van Riet Paap Jasper, Mariani Elena, Chattat Rabih, Koopmans Raymond, Kerhervé Hélène, Leppert Wojciech, Forycka Maria, Radbruch Lukas, Jaspers Birgit, Vissers Kris, Vernooij-Dassen Myrra, Engels Yvonne
Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
BMC Palliat Care. 2015 Nov 4;14:56. doi: 10.1186/s12904-015-0053-8.
People with dementia can benefit from a palliative care approach. Recommendations, such as those of the EAPC have been proposed to strengthen the provision of palliative care for this group of patients. Yet, it remains challenging for professionals to identify when a person with dementia is in need of palliative care. The objective of this study therefore was to explore when professionals in long-term care settings consider a person with dementia in need of palliative care.
Teams with in total 84 professionals working in 13 long-term care settings from 6 countries (France, Germany, Italy, Norway, Poland and the Netherlands) received a case-vignette concerning a person with dementia recently admitted to a nursing home. Teams were asked to discuss when they considered people with dementia eligible for palliative care. The constant comparative method was used to analyse their answers.
Three different time points in the disease trajectory when people with dementia were considered to be eligible for palliative care were extracted: (1) early in the disease trajectory; (2) when signs and symptoms of advanced dementia are present; and (3) from the time point that curative treatment of co-morbidities is futile. Yet, none of these time points was uniformly considered by the professional teams across Europe. In some cases, professionals working in the same nursing home didn't even reach consensus when considering persons with dementia eligible for palliative care.
The results of the study identified that professionals across Europe have different opinions regarding the time point when to consider a person with dementia in need of palliative care.
痴呆症患者可从姑息治疗方法中获益。已经提出了一些建议，如欧洲姑息治疗协会（EAPC）的建议，以加强为这组患者提供姑息治疗。然而，专业人员要确定痴呆症患者何时需要姑息治疗仍然具有挑战性。因此，本研究的目的是探讨长期护理机构中的专业人员何时认为痴呆症患者需要姑息治疗。
来自6个国家（法国、德国、意大利、挪威、波兰和荷兰）13个长期护理机构的总共84名专业人员组成的团队收到了一个关于最近入住养老院的痴呆症患者的病例 vignette。团队被要求讨论他们认为痴呆症患者何时适合接受姑息治疗。采用持续比较法分析他们的答案。
提取了痴呆症患者被认为适合接受姑息治疗的疾病轨迹中的三个不同时间点：（1）疾病轨迹早期；（2）出现晚期痴呆症的体征和症状时；（3）从合并症的治愈性治疗无效之时起。然而，欧洲的专业团队并未统一认可这些时间点中的任何一个。在某些情况下，同一养老院的专业人员在考虑痴呆症患者是否适合接受姑息治疗时甚至无法达成共识。
研究结果表明，欧洲各地的专业人员对于何时认为痴呆症患者需要姑息治疗的时间点存在不同意见。
