Batten Monique, Nguyen Bella, Burke Brandon, Harryanto Hilman, Mitchell Imogen, Davis Alison
Australian National University Medical School, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Department of Medical Oncology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Asia Pac J Clin Oncol. 2018 Oct;14(5):e528-e534. doi: 10.1111/ajco.13001. Epub 2018 Jun 13.
To examine the current patterns of end-of-life care of medical oncology patients dying in an Australian tertiary acute hospital setting in order to determine potential areas for improvement.
A retrospective observational study was undertaken of 295 consecutive adult medical oncology inpatients dying between 2010 and 2015. Charts were reviewed for evidence of (1) resuscitation plans, (2) acute interventions in the 48-h period prior to death, (3) palliative care involvement and (4) recognition of the dying patient and comfort care plans.
At the time of death, 98% of patients had a resuscitation plan, 71% of which were completed by the medical oncology team. Fifty-nine percent of medical emergency team reviews occurred in patients without a documented resuscitation plan. Within 48 h of death, active interventions were still being given to 64% of patients in the total patient population. Comfort care plans were documented in 86% of patients; however, 62% of these were only documented within 48 h of death and 20% of patients with a documented comfort care plan still received noncomfort measures.
There was a high level of documented resuscitation plans, comfort care plans and recognition of dying. However, active interventions were common within 48 h of death, and comfort care plans and recognition of dying often occurred late. These data indicate a gap between documenting a resuscitation plan and providing timely and appropriate end-of-life care. Understanding the gaps in delivering appropriate care provides an opportunity for improving end-of-life care.
研究澳大利亚一家三级急症医院中临终的肿瘤内科患者的临终护理现状模式，以确定潜在的改进领域。
对2010年至2015年间连续死亡的295名成年肿瘤内科住院患者进行回顾性观察研究。查阅病历以寻找以下方面的证据：（1）复苏计划；（2）死亡前48小时内的急性干预措施；（3）姑息治疗参与情况；（4）对临终患者的识别及舒适护理计划。
在死亡时，98%的患者有复苏计划，其中71%由肿瘤内科团队完成。59%的医疗急救团队评估发生在没有记录复苏计划的患者中。在死亡的48小时内，总体患者中有64%仍在接受积极干预。86%的患者记录了舒适护理计划；然而，其中62%是在死亡前48小时内才记录的，并且20%有记录的舒适护理计划的患者仍接受了非舒适护理措施。
有大量记录的复苏计划、舒适护理计划以及对临终状态的识别。然而，在死亡48小时内积极干预很常见，舒适护理计划和对临终状态的识别往往出现得较晚。这些数据表明在记录复苏计划与提供及时、恰当的临终护理之间存在差距。了解在提供恰当护理方面的差距为改善临终护理提供了机会。
