Kralik Debbie, Anderson Barbara
Director, Research Unit, Royal District Nursing Service of SA Inc., Adelaide, SA, AustraliaSenior Research Fellow, Research Unit, Royal District Nursing Service of SA Inc., Adelaide, SA, Australia.
J Clin Nurs. 2008 Nov;17(11c):429-35. doi: 10.1111/j.1365-2702.2008.02580.x.
To identify home-based palliative care service utilisation by people with cancer and non-cancer conditions.
Palliative care knowledge and skill have been derived from working with people with cancer. People with chronic conditions are now referred for home-based palliative care; however, there has been few studies published that have explored the impact of service utilisation by people with end-stage chronic conditions.
The Australia-modified Karnofsky Performance Status (AKPS) scale was calculated for each person upon referral for home-based palliative care services to determine the functional capacity of the individual at the point of referral. Clients were divided into those with cancer diagnosis and those with non-cancer diagnosis. Service utilisation of the individual client was determined until separation from the palliative care service. The study was undertaken in 2007.
The majority of people with cancer (63%) and non-cancer (71%) were assessed as having an AKPS score between 50-60. Thirty-one cancer clients (18·7%) and three non-cancer clients (7·1%) had an AKPS score between 70-90. This suggests that people with cancer are referred to palliative care services earlier than people with non-cancer conditions. People with non-cancer conditions were substantially higher users of home-based palliative care services over a longer period of time.
Home-based palliative care service utilisation was higher for people with non-cancer conditions. Cost analysis research is recommended to delineate the actual costs of home-based palliative care service provision between people with cancer and non-cancer conditions.
There is growing awareness of the need for palliative care services for people with non-cancer conditions. However, these services are provided for longer periods of time for this client group. Implications for practice are that the palliative care needs of people with non-cancer conditions may not be met within current palliative care service provision. There may be funding implications for home-based palliative care services that intend to meet the needs of people at end of life with non-cancer conditions.
确定癌症患者和非癌症患者对居家姑息治疗服务的利用情况。
姑息治疗的知识和技能源于与癌症患者的合作。慢性病患者现在也被转介接受居家姑息治疗；然而，很少有已发表的研究探讨终末期慢性病患者利用该服务的影响。
在为每位居家姑息治疗服务转介患者计算澳大利亚改良卡氏功能状态量表（AKPS），以确定转介时个体的功能能力。将患者分为癌症诊断患者和非癌症诊断患者。确定个体患者的服务利用情况，直至其不再接受姑息治疗服务。该研究于2007年进行。
大多数癌症患者（63%）和非癌症患者（71%）的AKPS评分在50 - 60之间。31名癌症患者（18.7%）和3名非癌症患者（7.1%）的AKPS评分在70 - 90之间。这表明癌症患者比非癌症患者更早被转介至姑息治疗服务。非癌症患者在更长时间内对居家姑息治疗服务的使用量显著更高。
非癌症患者对居家姑息治疗服务的利用率更高。建议进行成本分析研究，以明确癌症患者和非癌症患者居家姑息治疗服务提供的实际成本。
人们越来越意识到非癌症患者对姑息治疗服务的需求。然而，为该患者群体提供这些服务的时间更长。实践中的影响是，在当前的姑息治疗服务提供中，非癌症患者的姑息治疗需求可能无法得到满足。对于旨在满足非癌症终末期患者需求的居家姑息治疗服务，可能存在资金方面的影响。
