Department of Family Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Palliat Med. 2011 Jun;14(6):683-7. doi: 10.1089/jpm.2010.0331. Epub 2011 Apr 19.
Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system.
From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed.
A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% (p < 0.0001), and awareness of disease prognosis from 46.05% to 57.69% (p = 0.0006). Combined hospice care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%).
Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.
许多晚期癌症患者会出现与疾病相关的身体和心理症状。这些症状在常规治疗中很少得到治疗。姑息治疗计划的目的是填补这一护理空白。然而，临终关怀病房的床位有限。为了让更多的晚期癌症患者从临终关怀团队那里获得关怀，台湾最近开发了一种综合临终关怀系统。本研究报告了我们在这方面的经验。
从 2009 年 1 月到 12 月，接受临终关怀团队咨询的接受综合临终关怀的晚期癌症患者被纳入研究。分析了人口统计学数据、临床症状、转诊科室、癌症类型和结果。
共有 354 名急性病房的晚期癌症患者被转介到临终关怀咨询团队。患者平均年龄为 61 岁，男性比例为 63.28%。接受综合临终关怀后，不复苏（DNR）医嘱的签署率从 41.53%显著提高到 71.47%（p<0.0001），对疾病预后的认识从 46.05%提高到 57.69%（p=0.0006）。综合临终关怀还使 64.21%的未转至临终关怀病房的晚期癌症患者能够在急性病房接受临终关怀咨询团队的综合关怀，从而提高了晚期癌症患者的临终关怀利用率。患者的主要症状是疼痛（58%）、呼吸困难（52%）、便秘（45%）和疲劳（23%）。
通过临终关怀咨询系统，临终关怀综合关怀对临终关怀的利用、DNR 签署率和晚期癌症患者的生命末期护理质量有积极影响。
