du Couëdic L, Morel V, Trehello L, Trehony A, Robert M, Sandron D
Service de pneumologie, CHG de Saint-Nazaire, Saint-Nazaire cedex, France.
Rev Mal Respir. 2012 Nov;29(9):1088-94. doi: 10.1016/j.rmr.2012.04.010. Epub 2012 Jul 24.
The aim of our study was to examine the practices and performance of a team working in a respiratory unit concerning the palliative care of patients with COPD, in a group of patients who died in hospital as a result of their disease.
The first step was focused on those patients who died in the respiratory care unit of the General Hospital of Saint-Nazaire during the year 2008 and who received end-of-life care, and the reasons for their death. In the second step, we selected and analysed retrospectively the records of patients who died from COPD. In the third step semi-directive interviews were held with a sample of nine care workers who were judged to be representative of the staff working in the respiratory ward of Saint-Nazaire Hospital. The interviews consisted of seven questions related to palliative practices and professional experiences acquired during the care of patients with COPD.
In a population of 51 patients who received end-of-life care during the year 2008, 34 were referred on account of lung cancer and only one was referred for COPD. Bronchial carcinoma was the main cause of death (36 cases) then COPD (16 cases) in a total of 92 deaths (2008). Retrospective analysis of the records of patients who died from COPD showed a limitation of care in 43% of cases, midazolam induced sedation in 43%, treatment with morphine in 37%, support for the family or relatives in 62% and some anticipated decisions in 6%. Analysis of the interviews showed that the subject of death is rarely or never discussed with these patients in contrast to patients dying from bronchial cancer.
The practices of a respiratory team concerning palliative care in COPD patients appear to be limited to end-of-life care. This clearly reflects a need for palliative care education in workers of respiratory care units in order to deliver a global palliative approach at an earlier stage in the care of COPD patients and to improve communication concerning end-of-life treatments.
我们研究的目的是，在一组因疾病在医院死亡的患者中，考察一个呼吸科团队在慢性阻塞性肺疾病（COPD）患者姑息治疗方面的做法和表现。
第一步聚焦于2008年在圣纳泽尔综合医院呼吸科接受临终关怀并死亡的患者，以及他们的死亡原因。第二步，我们回顾性地选择并分析了死于慢性阻塞性肺疾病患者的病历。第三步，对九名被认为能够代表圣纳泽尔医院呼吸科工作人员的医护人员进行了半指导性访谈。访谈包括七个与姑息治疗做法以及在照顾慢性阻塞性肺疾病患者过程中获得的专业经验相关的问题。
在2008年接受临终关怀的51名患者中，34名因肺癌转诊，只有1名因慢性阻塞性肺疾病转诊。在总共92例死亡病例（2008年）中，支气管癌是主要死因（36例），其次是慢性阻塞性肺疾病（16例）。对死于慢性阻塞性肺疾病患者病历的回顾性分析显示，43%的病例存在护理不足，43%使用咪达唑仑诱导镇静，37%使用吗啡治疗，62%为家属或亲属提供支持，6%有一些预先决策。访谈分析表明，与死于支气管癌的患者相比，很少或从未与这些患者讨论过死亡话题。
呼吸科团队在慢性阻塞性肺疾病患者姑息治疗方面的做法似乎仅限于临终关怀。这清楚地反映出，呼吸科护理人员需要接受姑息治疗教育，以便在慢性阻塞性肺疾病患者护理的早期阶段提供全面的姑息治疗方法，并改善关于临终治疗的沟通。
