Küttner Stefanie, Wüller Johannes, Pastrana Tania
Department of Hematology and Internal Oncology,Hospital of Düren,Düren,Germany.
Home Care Städteregion Aachen,Aachen,Germany.
Palliat Support Care. 2017 Apr;15(2):205-213. doi: 10.1017/S1478951516000560. Epub 2016 Jul 26.
The aims of the present study were (1) to describe the prevalence of psychosocial distress in palliative care patients living at home and the related factors, and (2) to test implementation of the Distress Thermometer (DT) within a home-based palliative care service.
Ours was a 15-month prospective study beginning in September of 2013 in western Germany with consecutive patients cared for by a home care palliative care service. The research was implemented during the first visit by the home care team. Patients were excluded if they were under 18 years of age, mentally or physically unable to complete the assessment questionnaires as judged by their healthcare worker, or unable to understand the German language. During the first encounter, the Distress Thermometer (DT), a Problem List (PL), and a structured questionnaire for evaluation were applied and sociodemographic and medical data collected.
A total of 103 patients (response rate = 70%; mean age = 67; female = 54%; married = 67%; oncological condition = 91%; Karnofsky Performance Status [KPS] score 0-40 = 34%, 50-70 = 60%, >80 = 6%) were included. The incidence of distress (DT score ≥4) was 89.3% (mean = 6.3 ± 2.5). No statistical association was found between level of distress and sociodemographic or medical factors. The five most reported problems were "fatigue" (90%), "getting around" (84%), "eating" (63%), "bathing/dressing" (60%), and "sleep" (57%). The number of problems reported correlated with level of distress (ρ = 0.34). The DT was comprehensible, and 80% considered its completion as unremarkable, while 14% found it "relieving."
A significant proportion of patients treated at home reported symptoms of distress. The most oft-mentioned problems were physical and emotional in nature. The findings of our study highlight the importance of creating new concepts and structures in order to address the psychosocial needs of patients in home care with palliative needs.
本研究的目的是（1）描述居家姑息治疗患者心理社会困扰的患病率及其相关因素，以及（2）在居家姑息治疗服务中测试痛苦温度计（DT）的应用情况。
我们于2013年9月在德国西部开展了一项为期15个月的前瞻性研究，研究对象为接受居家姑息治疗服务的连续患者。该研究在居家护理团队首次访视时进行。如果患者年龄在18岁以下、医护人员判断其精神或身体上无法完成评估问卷，或无法理解德语，则将其排除。在首次接触时，应用痛苦温度计（DT）、问题清单（PL）和一份结构化评估问卷，并收集社会人口统计学和医疗数据。
共纳入103例患者（应答率=70%；平均年龄=67岁；女性=54%；已婚=67%；肿瘤疾病=91%；卡诺夫斯基功能状态[KPS]评分0 - 40=34%，50 - 70=60%，>80=6%）。痛苦发生率（DT评分≥4）为89.3%（平均值=6.3±2.5）。未发现痛苦程度与社会人口统计学或医疗因素之间存在统计学关联。报告最多的五个问题是“疲劳”（90%）、“行动不便”（84%）、“进食”（63%）、“洗澡/穿衣”（60%）和“睡眠”（57%）。报告的问题数量与痛苦程度相关（ρ=0.34）。DT易于理解，80%的人认为完成该问卷并无异常，而14%的人觉得它“能缓解痛苦”。
在家接受治疗的患者中有很大一部分报告了痛苦症状。最常提到的问题本质上是身体和情感方面的。我们的研究结果强调了创建新概念和结构以满足居家姑息治疗患者心理社会需求的重要性。
