Addington-Hall J M, MacDonald L D, Anderson H R, Chamberlain J, Freeling P, Bland J M, Raftery J
Department of Public Health Sciences, St George's Hospital Medical School, University of London.
BMJ. 1992 Nov 28;305(6865):1317-22. doi: 10.1136/bmj.305.6865.1317.
To measure effects on terminally ill cancer patients and their families of coordinating the services available within the NHS and from local authorities and the voluntary sector.
Randomised controlled trial.
Inner London health district.
Cancer patients were routinely notified from 1987 to 1990. 554 patients expected to survive less than one year entered the trial and were randomly allocated to a coordination or a control group.
All patients received routinely available services. Coordination group patients received the assistance of two nurse coordinators, whose role was to ensure that patients received appropriate and well coordinated services, tailored to their individual needs and circumstances.
Patients and carers were interviewed at home on entry to the trial and at intervals until death. Interviews after bereavement were also conducted. Outcome measures included the presence and severity of physical symptoms, psychiatric morbidity, use of and satisfaction with services, and carers' problems. Results from the baseline interview, the interview closest to death, and the interview after bereavement were analysed.
Few differences between groups were significant. Coordination group patients were less likely to suffer from vomiting, were more likely to report effective treatment for it, and less likely to be concerned about having an itchy skin. Their carers were more likely to report that in the last week of life the patient had had a cough and had had effective treatment for constipation, and they were less likely to rate the patient's difficulty swallowing as severe or to report effective treatment for anxiety. Coordination group patients were more likely to have seen a chiropodist and their carers were more likely to contact a specialist nurse in a night time emergency. These carers were less likely to feel angry about the death of the patient.
This coordinating service made little difference to patient or family outcomes, perhaps because the service did not have a budget with which it could obtain services or because the professional skills of the nurse-coordinators may have conflicted with the requirements of the coordinating role.
评估协调国民保健服务体系（NHS）、地方当局及志愿部门所提供的各项服务，对晚期癌症患者及其家属产生的影响。
随机对照试验。
伦敦市中心卫生区。
1987年至1990年期间，癌症患者按常规方式被通知参与试验。554名预计存活时间不足一年的患者进入试验，并被随机分配至协调组或对照组。
所有患者均接受常规可得的服务。协调组患者接受两名护士协调员的协助，其职责是确保患者获得适合其个人需求和情况的恰当且协调良好的服务。
患者及护理人员在试验开始时、直至死亡期间每隔一段时间接受家访面谈。丧亲后也进行面谈。观察指标包括身体症状的存在及严重程度、精神疾病发病率、服务的使用情况及满意度，以及护理人员面临的问题。对基线面谈、最接近死亡时的面谈以及丧亲后面谈的结果进行分析。
两组之间几乎没有显著差异。协调组患者呕吐的可能性较小，更有可能报告针对呕吐的有效治疗，且不太可能担心皮肤瘙痒。他们的护理人员更有可能报告患者在生命的最后一周咳嗽且接受了便秘的有效治疗，且他们将患者吞咽困难评为严重程度较低或报告焦虑得到有效治疗的可能性较小。协调组患者更有可能看过足病医生，其护理人员在夜间紧急情况下更有可能联系专科护士。这些护理人员对患者死亡感到愤怒的可能性较小。
这项协调服务对患者或家属的结局影响不大，可能是因为该服务没有可用于获取服务的预算，或者是因为护士协调员的专业技能可能与协调角色的要求相冲突。
