目标:一些患者出现严重的症状,难以接受强化姑息治疗,有时使用姑息镇静。姑息性镇静可分为比例和连续深度镇静(CDS)。这项研究的主要目的是比较接受比例或CDS的患者家属之间的家庭经历。
方法:对根据镇静方案接受比例或CDS的癌症患者家属进行多中心问卷调查。镇静的总体评估(满意度,家庭感知的痛苦,时机的适当性,和患者痛苦)和13项家庭关切,美好的死亡,满意的护理,抑郁症,护理质量,未完成的事业,并测量症状缓解和保持沟通之间的平衡。
结果:在2120例死亡患者中,222例患者连续输注咪达唑仑。147名患者使用了镇静方案,并向124个家庭发送了调查问卷。最终返回了总共78个回复(成比例,58vs.CDS,20).总体评价无显著差异,家庭问题,良好死亡的总分,满意,抑郁症,或症状缓解和保持沟通之间的平衡。另一方面,一些护理项目的质量,即,与医务人员的关系(P<0.01),护士的身体护理(P=0.04),协调和一致性(P=0.04),CDS组明显优于比例镇静组。在CDS集团中,家族报告的未完成业务也更好,具有边际意义。
结论:CDS的家庭经验不低于比例镇静,实际上对护理质量和未完成业务的某些要素给予了更有利的评价。
OBJECTIVE: Some patients experience intense symptoms refractory to intensive palliative care, and palliative sedation is sometimes used. Palliative sedation may be classified into proportional and continuous deep sedation (CDS). The primary aim of this study was to compare family experience between families of patients who received proportional or CDS.
METHODS: A multicenter questionnaire survey was conducted involving bereaved families of cancer patients who received proportional or CDS based on a sedation protocol. Overall evaluation of sedation (satisfaction, family-perceived distress, appropriateness of timing, and patient distress) and 13-item family concerns, good death, satisfaction with care, depression, quality of care, unfinished business, and balance between symptom relief and maintaining communication were measured.
RESULTS: Among the 2120 patients who died, 222 patients received a continuous infusion of midazolam. A sedation protocol was used in 147 patients, and questionnaires were sent to 124 families. A total of 78 responses were finally returned (proportional, 58 vs. CDS, 20). There were no significant differences in the overall evaluation, family concerns, total score of good death, satisfaction, depression, or balance between symptom relief and maintaining communication. On the other hand, some quality of care items, i.e., relationship with medical staff (P < 0.01), physical care by nurses (P = 0.04), and coordination and consistency (P = 0.04), were significantly better in the CDS group than in the proportional sedation group. Family-reported unfinished business was also better in the CDS group, with marginal significance.
CONCLUSIONS: Family experience of CDS was not less favorable than proportional sedation, and actually rated more favorably for some elements of quality of care and unfinished business.