Peters Louise, Sellick Ken
School of Nursing, Monash University, Melbourne, Australia.
J Adv Nurs. 2006 Mar;53(5):524-33. doi: 10.1111/j.1365-2648.2006.03754.x.
This paper reports a comparative study of the symptom experience, physical and psychological health, perceived control of the effects of cancer and quality of life of terminally ill cancer patients receiving inpatient and home-based palliative care, and the factors that predict quality of life.
Quality of life is a major goal in the care of patients with terminal cancer. In addition to symptom management, psychological care and provision of support, being cared for at home is considered an important determinant of patient well-being. A more comprehensive understanding of the impact of cancer on patients and their families will inform the delivery of palliative care services.
Fifty-eight patients with terminal cancer (32 inpatients, 26 home-based) were recruited from major palliative care centres in Australia in 1999. A structured questionnaire designed to obtain sociodemographic information, medical details and standard measures of symptoms, physical and psychological health, personal control and quality of life was administered by personal interview.
The two groups were similar on most demographic measures, although more home-care patients were married, of Australian descent and had private health insurance cover. The most prevalent symptoms reported were weakness, fatigue, sleeping during the day and pain. Patients receiving home-based services had statistically significantly less symptom severity and distress, lower depression scores, and better physical health and quality of life than those receiving inpatient care. Home-care patients also reported statistically significantly more control over the effects of their illness, medical care and treatment received, and the course of the disease. Multiple regression analyses showed that better global physical health, greater control over the effects of cancer and lower depression scores were statistically significant predictors of higher quality of life.
The main issues arising from the findings for nurses are the early detection and management of both physical and psychological symptoms, particularly fatigue, pain, anxiety and depression, and the need to use strategies that will empower patients to have a greater sense of control over their illness and treatment. Research is needed to identify other factors that may impact on quality of life, and to establish the extent to which inpatient and home-based care meets the needs of both the patient with terminal cancer and their family.
本文报告了一项比较研究，该研究针对接受住院姑息治疗和居家姑息治疗的晚期癌症患者的症状体验、身心健康、对癌症影响的感知控制以及生活质量，以及预测生活质量的因素。
生活质量是晚期癌症患者护理的主要目标。除了症状管理、心理护理和提供支持外，在家中接受护理被认为是患者幸福感的重要决定因素。对癌症对患者及其家人影响的更全面理解将为姑息治疗服务的提供提供信息。
1999年从澳大利亚主要的姑息治疗中心招募了58名晚期癌症患者（32名住院患者，26名居家患者）。通过个人访谈进行了一份结构化问卷，旨在获取社会人口统计学信息、医疗细节以及症状、身心健康、个人控制和生活质量的标准测量。
两组在大多数人口统计学指标上相似，尽管更多居家护理患者已婚、为澳大利亚血统且有私人医疗保险。报告的最常见症状是虚弱、疲劳、白天嗜睡和疼痛。与接受住院护理的患者相比，接受居家服务的患者在症状严重程度和痛苦方面统计学上显著更低，抑郁评分更低，身体健康和生活质量更好。居家护理患者在对疾病影响、所接受的医疗护理和治疗以及疾病进程的控制方面也报告统计学上显著更多。多元回归分析表明，更好的整体身体健康、对癌症影响的更大控制以及更低的抑郁评分是生活质量更高的统计学显著预测因素。
研究结果给护士带来的主要问题是早期发现和管理身体和心理症状，特别是疲劳、疼痛、焦虑和抑郁，以及需要使用策略使患者对其疾病和治疗有更强的控制感。需要进行研究以确定可能影响生活质量的其他因素，并确定住院护理和居家护理在多大程度上满足晚期癌症患者及其家人的需求。
