociodemographic and medical questionnaire, the Edmonton Symptom Assessment Scale (ESAS), and the Palliative Care Outcome Scale (POS) completed by patients within the first 24 h after admission.
RESULTS: The participants were mostly male (61.7%), with a median age of 72 years. The majority of patients (n = 32; 53.3%) were undergoing outpatient treatment, while the remaining individuals (n = 28; 46.7%) were transferred from other hospital services (inpatient care). In the outpatient care group, higher scores for fatigue and dyspnea were observed. Conversely, in the inpatient care group, higher scores were observed for pain, depression, and anxiety. There were significant differences between the two groups regarding the POS dimensions of meaning of life, self-feelings, and lost time. In the inpatient group, there was a longer time between diagnosis and referral to PC; however, it was also in the inpatient group that there was less time between PC referral and first PC evaluation, between PC referral and PC unit admission, and between PC referral and death. There were no significant correlations between referral times and ESAS/POS scores in the inpatient and outpatient groups.
CONCLUSIONS: The patients admitted to the Palliative Care Unit presented a high symptom burden and changes in the perception of quality of life. However, there are no statistically significant differences between one model of approach in relation to the other. It was found that poorer symptom control and quality of life were associated with a shorter referral time for PC, because this was only initiated after curative care was suspended, particularly in our institutional context. Early referrals to the PC team are essential not only to relieve symptom-related distress but also to improve treatment outcomes and quality of life for people with cancer.