Kaufman Karen, Salkeld Ellen J
Perm J. 2008 Winter;12(1):23-6. doi: 10.7812/TPP/07-124.
In recent years, complementary and alternative medicine modalities, including acupuncture, have been incorporated intohospice careboth to address symptom distress and to enhance quality of life. Beginning in 1997, Kaiser Permanente Northwest Hospice began offering limited acupuncture services to hospice patients and, in some cases, their caregivers. Data collection-comprising a chart review (n = 71) and in-depth interviews with the two program acupuncturists-was initiated to explore in a preliminary fashion both the processes involved in acupuncture delivery and outcomes associated with this intervention. Information culled from the patient charts (representing the year 2003) revealed a median age of 68.5 years, a cancer diagnosis in 63% of cases, and a median hospice length of stay of 102 days. The most commonly cited chief complaints presented to the acupuncturists included pain (70%), anxiety (45%), shortness of breath (27%), and nausea/vomiting (14%). Patients received a median of three acupuncture treatments; excellent or good results were noted in the charts of 34% of patients whose chief complaint was pain, in 31% of anxiety chief complaints, in 22% of shortness-of-breath chief complaints, and in 29% for nausea/vomiting chief complaints. The program acupuncturists described their practice with this group of patients as a departure from how they treat patients in a typical practice context. They described a greater focus on providing comfort through ameliorating symptoms and a diminished focus on more holistic goals, which often are typical elements in an acupuncture intervention. Nonetheless, acupuncturists also observed instances of outcomes in psychologic, social, and spiritual domains, regardless of whether these outcomes were the principal focus of treatment. These data add to the accumulating anecdotal reports suggesting that acupuncture is a promising adjunctive therapy for those nearing the end of life in the home hospice setting. More in-depth and precise assessment is warranted to comprehensively evaluate acupuncture as a viable adjunct to current usual and customary hospice care.
近年来，包括针灸在内的补充替代医学模式已被纳入临终关怀护理，以缓解症状困扰并提高生活质量。从1997年开始，凯撒永久医疗集团西北临终关怀中心开始为临终关怀患者以及某些情况下他们的护理人员提供有限的针灸服务。开始进行数据收集，包括病历审查（n = 71）以及对两名项目针灸师的深入访谈，以初步探索针灸实施过程以及与该干预措施相关的结果。从患者病历（代表2003年）中收集的信息显示，患者的中位年龄为68.5岁，63%的病例被诊断患有癌症，临终关怀的中位住院时间为102天。向针灸师提及的最常见主要症状包括疼痛（70%）、焦虑（45%）、呼吸急促（27%）以及恶心/呕吐（14%）。患者接受针灸治疗的中位次数为三次；在主要症状为疼痛的患者病历中，34%显示效果极佳或良好；主要症状为焦虑的患者中，这一比例为31%；主要症状为呼吸急促的患者中为22%；主要症状为恶心/呕吐的患者中为29%。项目针灸师表示，他们对这组患者的治疗方式与在典型临床环境中治疗患者的方式有所不同。他们称，更注重通过缓解症状来提供舒适感，而对更全面目标的关注有所减少，而这些通常是针灸干预中的典型要素。尽管如此，针灸师也观察到了心理、社会和精神领域出现的一些结果，无论这些结果是否是治疗的主要关注点。这些数据进一步充实了越来越多的轶事报告，表明针灸对于居家临终关怀环境中接近生命末期的患者来说是一种有前景的辅助治疗方法。有必要进行更深入、精确的评估，以全面评估针灸作为当前常规临终关怀护理可行辅助手段的作用。
