Romem Anat, Tom Sarah E, Beauchene Michelle, Babington Lynn, Scharf Steven M, Romem Ayal
School of Nursing Sciences, The Academic College of Tel-Aviv, Yaffo, Israel.
Pharmaceutical Health Services Research Department, University of Maryland, Baltimore, MD, USA.
Palliat Med. 2015 May;29(5):464-9. doi: 10.1177/0269216315570411. Epub 2015 Feb 13.
Limited data exist concerning the unique pain characteristics of patients with non-cancer terminal diseases referred for inpatient hospice care.
To define the unique pain characteristics of patients admitted to an acute inpatient hospice setting with end-stage dementia or chronic obstructive lung disease (or chronic obstructive pulmonary disease) and to compare them to patients with end-stage cancer.
Retrospective patient chart review. Demographic, physiological, pain parameters, and medication utilization data were extracted. Associations between pain characteristics, medication utilization, and admission diagnoses were assessed. Analyses included descriptive statistics.
SETTING/PARTICIPANTS: In total, 146 patients admitted to an acute inpatient hospice between 1 April 2011 and 31 March 2012 with an underlying primary diagnosis of chronic obstructive pulmonary disease (n = 51), dementia (n = 48), or cancer (n = 47).
Pain was highly prevalent in all diagnostic groups, with cancer patients experiencing more severe pain on admission. Cancer patients received a significantly higher cumulative opioid dose compared with dementia and chronic obstructive pulmonary disease patients. Pain control within 24 h of pain onset was achieved in less than half of all patient groups with chronic obstructive pulmonary disease patients the least likely to achieve pain control.
Despite the fact that pain is the most common complaint at the end of life, pain management may be suboptimal for some primary diagnoses. Admission diagnosis is the strongest predictor of pain control. Patient with cancer achieve the best pain control, and chronic obstructive pulmonary disease patients are the least likely to have their pain adequately treated.
关于转诊至住院临终关怀机构的非癌症终末期疾病患者独特的疼痛特征，现有数据有限。
明确入住急性住院临终关怀机构的终末期痴呆或慢性阻塞性肺疾病（或慢性阻塞性肺病）患者的独特疼痛特征，并将其与终末期癌症患者进行比较。
回顾性患者病历审查。提取人口统计学、生理学、疼痛参数和药物使用数据。评估疼痛特征、药物使用与入院诊断之间的关联。分析包括描述性统计。
设置/参与者：2011年4月1日至2012年3月31日期间，共有146名患者入住急性住院临终关怀机构，其潜在的主要诊断为慢性阻塞性肺病（n = 51）、痴呆（n = 48）或癌症（n = 47）。
疼痛在所有诊断组中都非常普遍，癌症患者入院时疼痛更严重。与痴呆和慢性阻塞性肺病患者相比，癌症患者接受的阿片类药物累积剂量显著更高。在所有患者组中，不到一半的患者在疼痛发作后24小时内实现了疼痛控制，慢性阻塞性肺病患者最不可能实现疼痛控制。
尽管疼痛是生命末期最常见的主诉，但对于某些主要诊断，疼痛管理可能并不理想。入院诊断是疼痛控制的最强预测因素。癌症患者疼痛控制最佳，慢性阻塞性肺病患者疼痛得到充分治疗的可能性最小。
