Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University, Taoyuan, Taiwan; Saint Peter's Palliative Care Team, Saint Paul's Hospital, Taoyuan, Taiwan.
J Formos Med Assoc. 2013 Jul;112(7):406-15. doi: 10.1016/j.jfma.2011.08.021. Epub 2012 Apr 28.
BACKGROUND/PURPOSE: Taiwan is only now beginning to offer palliative care to patients who do not have cancer. This study aimed to document the polysymptomatic presentation of illness in Taiwanese patients with late-stage nonmalignant disease and to evaluate the potential benefits of palliative care for these patients. The results may help to educate healthcare personnel regarding the need for and importance of palliative treatment as comprehensive, appropriate end-of-life care for patients with nonmalignant disease.
We retrospectively analyzed 115 patients without cancer hospitalized in a community hospital in Taiwan: 61 had organic brain disease, 31 had chronic obstructive pulmonary disease, 17 had chronic renal failure, 14 had congestive heart failure, 12 had liver cirrhosis, and 20 had multiple illnesses. The median age was 81 years (interquartile range 69-86 years), and 51% of patients were enrolled from intensive care. Symptoms and their severity were analyzed. Patients' and their families' understanding of the diagnosis and prognosis and "Do Not Resuscitate" (DNR) consent were evaluated pre- and post-palliative care.
The four leading symptoms were fatigue (96%), fever (86%), cough (81%), and dyspnea (79%). No significant differences in symptom prevalence were found between different sexes, ages, performance statuses, ward locations, or underlying diseases, except for fewer episodes of dizziness, more frequent episodes of cough in patients older than 80 years, and more episodes of jaundice in ward service subjects. Only the presence of abdominal distension differed significantly between surviving and deceased patients (22.9% vs. 40.3%; p=0.004). After the start of palliative care, patients' DNR consent increased (105/115 before, 114/115 after). Patients' recognition of the diagnosis and prognosis increased from 13 to 64, respectively, with a simultaneous increase in family members' recognition (66 before, 114 after).
Hospice care with good symptom control is warranted for patients with late-stage nonmalignant disease who need appropriate end-of-life care. Medical personnel need education in the importance of palliative care and the identification of patients who could benefit from it. In addition, patients should be informed of its availability.
背景/目的：台湾现在才开始为非癌症患者提供缓和医疗。本研究旨在记录台湾晚期非恶性疾病患者的多症状表现，并评估缓和医疗对这些患者的潜在益处。研究结果可能有助于教育医疗保健人员，使他们认识到晚期非恶性疾病患者需要全面、适当的临终关怀，并认识到缓和治疗的重要性。
我们回顾性分析了台湾一家社区医院的 115 名非癌症住院患者：61 名有机脑疾病患者，31 名慢性阻塞性肺病患者，17 名慢性肾衰竭患者，14 名充血性心力衰竭患者，12 名肝硬化患者，20 名多器官疾病患者。中位年龄为 81 岁（四分位距 69-86 岁），51%的患者从重症监护病房转入。分析症状及其严重程度。评估患者及其家属对诊断和预后的理解以及“不复苏”（DNR）同意情况，在接受缓和医疗前后进行。
前四位症状是疲劳（96%）、发热（86%）、咳嗽（81%）和呼吸困难（79%）。不同性别、年龄、表现状态、病房位置或基础疾病的患者的症状发生率无显著差异，除 80 岁以上患者头晕发作次数减少、咳嗽发作次数更频繁、病房服务患者黄疸发作次数更多外。只有腹胀的存在在存活和死亡患者之间有显著差异（22.9%对 40.3%；p=0.004）。开始缓和医疗后，患者的 DNR 同意率增加（115 例中有 105 例，115 例中有 114 例）。患者对诊断和预后的认识分别从 13 例增加到 64 例，同时患者家属的认识也从 66 例增加到 114 例。
对于需要适当临终关怀的晚期非恶性疾病患者，需要提供姑息治疗，并控制好症状。医务人员需要接受姑息治疗的重要性和识别可能从中受益的患者的教育。此外，应向患者提供姑息治疗的信息。
