Pimentel Lindsey E, Yennurajalingam Sriram, Chisholm Gary, Edwards Tonya, Guerra-Sanchez Maria, De La Cruz Maxine, Tanco Kimberson, Vidal Marieberta, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
J Pain Symptom Manage. 2015 May;49(5):939-44. doi: 10.1016/j.jpainsymman.2014.10.020. Epub 2015 Feb 7.
There is limited literature on characteristics of telephone triage programs and the nature of interventions in palliative care.
Our aim was to determine frequency and type of care provided by a Supportive Care Center Telephone Triaging Program (SCCTP) in advanced cancer patients (ACPs).
Electronic medical records were reviewed of 400 consecutive ACPs referred to palliative care at a comprehensive cancer center and given access to the SCCTP: 200 from the outpatient (OP) supportive care center and 200 from inpatient (IP) palliative care given access after discharge. We reviewed call frequency, type, reason, and outcomes including pain and other symptoms (Edmonton Symptom Assessment Scale and Memorial Delirium Assessment Scale [MDAS]) associated with utilization of the SCCTP.
A total of 375 patients were evaluable. One hundred fifteen of 400 patients (29%) used the SCCTP: 96 OPs (83%) used the SCCTP vs. only 19 IPs (17%) (P < 0.001). The most common reasons for calls were pain (24%), pain medication refills (24%), and counseling (12%). For 115 phone calls, 43% (145 of 340) of recommendations were regarding care at home and 56% were regarding opioids. Patients who used the SCCTP had worse pain (P = 0.006), fatigue (P = 0.045), depression (P = 0.041), and well-being (P = 0.015) and better MDAS scores (P = 0.014) compared with nonusers. OPs had a higher prevalence of symptom distress (P = 0.013), depression (P < 0.001), anxiety (P < 0.01), and insomnia scores (P = 0.001); MDAS scores were significantly higher in IPs (P < 0.001).
In this study, we found that overall utilization of the SCCTP by ACPs referred to palliative care was relatively low at 28.7%. The use of the SCCTP was particularly poor among the IPs on discharge. Patients who used SCCTP had worse pain, fatigue, depression, and well-being scores and better delirium scores.
关于电话分诊项目的特征以及姑息治疗中干预措施的性质，相关文献有限。
我们的目的是确定支持性护理中心电话分诊项目（SCCTP）为晚期癌症患者（ACP）提供护理的频率和类型。
回顾了一家综合癌症中心连续转诊至姑息治疗并可使用SCCTP的400例ACP的电子病历：200例来自门诊（OP）支持性护理中心，200例来自出院后可使用该项目的住院（IP）姑息治疗患者。我们回顾了呼叫频率、类型、原因和结果，包括与使用SCCTP相关的疼痛和其他症状（埃德蒙顿症状评估量表和纪念谵妄评估量表[MDAS]）。
共有375例患者可进行评估。400例患者中有115例（29%）使用了SCCTP：96例OP患者（83%）使用了SCCTP，而只有19例IP患者（17%）使用了该项目（P<0.001）。最常见的呼叫原因是疼痛（24%）、补充止痛药物（24%）和咨询（12%）。在115次电话呼叫中，43%（340次中的145次）的建议是关于居家护理，56%是关于阿片类药物。与未使用者相比，使用SCCTP 的患者疼痛更严重（P = 0.006）、疲劳更严重（P = 0.045）、抑郁更严重（P = 0.041）、生活质量更差（P = 0.015），但谵妄评估量表得分更高（P = 0.014）。OP患者症状困扰的患病率更高（P = （0.013）、抑郁更严重（P<0.001）、焦虑更严重（P<0.01）、失眠得分更高（P = 0.001）；IP患者的MDAS得分显著更高（P<0.001）。
在本研究中，我们发现转诊至姑息治疗的ACP对SCCTP的总体使用率相对较低，为28.7%。出院时IP患者对SCCTP的使用尤其少。使用SCCTP的患者疼痛、疲劳、抑郁和生活质量得分更差，但谵妄得分更高。
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