Bostwick Doran, Wolf Steven, Samsa Greg, Bull Janet, Taylor Donald H, Johnson Kimberly S, Kamal Arif H
Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
J Pain Symptom Manage. 2017 Jun;53(6):1079-1084.e1. doi: 10.1016/j.jpainsymman.2017.02.014. Epub 2017 Apr 27.
Historically, palliative care has been focused on those with cancer. Although these ties persist, palliative care is rapidly integrating into the care of patients with common, non-cancer serious illnesses. Despite this, the bulk of literature informing palliative care practices stems from the care of cancer patients.
We compared functionality, advanced care planning, hospital admissions, prognosis, quality of life, pain, dyspnea, fatigue, and depression between patients with cancer and three non-cancer diagnoses-end-stage renal disease (ESRD), heart failure (HF), and chronic obstructive pulmonary disease (COPD).
We conducted a cross-sectional, retrospective analysis of the characteristics and symptoms of patient's with ESRD, HF, COPD, and cancer at time of first specialty palliative care referral. Using a web-based point of care quality assessment and reporting tool, Quality Data and Collection Tool-Palliative care, this analysis evaluated all eligible patients who received a palliative care consultation between October 1, 2012 and November 25, 2014. Data were obtained from 13 participating sites. The primary outcome for the study was functionality using the palliative performance scale. Hospital admission in the last 30 days, prognosis, patient's understanding of prognosis, advanced care planning including code status and appointed decision maker, pain, fatigue, depression, and dyspnea were also evaluated as secondary outcomes. We tested for an association between our outcomes with disease type (cancer vs. non-cancer) fitting multivariable logistic regression models.
We found that the patients with primary diagnoses other than cancer were less functional at time of referral (odds ratio: 1.6; 95% CI: 1.1, 2.3; P < 0.05).
Patients with COPD, ESRD, and HF were less functional and more likely to be hospitalized at time of referral to palliative care than cancer patients. These findings may be reflective of the slower and more varied trajectory of non-cancer serious illness. One aim of palliative care for those with non-cancer severe illness should be directed toward improving and assisting with functionality and decreasing frequency of hospital admissions. These interventions could take place in the palliative care office, but could also be integrated into hospital discharge plans.
从历史上看，姑息治疗一直专注于癌症患者。尽管这些关联仍然存在，但姑息治疗正在迅速融入常见非癌症严重疾病患者的护理中。尽管如此，为姑息治疗实践提供信息的大部分文献都源于癌症患者的护理。
我们比较了癌症患者与三种非癌症诊断（终末期肾病（ESRD）、心力衰竭（HF）和慢性阻塞性肺疾病（COPD））患者之间的功能、临终关怀计划、住院情况、预后、生活质量、疼痛、呼吸困难、疲劳和抑郁情况。
我们对首次专科姑息治疗转诊时ESRD、HF、COPD和癌症患者的特征及症状进行了横断面回顾性分析。使用基于网络的即时护理质量评估和报告工具“质量数据与收集工具 - 姑息治疗”，该分析评估了2012年10月1日至2014年11月25日期间接受姑息治疗咨询的所有符合条件的患者。数据来自13个参与站点。该研究的主要结局是使用姑息治疗表现量表评估的功能。过去30天内的住院情况。预后、患者对预后的理解、包括代码状态和指定决策者在内的临终关怀计划、疼痛、疲劳、抑郁和呼吸困难也作为次要结局进行评估。我们通过拟合多变量逻辑回归模型来检验结局与疾病类型（癌症与非癌症）之间的关联。
我们发现，除癌症外的原发性诊断患者在转诊时功能较差（比值比：1.6；95%置信区间：1.1，2.3；P < 0.05）。
与癌症患者相比，COPD、ESRD和HF患者在转诊至姑息治疗时功能较差，且更有可能住院。这些发现可能反映了非癌症严重疾病的病程较慢且更为多样。对于患有非癌症严重疾病的患者，姑息治疗的一个目标应是致力于改善和协助其功能，并减少住院频率。这些干预措施可以在姑息治疗办公室进行，但也可以纳入医院出院计划中。
