Graduate College of Social Work, University of Houston, Houston, Texas, USA.
J Pain Symptom Manage. 2012 Jan;43(1):47-58. doi: 10.1016/j.jpainsymman.2011.03.016. Epub 2011 Aug 10.
Parenteral hydration at the end of life is controversial and has generated considerable debate for decades.
To identify palliative care physician parenteral hydration prescribing patterns and factors that influence prescribing levels (PLs) for patients during their last weeks of life.
A cross-sectional, representative online survey of Latin American palliative care physicians was conducted in 2010. Physicians were asked to report the percentage of their terminally ill patients for whom they prescribed parenteral hydration. Predictors of parenteral hydration PLs were identified using logistic regression analysis.
Two hundred thirty-eight of 320 physicians completed the survey (74% response rate). Sixty percent of physicians reported prescribing parenteral hydration to 40%-100% of their patients during the last weeks of life. Factors influencing moderate/high PLs were the following: agreeing that parenteral hydration is clinically and psychologically efficacious (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.5-8.3), disagreeing that withholding parenteral hydration alleviates symptoms (OR 3.3, 95% CI 1.3-8.1), agreeing that parenteral hydration is essential for meeting the minimum standards of care (OR 3.2, 95% CI 1.4-7.5), preferring the subcutaneous route of parenteral hydration for patient comfort and home use (OR 2.9, 95% CI 1.3-6.5), and being younger than 45 years of age (OR 2.6, 95% CI 1.3-5.2).
The strongest determinant of prescribing patterns was agreement with the clinical/psychological efficaciousness of parenteral hydration. Our results reflect parenteral hydration prescribing patterns and perceptions that substantially differ from the conventional/traditional hospice philosophy. These findings suggest that the decision to prescribe or withhold parenteral hydration is largely based on clinical perceptions and that most palliative care physicians from this region of the world individualize treatment decisions.
在生命末期进行肠外补液存在争议，几十年来一直引发广泛争论。
确定姑息治疗医师进行肠外补液的处方模式，以及影响患者临终最后几周肠外补液处方水平（PL）的因素。
2010 年对拉丁美洲姑息治疗医师进行了一项横断面、代表性的在线调查。医师报告了为终末期患者开具肠外补液的百分比。使用逻辑回归分析确定肠外补液 PL 的预测因素。
320 名医师中有 238 名（74%的应答率）完成了调查。60%的医师报告在生命的最后几周为 40%-100%的患者开具肠外补液。影响中度/高度 PL 的因素包括：认为肠外补液在临床和心理上有效（比值比[OR]3.5；95%置信区间[CI]1.5-8.3）、不同意肠外补液可以缓解症状（OR 3.3，95%CI 1.3-8.1）、认为肠外补液是满足最低护理标准所必需的（OR 3.2，95%CI 1.4-7.5）、为了患者的舒适和家庭使用更喜欢皮下途径给予肠外补液（OR 2.9，95%CI 1.3-6.5）和年龄小于 45 岁（OR 2.6，95%CI 1.3-5.2）。
决定处方模式的最强因素是对肠外补液的临床/心理疗效的认同。我们的结果反映了与传统临终关怀理念有很大不同的肠外补液处方模式和认知。这些发现表明，决定开处方或不开处方主要基于临床认知，并且来自该地区的大多数姑息治疗医师会个体化治疗决策。
