Baer W M, Hanson L C
Division of General Medicine, School of Medicine, University of North Carolina, Chapel Hill 27599-7110, USA.
J Am Geriatr Soc. 2000 Aug;48(8):879-82. doi: 10.1111/j.1532-5415.2000.tb06883.x.
To determine if family members perceive that hospice improves the care of dying nursing home residents during the last 3 months of life.
Mailed survey.
Family members for all nursing home hospice enrollees in North Carolina during a 6-month period.
After residents' deaths, family members answered questions about the quality of care for symptoms before and after hospice, the added value of hospice, the effect of hospice on hospitalization, and special services provided by nursing home staff or by hospice staff.
A total of 292 (73%) of 398 eligible family members completed surveys. The average age of the nursing home residents who had received hospice was 79.5 years; 50% had cancer and 76% were dependent for self-care. In their last 3 months, 70% of decedents had severe or moderate pain, 56% had severe or moderate dyspnea, and 61% had other symptoms. Quality of care for physical symptoms was rated good or excellent by 64% of family before hospice and 93% after hospice (P<.001). Dying residents' emotional needs included care for moderate or severe depression (47%), anxiety (50%), and loneliness (35%). Quality of care for emotional needs was rated good or excellent by 64% of family before hospice and 90% after hospice (P<.001). Fifty-three percent of respondents believed hospice prevented hospitalizations. Family estimated the median added value of hospice to be $75 per day and described distinct special services provided by hospice and by nursing home staff.
Family members believe that nursing home hospice improves quality of care for symptoms, reduces hospitalizations, and adds value and services for dying nursing home residents.
确定家庭成员是否认为临终关怀改善了临终疗养院居民生命最后3个月的护理质量。
邮寄调查。
北卡罗来纳州6个月期间所有入住临终关怀疗养院的居民的家庭成员。
居民死亡后，家庭成员回答有关临终关怀前后症状护理质量、临终关怀的附加价值、临终关怀对住院治疗的影响以及疗养院工作人员或临终关怀工作人员提供的特殊服务的问题。
398名符合条件的家庭成员中，共有292名（73%）完成了调查。接受临终关怀的疗养院居民的平均年龄为79.5岁；50%患有癌症，76%在自我护理方面存在依赖。在他们生命的最后3个月里，70%的死者有重度或中度疼痛，56%有重度或中度呼吸困难，61%有其他症状。64%的家庭成员在临终关怀前将身体症状的护理质量评为良好或优秀，临终关怀后这一比例为93%（P<0.001）。临终居民的情感需求包括对中度或重度抑郁（47%）、焦虑（50%）和孤独（35%）的护理。64%的家庭成员在临终关怀前将情感需求的护理质量评为良好或优秀，临终关怀后这一比例为90%（P<0.001）。53%的受访者认为临终关怀避免了住院治疗。家庭成员估计临终关怀的中位数附加价值为每天75美元，并描述了临终关怀和疗养院工作人员提供的不同特殊服务。
家庭成员认为疗养院临终关怀改善了症状护理质量，减少了住院治疗，并为临终疗养院居民增加了价值和服务。
