1 University of Washington School of Medicine , Seattle, Washington.
2 Fred Hutchinson Cancer Research Center , Seattle, Washington.
J Palliat Med. 2018 Mar;21(3):328-334. doi: 10.1089/jpm.2017.0257. Epub 2017 Oct 23.
While early involvement and integration of palliative care with oncology can positively impact quality of life and survival of patients with advanced cancer, there is a dearth of information regarding this integration in sub-Saharan Africa.
We sought to describe the rate and factors predicting specialist palliative referrals among cancer patients in Uganda.
We examined the rate of referrals of cancer patients to palliative specialists via a chart review, while also surveying and interviewing doctors at the Uganda Cancer Institute (UCI) about their approaches to palliative care.
All adult patients at the UCI who died in a 20-month interval from 2014 to 2015. All UCI doctors were approached for the survey and 25 (96%) participated. Seven of these doctors were also individually interviewed.
Number of referrals to palliative specialists and qualitative responses to questions about end-of-life care management.
Sixty-six (11.1%) of 595 patients were referred to palliative care specialists. Patients with worse ECOG performance statuses were more likely to be referred to palliative specialists (odds ratio 2.23, p = 0.03); no other factors were predictive of a referral. Median number of days lived after referral was 5 days (interquartile range 2-13). Doctors explained the low referral rate and short life expectancy after referral by limited palliative resources and a reticence to have end-of-life management conversations with patients due to cultural taboos.
Despite recognized benefits of palliative collaboration, doctors at the UCI seldom refer patients to palliative care specialists due to limited staffing, cultural barriers, and difficult interservice communication.
尽管早期将姑息治疗与肿瘤学相结合可以积极影响晚期癌症患者的生活质量和生存，但在撒哈拉以南非洲地区，关于这种整合的信息却很少。
我们旨在描述乌干达癌症患者向姑息治疗专家转诊的比例及其预测因素。
我们通过病历回顾检查癌症患者向姑息治疗专家转诊的比例，同时调查并访谈乌干达癌症研究所（UCI）的医生，了解他们对姑息治疗的方法。
2014 年至 2015 年期间，在 20 个月的时间内，UCI 所有死亡的成年患者。所有 UCI 医生都接受了调查，其中 25 人（96%）参与了调查。其中 7 名医生还接受了单独访谈。
向姑息治疗专家转诊的人数以及对临终关怀管理相关问题的定性回答。
595 名患者中有 66 名（11.1%）被转诊至姑息治疗专家。ECOG 表现状态较差的患者更有可能被转诊至姑息治疗专家（优势比 2.23，p=0.03）；没有其他因素可预测转诊。转诊后平均存活天数为 5 天（中位数 2-13）。医生解释低转诊率和转诊后预期寿命较短的原因是姑息治疗资源有限，以及由于文化禁忌，不愿与患者进行临终管理谈话。
尽管姑息治疗合作有公认的益处，但 UCI 的医生很少将患者转诊至姑息治疗专家，原因是人员配备有限、文化障碍和服务间沟通困难。
