Quill Timothy, Norton Sally, Shah Mindy, Lam Yvonne, Fridd Charlotte, Buckley Marsha
Center for Palliative Care and Clinical Ethics, University of Rochester Medical Center, NY 14642, USA.
J Palliat Med. 2006 Apr;9(2):382-8. doi: 10.1089/jpm.2006.9.382.
Hospitalized patients with a wide range of serious, but not necessarily terminal illnesses are now receiving palliative care consultations. The purpose of this report is to describe what palliative care patients say is "most important to achieve" at the time of initial consultation.
We conducted a retrospective descriptive content analysis of patient responses to the question "What is most important for you to achieve?" recorded at the time of initial inpatient palliative care consultation. Two hundred fifteen patient records had documented first-person patient responses recorded. These responses were independently reviewed and categorized in a four-phase iterative process.
Responses were divided into four major categories: (1) Improving quality and meaning ("I want to be able to sit on my front porch and watch the farm go by.") (52%); (2) Achieving relief or comfort ("Can you get rid of my pain?") (34%); (3) Altering the trajectory of illness ("If there is a treatment that can make me well, I want it.") (22%); and (4) Preparing for dying ("I am not afraid of dying. I just don't want to suffer.") (11%). Five percent of responses were unable to be reliably categorized ("You ask hard questions."). Some respondents gave more than one response, so the total is greater than 100%.
Patients receiving palliative care consultation give a wide range of responses to the question "What is most important for you to achieve?" Such patient-centered inquiry about priorities deserves more systematic study in the future if patient-specific goals are to be a marker of high-quality palliative care.
患有各种严重但不一定是绝症的住院患者现在正在接受姑息治疗咨询。本报告的目的是描述姑息治疗患者在初次咨询时所说的“最想实现的”事情。
我们对住院患者初次姑息治疗咨询时记录的“对你来说最重要的事情是什么？”这一问题的患者回答进行了回顾性描述性内容分析。215份患者记录中有记录的第一人称患者回答。这些回答在一个四阶段的迭代过程中进行了独立审查和分类。
回答分为四大类：（1）提高生活质量和意义（“我希望能够坐在前门廊上看着农场的景象。”）（52%）；（2）实现缓解或舒适（“你能消除我的疼痛吗？”）（34%）；（3）改变疾病轨迹（“如果有一种治疗方法能让我康复，我想要。”）（22%）；以及（4）为死亡做准备（“我不害怕死亡。我只是不想受苦。”）（11%）。5%的回答无法可靠分类（“你问的问题很难。”）。一些受访者给出了不止一个回答，所以总数超过了100%。
接受姑息治疗咨询的患者对“对你来说最重要的事情是什么？”这个问题给出了广泛的回答。如果以患者为中心的特定目标要成为高质量姑息治疗的标志，那么这种关于优先事项的以患者为中心的询问在未来值得进行更系统的研究。
