Eriksson Heléne, Milberg Anna, Hjelm Katarina, Friedrichsen Maria
Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
Palliative Education & Research Centre, Vrinnevi Hospital, Norrköping, Sweden.
PLoS One. 2016 Feb 4;11(2):e0147694. doi: 10.1371/journal.pone.0147694. eCollection 2016.
Although stroke is a significant public health challenge and the need for palliative care has been emphasized for these patients, there is limited data on end-of-life care for patients dying from stroke.
To study the end-of-life care during the last week of life for patients who had died of stroke in terms of registered symptom, symptom management, and communication, in comparison with patients who had died of cancer.
This study is a retrospective, comparative registry study.
A retrospective comparative registry study was performed using data from a Swedish national quality register for end-of-life care based on WHO`s definition of Palliative care. Data from 1626 patients who had died of stroke were compared with data from 1626 patients who had died of cancer. Binary logistic analyses were used to calculate odds ratios, with 95% CI.
Compared to patients who was dying of cancer, the patients who was dying of stroke had a significantly higher prevalence of having death rattles registered, but a significantly lower prevalence of, nausea, confusion, dyspnea, anxiety, and pain. In addition, the stroke group had significantly lower odds ratios for health care staff not to know whether all these six symptoms were present or not. Patients who was dying of stroke had significantly lower odds ratio of having informative communication from a physician about the transition to end-of-life care and of their family members being offered bereavement follow-up.
The results indicate on differences in end-of-life care between patients dying of stroke and those dying from cancer. To improve the end-of-life care in clinical practice and ensure it has consistent quality, irrespective of diagnosis, education and implementation of palliative care principles are necessary.
尽管中风是一项重大的公共卫生挑战，并且这些患者对姑息治疗的需求已得到强调，但关于中风死亡患者临终关怀的数据有限。
研究中风死亡患者在生命最后一周的临终关怀情况，包括登记症状、症状管理和沟通情况，并与癌症死亡患者进行比较。
本研究是一项回顾性、比较性登记研究。
使用来自瑞典全国临终关怀质量登记处的数据进行回顾性比较登记研究，该登记处基于世界卫生组织对姑息治疗的定义。将1626例中风死亡患者的数据与1626例癌症死亡患者的数据进行比较。采用二元逻辑分析计算比值比及95%置信区间。
与癌症临终患者相比，中风临终患者登记有死亡呼噜声的患病率显著更高，但恶心、意识模糊、呼吸困难、焦虑和疼痛的患病率显著更低。此外，中风组医护人员不知道这六种症状是否都存在的比值比显著更低。中风临终患者从医生那里获得关于临终关怀过渡的信息性沟通以及其家人获得丧亲后续跟进的比值比显著更低。
结果表明中风死亡患者与癌症死亡患者在临终关怀方面存在差异。为改善临床实践中的临终关怀并确保其质量一致，无论诊断如何，实施姑息治疗原则的教育和实践都是必要的。
