Culp Stacey, Lupu Dale, Arenella Cheryl, Armistead Nancy, Moss Alvin H
Department of Statistics, West Virginia University, Morgantown, West Virginia, USA.
Daleview Associates, Silver Spring, Maryland, USA.
J Pain Symptom Manage. 2016 Apr;51(4):756-761.e2. doi: 10.1016/j.jpainsymman.2015.11.017. Epub 2015 Dec 17.
Because of high symptom burden, numerous comorbidities, and shortened life expectancy, dialysis patients are increasingly recognized as appropriate candidates for early and continuous supportive care.
The objectives of this study were to describe dialysis professionals' perceptions of the adequacy of supportive care in dialysis centers, barriers to providing it, suggestions for improving it, and familiarity with the existing evidence-based resources for supportive care of dialysis patients.
The Coalition for Supportive Care of Kidney Patients conducted an online survey of dialysis professionals and administrators solicited through the 18 End-Stage Renal Disease Networks and the Renal Physicians Association.
Only 4.5% of 487 respondents believed their dialysis centers were presently providing high-quality supportive care. They identified bereavement support, spiritual support, and end-of-life care discussions as the top three unmet needs. They reported that lack of a predictive algorithm for prognosis was the top barrier, and "guidelines to help with decision-making in seriously ill patients" was the top priority to improve supportive care. A majority of respondents were unaware that an evidence-based validated prognostic model and a clinical practice guideline to help with decision-making were already available.
Dialysis professionals report significant unmet supportive care needs and barriers in their centers with only a small minority rating themselves as competently providing supportive care. There is an urgent need for education of dialysis professionals about available supportive care resources to provide quality supportive care to dialysis patients.
由于症状负担重、合并症众多以及预期寿命缩短，透析患者越来越被视为早期和持续支持性护理的合适对象。
本研究的目的是描述透析专业人员对透析中心支持性护理充分性的看法、提供支持性护理的障碍、改进建议以及对现有透析患者支持性护理循证资源的熟悉程度。
肾病患者支持性护理联盟对通过18个终末期肾病网络和肾脏内科医师协会征集的透析专业人员和管理人员进行了在线调查。
487名受访者中只有4.5%认为他们的透析中心目前提供高质量的支持性护理。他们将丧亲支持、精神支持和临终护理讨论列为三大未满足需求。他们报告称，缺乏预后预测算法是最大障碍，而“帮助重症患者决策的指南”是改善支持性护理的首要任务。大多数受访者不知道已经有了经过循证验证的预后模型和帮助决策的临床实践指南。
透析专业人员报告称，他们所在的中心存在大量未满足的支持性护理需求和障碍，只有少数人认为自己能够胜任提供支持性护理。迫切需要对透析专业人员进行有关现有支持性护理资源的教育，以便为透析患者提供高质量的支持性护理。
