Axelsson Lena, Klang Birgitta, Lundh Hagelin Carina, Jacobson Stefan H, Gleissman Sissel Andreassen
Sophiahemmet University, Stockholm, Sweden.
Division of nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Scand J Caring Sci. 2015 Dec;29(4):776-84. doi: 10.1111/scs.12209. Epub 2015 Mar 9.
The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives.
Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation.
Qualitative and descriptive.
Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved.
In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal.
Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care.
本研究旨在描述接受维持性血液透析治疗患者的亲属所讲述的患者临终情况。
许多接受血液透析的患者年龄较大，患有多种合并症，症状被低估，且处于生命的最后一年。为了改善护理，我们需要更多地了解他们的临终状况。
定性和描述性研究。
对14名已故血液透析患者的亲属进行了定性回顾性访谈（在患者死亡后3至13个月）。使用定性内容分析法对数据进行分析。该研究已获得伦理批准。
在生命的最后几个月里，患者健康状况逐渐恶化，出现急性发作，需要住院治疗。这包括生活空间的减少以及沮丧情绪的表达，但也有喜悦之情。在生命的最后几周出现了三种模式：随着生命消逝对死亡的不确定预期；停止血液透析后等待死亡；重症监护后突然但并非意外的死亡。研究结果显示了停止血液透析决策的复杂性。
不同的临终模式都涉及日益复杂的护理需求和生存问题。研究结果表明需要更早地进行护理规划。需要确定组织因素，以促进连续性和全人护理，满足这些患者复杂症状负担和合并症下的特殊护理需求。研究结果表明在血液透析护理中对患者的治疗需要整合姑息治疗方法。
