Anderson H, Ward C, Eardley A, Gomm S A, Connolly M, Coppinger T, Corgie D, Williams J L, Makin W P
Department of Clinical Audit and Quality Assurance, Christie Hospital, Manchester, UK.
Palliat Med. 2001 Jul;15(4):279-86. doi: 10.1191/026921601678320269.
Patients with a terminal illness, identified by palliative care teams working in Manchester, and patients attending a heart failure clinic, were asked to participate in a prospective survey to determine their main concerns. Data were collected from 213 palliative care (PC) patients (mostly with cancer) and 66 patients with heart failure (HF). The median ages of the two patient groups were similar, but the HF patients were more likely to be male and living with a partner; 13% of PC and 7% of HF patients reported that they had no carer. The PC patients had more district nurse, hospice, social work and physiotherapy input. The most frequently reported troublesome problems for PC patients were pain (49%), loss of independence (30%) and difficulty walking (27%). HF patients reported dyspnoea (55%), angina (32%) and tiredness (27%) as the most troublesome problems. From a checklist of symptoms, the frequency of tiredness (PC = 77%, HF = 82%) and difficulty getting about (PC = 71%, HF = 65%) were high in each group. Psychological problems were reported by 61% of PC and 41% of HF patients. Cardiac patients reported more breathlessness and cough than PC patients (83% vs 49% and 44% vs 26%, respectively). Reduced libido was more common in cardiac patients (42% vs 21%). Patient disclosure of troublesome problems to professional carers was high (>87% in both PC and HF patients). Documented action was greater for physical than social or psychological problems. For PC patients, documented action was recorded for 83% physical, 43% social/functional and 52% psychological problems. For HF patients documented action was recorded for 74% cardiac, 60% physical - non-cardiac, 30% social/functional and 28% psychological problems. Clearly many patients' troublesome problems were not being addressed. As a result of this study, specific action by health care professionals was taken in 50% of PC patients and 71% of HF patients. We plan to target specific educational events on the treatment of physical problems, psychological assessment and social service provision.
由曼彻斯特的姑息治疗团队确定的晚期疾病患者以及前往心力衰竭诊所就诊的患者，被邀请参与一项前瞻性调查，以确定他们主要关心的问题。研究收集了213名姑息治疗（PC）患者（大多数患有癌症）和66名心力衰竭（HF）患者的数据。两组患者的年龄中位数相似，但心力衰竭患者更可能为男性且有伴侣陪伴；13%的姑息治疗患者和7%的心力衰竭患者表示他们没有护理人员。姑息治疗患者接受地区护士、临终关怀、社会工作和物理治疗的情况更多。姑息治疗患者最常报告的困扰问题是疼痛（49%）、失去独立性（30%）和行走困难（27%）。心力衰竭患者报告呼吸困难（55%）、心绞痛（32%）和疲劳（27%）是最困扰的问题。在一份症状清单中，疲劳（姑息治疗组 = 77%，心力衰竭组 = 82%）和行动不便（姑息治疗组 = 71%，心力衰竭组 = 65%）在每组中的出现频率都很高。61%的姑息治疗患者和41%的心力衰竭患者报告有心理问题。心脏病患者报告的呼吸急促和咳嗽比姑息治疗患者更多（分别为83%对49%和44%对26%）。性欲减退在心脏病患者中更常见（42%对21%）。患者向专业护理人员透露困扰问题的比例很高（姑息治疗组和心力衰竭组均超过87%）。记录在案的针对身体问题的行动比对社会或心理问题的行动更多。对于姑息治疗患者，记录在案的针对身体问题的行动为83%，针对社会/功能问题的行动为43%，针对心理问题的行动为52%。对于心力衰竭患者，记录在案的针对心脏问题的行动为74%，针对非心脏身体问题的行动为60%，针对社会/功能问题的行动为30%，针对心理问题的行动为28%。显然，许多患者的困扰问题未得到解决。这项研究的结果是，50%的姑息治疗患者和71%的心力衰竭患者接受了医护人员的具体行动。我们计划针对身体问题的治疗、心理评估和社会服务提供开展特定的教育活动。
