Higginson I J, Wade A M, McCarthy M
Department of Epidemiology and Public Health, University College and Middlesex School of Medicine, London.
J Public Health Med. 1992 Mar;14(1):50-6.
The palliative care of 227 consecutive patients by two support teams was measured according to 17 key indicators in the Support Team Assessment Schedule (STAS), an instrument previously developed and validated for use in these settings. Mean time in care was 71 days (range 1-547); 56 per cent of patients died at home, 26 per cent in hospital, 18 per cent in a hospice. Totalled ratings (sum of 15 items, excluding two items owing to missed ratings) improved in 83 per cent of cases, remained unchanged in 3 per cent and deteriorated in 13 per cent. The main problems which the STAS identified at referral were family anxiety, symptom control, patient anxiety and communication between patient and family. Fifteen of the 17 items showed significant improvements (Wilcoxon Z ranged from -3.18 to -8.20, p less than 0.00005) between referral ratings and ratings for the last week of the patient's life; family anxiety and spiritual needs did not. Patient anxiety and symptom control, although improved, also remained relatively severe at death. These results demonstrate the value of measuring key indicators and indicate areas where improvement in palliative care is needed.
两个支持团队对227例连续患者的姑息治疗，依据支持团队评估量表（STAS）中的17项关键指标进行衡量。该量表是此前开发并经验证适用于此类情况的工具。平均护理时间为71天（范围1 - 547天）；56%的患者在家中死亡，26%在医院死亡，18%在临终关怀机构死亡。总计评分（15项评分之和，因评分缺失排除两项）在83%的病例中有所改善，3%保持不变，13%恶化。STAS在转诊时确定的主要问题是家庭焦虑、症状控制、患者焦虑以及患者与家人之间的沟通。17项指标中有15项在转诊评分与患者生命最后一周的评分之间显示出显著改善（Wilcoxon Z值范围为 - 3.18至 - 8.20，p小于0.00005）；家庭焦虑和精神需求未显示出改善。患者焦虑和症状控制虽有改善，但在死亡时仍相对严重。这些结果证明了衡量关键指标的价值，并指出了姑息治疗中需要改进的领域。
