Coyle Séamus, Scott Aileen, Nwosu Amara Callistus, Latten Richard, Wilson James, Mayland Catriona R, Mason Stephen, Probert Chris, Ellershaw John
Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK.
Marie Curie Hospice Liverpool, Liverpool, UK.
BMJ Open. 2016 Nov 10;6(11):e011763. doi: 10.1136/bmjopen-2016-011763.
To assess the feasibility of prospectively collecting biological samples (urine) from palliative care patients in the last weeks of life.
A 30-bedded specialist hospice in the North West of England.
Participants were adults with a diagnosis of advanced disease and able to provide written informed consent.
Potential participants were identified by a senior clinician over a 12-week period in 2014. They were then approached by a researcher and invited to participate according to a developed recruitment protocol.
Feasibility targets included a recruitment rate of 50%, with successful collection of samples from 80% who consented.
A total of 58 patients were approached and 33 consented (57% recruitment rate). Twenty-five patients (43%) were unable to participate or declined; 10 (17%) became unwell, too fatigued, lost capacity, died or were discharged home; and 15 (26%) refused, usually these patients had distressing pain, low mood or profound fatigue. From the 33 recruited, 20 participants provided 128 separate urine samples, 12 participants did not meet the inclusion criteria at the time of consent and 1 participant was unable to provide a sample. The criterion for a urinary catheter was removed for the latter 6 weeks. The collection rate during the first 6 weeks was 29% and 93% for the latter 6 weeks. Seven people died while the study was ongoing, and another 4 participants died in the following 4 weeks.
It is possible to recruit and collect multiple biological samples over time from palliative care patients in the last weeks and days of life even if they have lost capacity. Research into the biological changes at the end of life could develop a greater understanding of the biology of the dying process. This may lead to improved prognostication and care of patients towards the end of life.
评估在临终前几周前瞻性收集姑息治疗患者生物样本（尿液）的可行性。
英格兰西北部一家拥有30张床位的专科临终关怀医院。
参与者为被诊断患有晚期疾病且能够提供书面知情同意书的成年人。
2014年，一名资深临床医生在12周内识别出潜在参与者。随后，一名研究人员与他们联系，并根据制定的招募方案邀请他们参与。
可行性目标包括招募率达到50%，且从80%同意的参与者中成功收集样本。
总共接触了58名患者，33名同意参与（招募率为57%）。25名患者（43%）无法参与或拒绝；10名（17%）病情恶化、过于疲劳、失去行为能力、死亡或出院回家；15名（26%）拒绝，通常这些患者有剧痛、情绪低落或极度疲劳。在招募的33名患者中，20名参与者提供了128份单独的尿液样本，12名参与者在同意时不符合纳入标准，1名参与者无法提供样本。在最后6周取消了导尿管标准。前6周的收集率为29%，后6周为93%。7人在研究进行期间死亡，另有4名参与者在接下来的4周内死亡。
即使临终关怀患者已失去行为能力，也有可能在生命的最后几周和几天内随着时间推移招募并收集多个生物样本。对生命末期生物变化的研究有助于更深入地了解死亡过程的生物学机制。这可能会改善对临终患者的预后评估和护理。
