De Roo Maaike L, Albers Gwenda, Deliens Luc, de Vet Henrica C W, Francke Anneke L, Van Den Noortgate Nele, Van den Block Lieve
Department of Public and Occupational Health & Expertise Center of Palliative Care, EMGO Institute for Health and Care Research, Vrije University Medical Center, Amsterdam, The Netherlands.
End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.
J Pain Symptom Manage. 2015 Jul;50(1):1-8. doi: 10.1016/j.jpainsymman.2015.02.024. Epub 2015 Apr 4.
Although dying peacefully is considered an important outcome of high-quality palliative care, large-scale quantitative research on dying peacefully and the factors associated with a peaceful death is lacking.
To gain insight into how many residents with dementia in long-term care facilities die peacefully, according to their relatives, and whether that assessment is correlated with observed physical and psychological distress.
This was a retrospective cross-sectional study of deceased nursing home residents in a representative sample of long-term care facilities in Flanders, Belgium (2010). Structured post-mortem questionnaires were completed by relatives of the resident, who were asked to what extent they agreed that the resident "appeared to be at peace" during the dying process. Spearman correlation coefficients gave the correlations between physical and psychological distress (as measured using the Symptom Management at the End of Life with Dementia and Comfort Assessment in Dying at the End of Life with Dementia scales) and dying peacefully (as measured using the Quality of Dying in Long Term Care instrument).
The sample comprised 92 relatives of deceased residents with dementia. In 54% of cases, relatives indicated that the resident died peacefully. Weak-to-moderate correlations (0.2-0.57) were found between dying peacefully and physical distress in the last week of life. Regarding psychological distress, weak-to-moderate correlations were found for both the last week (0.33-0.44) and last month of life (0.28-0.47).
Only half of the residents with dementia died peacefully as perceived by their relatives. Relatives' assessment of whether death was peaceful is related to both physical and psychological distress. Further qualitative research is recommended to gain more in-depth insights into the aspects on which relatives base their judgment of dying peacefully.
尽管安详离世被视为高质量姑息治疗的一项重要成果，但关于安详离世以及与安详死亡相关因素的大规模定量研究仍较为缺乏。
了解长期护理机构中患有痴呆症的居民在亲属看来有多少人安详离世，以及该评估是否与观察到的身体和心理痛苦相关。
这是一项对比利时弗拉芒地区长期护理机构中有代表性样本的已故养老院居民进行的回顾性横断面研究（2010年）。由居民的亲属填写结构化的事后调查问卷，问卷询问他们在多大程度上同意居民在临终过程中“看起来很安详”。斯皮尔曼相关系数给出了身体和心理痛苦（使用《痴呆症临终症状管理量表》和《痴呆症临终舒适评估量表》进行测量）与安详离世（使用《长期护理中的死亡质量量表》进行测量）之间的相关性。
样本包括92名已故痴呆症居民的亲属。在54%的案例中，亲属表示居民安详离世。在生命最后一周，安详离世与身体痛苦之间存在弱到中等程度的相关性（0.2 - 0.57）。关于心理痛苦，在生命最后一周（0.33 - 0.44）和最后一个月（0.28 - 0.47）均发现了弱到中等程度的相关性。
在亲属看来，只有一半的痴呆症居民安详离世。亲属对死亡是否安详的评估与身体和心理痛苦均有关。建议进一步开展定性研究，以更深入地了解亲属判断安详离世所依据的方面。
