Connors Sonia, Graham Sheila, Peel Tim
North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK.
Palliat Med. 2007 Jun;21(4):285-7. doi: 10.1177/0269216307079172.
The outcomes of the first 4 years of a physiotherapy led non-pharmacological breathlessness management programme for patients with intrathoracic malignancy are described. Of the 169 patients enrolling, only 14 completed the full 4-week programme. All reported improvements in some parameters measured though these did not reach statistical significance. These patients tended to be fitter, had longer median survival and the mechanism of their breathlessness was not progressive cancer. The 155 patients who did not complete the programme had a short median survival (95 days), and tended to have cancer related breathlessness. Of these, 131 were seen, 85 receiving part of the programme, 15 needing other services and 31 started but died during the programme. Objective post intervention scores could not be made in this group, but anecdotal quotes suggested benefit. In a group whose natural history is a relentless deterioration over a period of months, pre- and post-intervention symptom scoring is difficult to achieve. It is suggested that a qualitative approach might be more sensitive at identifying which aspects of the service are most appropriate.
本文描述了一项由物理治疗主导的针对胸内恶性肿瘤患者的非药物性呼吸困难管理计划前四年的成果。在169名登记患者中，只有14名完成了为期4周的完整计划。所有患者报告称，一些测量参数有所改善，尽管这些改善未达到统计学意义。这些患者往往身体状况较好，中位生存期较长，且其呼吸困难的机制并非进行性癌症。未完成该计划的155名患者中位生存期较短（95天），且往往患有与癌症相关的呼吸困难。其中，131名患者接受了诊疗，85名接受了部分计划，15名需要其他服务，31名开始接受计划但在计划期间死亡。该组无法得出客观的干预后评分，但轶事性记录表明有获益。在一个自然病程为数月内持续恶化的群体中，很难实现干预前后的症状评分。建议采用定性方法可能在确定服务的哪些方面最合适时更具敏感性。
