O'Leary Norma, Murphy Niamh F, O'Loughlin Christina, Tiernan Eoin, McDonald Kenneth
Department of Palliative Medicine, St Vincent's University Hospital, Dublin, Ireland.
Eur J Heart Fail. 2009 Apr;11(4):406-12. doi: 10.1093/eurjhf/hfp007. Epub 2009 Feb 5.
Studies suggest that patients with advanced heart failure (HF) have unmet palliative care (PC) needs. However, many of these studies have been retrospective or based on patients receiving poorly coordinated ad hoc care. We aimed to demonstrate whether the PC needs of patients with advanced HF receiving specialist multidisciplinary coordinated care are similar to cancer patients deemed to have specialist PC needs; thereby justifying the extension of specialist PC services to HF patients.
This was a cross-sectional comparative cohort study of 50 HF patients and 50 cancer patients, using quantitative and qualitative methods. Both patient cohorts were statistically indistinguishable in terms of symptom burden, emotional wellbeing, and quality-of-life scores. HF patients had good access to community and social support. HF patients particularly valued the close supervision, medication monitoring, ease of access to service, telephone support, and key worker provided at the HF unit. A small subset of patients had unmet PC needs. A palliative transition point is described.
HF patients should not be excluded from specialist PC services. However, the majority of their needs can be met at a HF unit. Recognition of the palliative transition point may be key to ensuring that end-of-life issues are addressed. The palliative transition point needs further evaluation.
研究表明，晚期心力衰竭（HF）患者的姑息治疗（PC）需求未得到满足。然而，这些研究大多是回顾性的，或基于接受协调不佳的临时护理的患者。我们旨在证明，接受专科多学科协调护理的晚期HF患者的PC需求是否与被认为有专科PC需求的癌症患者相似；从而证明将专科PC服务扩展到HF患者的合理性。
这是一项对50名HF患者和50名癌症患者的横断面比较队列研究，采用定量和定性方法。两个患者队列在症状负担、情绪健康和生活质量评分方面在统计学上无显著差异。HF患者能够很好地获得社区和社会支持。HF患者特别重视HF病房提供的密切监督、药物监测、服务的便捷性、电话支持和关键工作人员。一小部分患者的PC需求未得到满足。描述了一个姑息治疗过渡点。
HF患者不应被排除在专科PC服务之外。然而，他们的大多数需求可以在HF病房得到满足。认识到姑息治疗过渡点可能是确保解决临终问题的关键。姑息治疗过渡点需要进一步评估。
