School of Health Sciences, University of Southampton, Highfield, Southampton.
Palliat Med. 2009 Apr;23(3):190-7. doi: 10.1177/0269216309102525. Epub 2009 Feb 27.
The importance of evaluating systematically the effectiveness of hospice care has been noted for at least 20 years. There is, however, limited evidence about whether and how the care provided to terminally ill patients by in-patient hospices in the UK differs from that provided in NHS hospitals. In this article, we, therefore, present a comparison of hospice in-patient care and hospital care for cancer patients in the UK, from the perspective of bereaved relatives who had experienced both types of care during the last 3 months of the patient's life. The Office of National Statistics drew a random sample of 800 deaths in South London in 2002, and sent the person who registered the death (the informant) a Views of Informal Carers - Evaluation of Services (VOICES) questionnaire 3-9 months after the death, with up to two reminders. There was a response rate of 48%. For this analysis, 40 cancer patients whose informant reported both a hospice in-patient admission and a hospital admission in the last 3 months of life were identified. Informants answered the same questions about each admission and responses on these were compared. There were statistically significant differences between respondents' views of hospice and hospital care on eight out of 13 variables measuring aspects of satisfaction with care, with a trend towards statistical significance on a further two: in all cases respondents rated hospice care more positively than hospital care. There were no differences in the experience of pain and breathlessness in the two settings, but respondents rated pain control by the hospice as more effective. In comparison to hospital care, from the perspective of bereaved relatives, hospice in-patient care provided better pain control, better communication with patients and families, and better medical, nursing and personal care, which treated the patient with more dignity. Further research is needed to confirm these findings using a wider sample of in-patient hospices in the UK and including the perspectives of patients. Providing high quality care for terminally ill patients in acute hospitals remains an important challenge.
评估临终关怀效果的重要性至少已经被关注了 20 年。然而，关于英国住院临终关怀机构为绝症患者提供的护理与国民保健制度（NHS）医院提供的护理之间是否存在差异以及差异何在，证据有限。因此，本文从患者生命的最后 3 个月中经历过这两种护理的丧亲者的角度，介绍了英国临终关怀住院护理与医院护理的比较。英国国家统计局（Office of National Statistics）从 2002 年伦敦南部的 800 例死亡中随机抽取了一个样本，并在患者死亡后 3-9 个月内向登记死亡的人（通知人）发送了一份“非正式照顾者意见调查-服务评估”（VOICES）问卷，并提供了最多两次提醒。回复率为 48%。在这项分析中，确定了 40 名癌症患者，其通知人报告在生命的最后 3 个月中既接受了临终关怀住院治疗，又接受了医院治疗。通知人对每次住院治疗都回答了相同的问题，并对这些回答进行了比较。在衡量对护理满意度的 13 个变量中的 8 个方面，受访者对临终关怀和医院护理的看法存在统计学上的显著差异，另外两个方面则存在统计学上的显著趋势：在所有情况下，受访者对临终关怀的评价均高于医院护理。在这两种环境中，疼痛和呼吸困难的经历没有差异，但受访者认为临终关怀对疼痛的控制更有效。与医院护理相比，从丧亲者的角度来看，临终关怀住院护理在疼痛控制、与患者和家属的沟通、医疗、护理和个人护理方面提供了更好的服务，使患者得到了更有尊严的治疗。需要进一步的研究，使用英国更多住院临终关怀机构的更广泛样本，并包括患者的观点，来证实这些发现。为急性医院的绝症患者提供高质量的护理仍然是一个重要的挑战。
