Braiteh Fadi, El Osta Badi, Palmer J Lynn, Reddy Suresh K, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, The University of Texas-M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
J Palliat Med. 2007 Aug;10(4):948-55. doi: 10.1089/jpm.2006.0257.
There is limited information available about the role and effect of a palliative care consultation service (mobile team, MT) in patient care. The purpose of this retrospective chart review was to determine the characteristics, findings, and outcomes of patients referred to MT in a comprehensive cancer center and to thereby gain information about its role in this setting.
The study group was 61 consecutive patients assessed by one MT during 2-month period. We reviewed their charts for information about demographic and disease features, reasons for consultation, findings, interventions, and outcomes.
Patients were mainly referred by thoracic (n = 21; 34%), genitourinary (n = 10; 16%), and gynecology (n = 9; 15%) services. The majority of patients had metastatic disease (n = 56; 92%). Evaluation of pain was the main reason for the consultation (n = 47; 77%) followed by delirium (n = 10; 16%). The MT found a total of 449 symptoms (median 8 per patient), whereas the referring team had mentioned only 86 (1 symptom per patient) in their requests. Twenty patients (38%) screened positive for a history of alcoholism. The MT diagnosed delirium in 34 patients (56%) and frequently found features of opioid-induced side effects, such as sedation (n = 46; 75%), constipation (n = 43; 70%), and confusion (n = 34; 56%). Frequent MT interventions were: administration of neuroleptics (n = 33; 54%), opioid rotation (n = 30; 49%), and enema (n = 33; 54%). Seventeen patients (28%) showed symptoms improvement within 24 hours and 23 patients within 72 hours (38%). Twenty-five patients (41%) required transfer to the palliative care unit.
The MT had a positive impact on these patients' care in terms of clinical findings and outcomes. Further investigations are warranted.
关于姑息治疗咨询服务（移动团队，MT）在患者护理中的作用和效果，现有信息有限。本回顾性病历审查的目的是确定在一家综合癌症中心被转诊至MT的患者的特征、检查结果和结局，从而获取有关其在此环境中作用的信息。
研究组为在2个月期间由一个MT连续评估的61例患者。我们查阅了他们的病历，以获取有关人口统计学和疾病特征、咨询原因、检查结果、干预措施和结局的信息。
患者主要由胸科（n = 21；34%）、泌尿生殖科（n = 10；16%）和妇科（n = 9；15%）科室转诊。大多数患者患有转移性疾病（n = 56；92%）。疼痛评估是咨询的主要原因（n = 47；77%），其次是谵妄（n = 10；16%）。MT共发现449种症状（每位患者中位数为8种），而转诊团队在其请求中仅提及86种（每位患者1种）。20例患者（38%）酒精中毒史筛查呈阳性。MT诊断出34例患者（56%）患有谵妄，并经常发现阿片类药物引起的副作用特征，如镇静（n = 46；75%）、便秘（n = 43；70%）和意识模糊（n = 34；56%）。MT频繁进行的干预措施包括：给予抗精神病药物（n = 33；54%）、阿片类药物轮换（n = 30；49%）和灌肠（n = 33；54%）。17例患者（28%）在24小时内症状改善，23例患者在72小时内症状改善（38%）。25例患者（41%）需要转至姑息治疗病房。
MT在临床检查结果和结局方面对这些患者的护理产生了积极影响。有必要进行进一步研究。
