Shega Joseph W, Levin Amy, Hougham Gavin W, Cox-Hayley Deon, Luchins Daniel, Hanrahan Patricia, Stocking Carol, Sachs Greg A
University of Chicago, Section of Geriatrics, School of Medicine, Chicago, Illinois 60637, USA.
J Palliat Med. 2003 Apr;6(2):315-20. doi: 10.1089/109662103764978641.
Hospice is the standard method for providing quality end-of-life care in the United States. However, studies reveal that persons with dementia are infrequently referred to hospice, that barriers exist to increasing hospice utilization in this population, and that patients with dementia would benefit from hospice or hospice-like services earlier in the disease course. The Palliative Excellence in Alzheimer Care Efforts (PEACE) program responds to these deficiencies, striving to improve end-of-life care of persons with dementia and to integrate palliative care into the primary care of patients with dementia throughout the course of the illness. The PEACE program is a disease management model for dementia that incorporates advance planning, patient-centered care, family support, and a palliative care focus from the diagnosis of dementia through its terminal stages. PEACE is coordinated through the primary care geriatrics practice of the University of Chicago. Patients and caregivers are interviewed every 6 months for 2 years, and a postdeath interview is conducted with caregivers. These interviews assess care domains important for the optimal care of persons with dementia and their caregivers. A nurse coordinator reviews interviews and provides feedback to physicians, facilitating enhanced individual care and continuous quality improvement for the practice. Initial feedback suggests patients have adequate pain control, satisfaction with quality of care, appropriate attention to prior stated wishes, and death occurring in the patient's location of choice. Families voiced similar high marks regarding quality of care. This program demonstrates an innovative model of providing quality palliative care for dementia patients and their caregivers.
在美国，临终关怀是提供优质临终护理的标准方法。然而，研究表明，患有痴呆症的人很少被转介到临终关怀机构，在这一人群中增加临终关怀服务的使用存在障碍，而且痴呆症患者在疾病进程的早期就会从临终关怀或类似临终关怀的服务中受益。阿尔茨海默病护理卓越姑息治疗（PEACE）项目应对这些不足，努力改善痴呆症患者的临终护理，并在疾病的整个过程中将姑息治疗纳入痴呆症患者的初级护理中。PEACE项目是一种针对痴呆症的疾病管理模式，从痴呆症的诊断到晚期，都纳入了预先规划、以患者为中心的护理、家庭支持和姑息治疗重点。PEACE项目由芝加哥大学的初级护理老年医学实践部门协调开展。患者和护理人员在两年内每6个月接受一次访谈，并对护理人员进行死亡后访谈。这些访谈评估了对痴呆症患者及其护理人员的最佳护理至关重要的护理领域。一名护士协调员会审查访谈内容，并向医生提供反馈，以促进个体护理的加强和该实践的持续质量改进。初步反馈表明，患者的疼痛得到了充分控制，对护理质量感到满意，对先前表达的意愿给予了适当关注，并且患者在其选择的地点离世。家属对护理质量也给予了类似的高度评价。该项目展示了一种为痴呆症患者及其护理人员提供优质姑息治疗的创新模式。
