1 UAB School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA.
2 Gulhane Training and Research Hospital, Ankara, Turkey.
Palliat Med. 2018 Jan;32(1):59-68. doi: 10.1177/0269216317733381. Epub 2017 Sep 27.
Early outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters.
Describe the evaluation and treatment recommendations made in early outpatient palliative care consultations.
Outpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated.
SETTING/PARTICIPANTS: Outpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US.
In all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations-marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms-mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations-counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations-pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants.
Outpatient palliative care consultations for newly diagnosed advanced cancer patients can address patients' needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom indicators versus reliance on oncologist referral.
全球临床肿瘤学指南建议进行早期门诊姑息治疗咨询。尽管有这些建议，但尚不清楚这些咨询应该包含哪些内容。
描述早期门诊姑息治疗咨询中的评估和治疗建议。
对门诊姑息治疗咨询图表记录进行定性编码，并列出频率。
地点/参与者：门诊姑息治疗咨询是作为一项早期与延迟随机对照试验（2010 年 11 月至 2013 年 4 月）的一部分自动触发的，该试验针对的是新诊断为晚期癌症且居住在美国东北部农村的患者。
共有 142 名患者（早期组 70 名；延迟组 72 名）接受了门诊姑息治疗咨询。这些咨询中最常涉及的领域包括一般评估-婚姻/伴侣状况（81.7%）、精神/情感健康（80.3%）和照顾者/家庭支持（79.6%）；症状-情绪（81.7%）、疼痛（73.9%）和认知/心理状态（68.3%）；一般治疗建议-咨询（39.4%）、维持现有药物（34.5%）和开始新药物（23.9%）；以及症状特异性治疗建议-疼痛（22.5%）、便秘（12.7%）、抑郁（12.0%）、完成预嘱（43.0%）、指定代理人（21.8%）和讨论疾病轨迹（21.1%）。与早期组相比，晚期组的医生更有可能评估一般疼痛（p=0.035）和对临终关怀的认识（p=0.005），并讨论/建议临终关怀（p=0.002）。
新诊断的晚期癌症患者的门诊姑息治疗咨询可以满足患者的需求，并提供有关在疾病早期可能未得到解决的问题的建议。未来的前瞻性研究应确定基于诊断或记录的症状指标自动触发的早期门诊姑息治疗咨询的价值，而不是依赖肿瘤医生的转诊。
