使用 interRAI 姑息治疗工具是否能减少接受姑息治疗的养老院居民的需求和症状？
Does using the interRAI Palliative Care instrument reduce the needs and symptoms of nursing home residents receiving palliative care?
机构信息
LUCAS Centre for Care Research and Consultancy,University of Leuven,Leuven,Belgium.
End-of-Life Care Research Group,Vrije Universiteit Brussels and Ghent University,Brussels,Belgium.
出版信息
Palliat Support Care. 2018 Feb;16(1):32-40. doi: 10.1017/S1478951517000153. Epub 2017 Apr 4.
OBJECTIVE
This study aimed to evaluate whether using the interRAI Palliative Care instrument (the interRAI PC) in nursing homes is associated with reduced needs and symptoms in residents nearing the end of their lives.
METHOD
A quasi-experimental pretest-posttest study using the Palliative care Outcome Scale (POS) was conducted to compare the needs and symptoms of residents nearing the end of their lives in the control and intervention nursing homes. Care professionals at the intervention nursing homes filled out the interRAI PC over the course of a year for all residents aged 65 years and older who were nearing the end of their lives. This intervention was not implemented in the control nursing homes.
RESULTS
At baseline, POS scores in the intervention nursing homes were lower (more favorable) than in the control nursing homes on the items "pain", "other symptoms", "family anxiety", and the total POS score. Posttest POS scores for "wasted time" were higher (less favorable) than pretest scores in the intervention nursing homes. In the intervention nursing homes where care professionals did not have prior experience with the interRAI Long-Term Care Facilities (LTCF) assessment instrument (n = 8/15), total POS scores were lower (more favorable) at posttest.
SIGNIFICANCE OF RESULTS
One year after introducing the interRAI PC, no reduction in residents' needs and symptoms were detected in the intervention nursing homes. However, reductions in needs and symptoms were found in the subgroup of intervention nursing homes without prior experience with the interRAI LTCF instrument. This may suggest that the use of an interRAI instrument other than the interRAI PC specifically can improve care. Future research should aim at replicating this research with a long-term design in order to evaluate the effect of integrating the use of the interRAI PC in the day-to-day practices at nursing homes.
目的
本研究旨在评估在养老院使用跨学科研究评估工具（interRAI Palliative Care instrument，interRAI PC）是否与接近生命终点的居民需求和症状的减少相关。
方法
本研究采用准实验前后测试设计，使用姑息治疗结局量表（Palliative care Outcome Scale，POS）比较了对照组和干预组养老院接近生命终点的居民的需求和症状。干预组养老院的护理人员在一年内为所有 65 岁及以上接近生命终点的居民填写 interRAI PC。对照组养老院则没有实施这一干预措施。
结果
基线时，干预组养老院在“疼痛”、“其他症状”、“家庭焦虑”和 POS 总分等项目上的 POS 得分低于（更有利）对照组；干预组养老院“浪费时间”的 POS 后测得分高于（更不利）前测得分。在没有使用过 interRAI 长期护理设施（LTCF）评估工具的干预组养老院中（n=8/15），POS 总分在后测时较低（更有利）。
结果的意义
在引入 interRAI PC 一年后，干预组养老院居民的需求和症状没有减少。然而，在没有使用过 interRAI LTCF 工具的干预组养老院亚组中，需求和症状有所减少。这可能表明，使用除 interRAI PC 之外的 interRAI 工具可以改善护理。未来的研究应旨在采用长期设计复制这一研究，以评估将 interRAI PC 纳入养老院日常实践的效果。
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