Department of Palliative Care, Comprehensive Cancer Center, University Medical Center Freiburg, Freiburg, Germany.
Cancer. 2014 Oct 15;120(20):3254-60. doi: 10.1002/cncr.28702. Epub 2014 Sep 8.
Prior research has shown that hospitals are often ill-prepared to provide care for dying patients. This study assessed whether the circumstances for dying on cancer center wards allow for a dignified death.
In this cross-sectional study, the authors surveyed physicians and nurses in 16 hospitals belonging to 10 cancer centers in Baden-Wuerttemberg, Germany. A revised questionnaire from a previous study was used, addressing the following topics regarding end-of-life care: structural conditions (ie, rooms, staff), education/training, working environment, family/caregivers, medical treatment, communication with patients, and dignified death.
In total, 1131 surveys (response rate = 50%) were returned. Half of the participants indicated that they rarely have enough time to care for dying patients, and 55% found the rooms available for dying patients unsatisfactory. Only 19% of respondents felt that they had been well-prepared to care for the dying (physicians = 6%). Palliative care staff reported much better conditions for the dying than staff from other wards (95% of palliative care staff indicated that patients die in dignity on their ward). Generally, physicians perceived the circumstances much more positively than nurses, especially regarding communication and life-prolonging measures. Overall, 57% of respondents believed that patients could die with dignity on their ward.
Only about half of the respondents perceived that a dignified death is possible on their ward. We recommend that cancer centers invest more in staffing, adequate rooms for dying patients, training in end-of-life care, advance-care planning standards, and the early integration of specialist palliative care services.
先前的研究表明，医院通常对临终患者的护理准备不足。本研究评估了癌症中心病房的临终环境是否允许有尊严地死亡。
在这项横断面研究中，作者调查了德国巴登-符腾堡州 10 个癌症中心所属的 16 家医院的医生和护士。使用了先前研究的修订问卷，涉及临终关怀的以下主题：结构条件（即房间、员工）、教育/培训、工作环境、家庭/护理人员、医疗、与患者的沟通以及有尊严的死亡。
共收回 1131 份调查问卷（应答率=50%）。一半的参与者表示，他们很少有足够的时间照顾临终患者，55%的人认为为临终患者提供的病房条件不佳。只有 19%的受访者认为自己已经为临终护理做好了充分的准备（医生=6%）。姑息治疗工作人员报告的临终条件比其他病房的工作人员要好得多（95%的姑息治疗工作人员表示，患者在他们的病房中尊严地去世）。一般来说，医生对环境的看法比护士更为积极，尤其是在沟通和延长生命措施方面。总体而言，57%的受访者认为患者可以在自己的病房中尊严地死亡。
只有约一半的受访者认为在他们的病房中可以实现有尊严的死亡。我们建议癌症中心在人员配备、临终患者的适当病房、临终关怀培训、预先护理计划标准以及早期整合专业姑息治疗服务方面进行更多投资。
