Fischer Stacy M, Gozansky Wendolyn S, Sauaia Angela, Min Sung-Joon, Kutner Jean S, Kramer Andrew
Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Denver, Colorado 80206, USA.
J Pain Symptom Manage. 2006 Apr;31(4):285-92. doi: 10.1016/j.jpainsymman.2005.08.012.
Palliative care is often offered only late in the course of disease after curative measures have been exhausted. To provide timelier symptom management, advance care planning, and spiritual support, we propose a simple set of prognostic criteria that identifies persons near the end of life. In this retrospective cohort study of five prognostic indicators, the CARING criteria (Cancer, Admissions > or = 2, Residence in a nursing home, Intensive care unit admit with multiorgan failure, > or = 2 Noncancer hospice Guidelines), logistic regression modeling demonstrated high sensitivity and specificity for mortality at 1 year (c statistic > 0.8). A simple set of clinically relevant criteria applied at the time of hospital admission can identify seriously ill persons who have a high likelihood of death in 1 year and, therefore, may benefit the most from incorporating palliative measures into the plan of care.
姑息治疗通常在疾病进程晚期、治愈性措施均已用尽后才提供。为了提供更及时的症状管理、预先护理规划和精神支持，我们提出了一套简单的预后标准，以识别接近生命末期的患者。在这项对五个预后指标进行的回顾性队列研究中，即关怀标准（癌症、入院次数≥2次、居住在养老院、因多器官衰竭入住重症监护病房、≥2条非癌症临终关怀指南），逻辑回归模型显示其对1年死亡率具有较高的敏感性和特异性（c统计量>0.8）。在入院时应用一套简单的临床相关标准，可以识别出在1年内死亡可能性很高的重症患者，因此，将姑息治疗措施纳入护理计划可能使他们受益最大。
