晚期痴呆症的触发式姑息治疗：一项试点随机试验。

Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial.

机构信息

Division of Geriatric Medicine and Palliative Care Program, Cecil G. Sheps Center for Health Services Research, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.

Department of Family Medicine and Palliative Care Program, Cecil G. Sheps Center for Health Services Research, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.

出版信息

J Pain Symptom Manage. 2019 Jan;57(1):10-19. doi: 10.1016/j.jpainsymman.2018.10.494. Epub 2018 Oct 18.

DOI:10.1016/j.jpainsymman.2018.10.494

PMID:30342242

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6310628/

Abstract

CONTEXT

Persons with late-stage dementia have limited access to palliative care.

OBJECTIVE

The objective of this study was to test dementia-specific specialty palliative care triggered by hospitalization.

METHODS

This pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus postacute transitional care. Control dyads received usual care and educational information. The primary outcome was 60-day hospital or emergency department visits. Secondary patient- and family-centered outcomes were patient comfort, family distress, palliative care domains addressed in the treatment plan, and access to hospice or community-based palliative care. Secondary decision-making outcomes were discussion of prognosis, goals of care, completion of Medical Orders for Scope of Treatment (MOST), and treatment decisions.

RESULTS

Of 137 eligible dyads, 62 (45%) were enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family two-week call) to 93% (initial consultation). Hospital and emergency department visits did not differ (intervention vs. control, 0.68 vs. 0.53 transfers per 60 days, P = 0.415). Intervention patients had more palliative care domains addressed and were more likely to receive hospice (25% vs. 3%, P < 0.019). Intervention families were more likely to discuss prognosis (90% vs. 3%, P < 0.001) and goals of care (90% vs. 25%, P < 0.001) and to have a MOST at 60-day follow-up (79% vs. 30%, P < 0.001). More intervention families made decisions to avoid rehospitalization (13% vs. 0%, P = 0.033).

CONCLUSION

Specialty palliative care consultation for hospitalized patients with late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes.

摘要

背景

晚期痴呆患者获得姑息治疗的机会有限。

目的

本研究旨在测试针对住院患者的痴呆专科姑息治疗。

方法

这项试点随机对照试验纳入了 62 对晚期痴呆患者及其家庭决策者入院时的患者。干预组接受痴呆专科姑息治疗咨询和急性后期过渡性护理。对照组接受常规护理和教育信息。主要结局为 60 天内的住院或急诊就诊。次要的以患者和家庭为中心的结局包括患者舒适度、家庭困扰、治疗计划中涉及的姑息治疗领域以及获得姑息治疗或社区为基础的姑息治疗的机会。次要的决策结果是讨论预后、护理目标、医疗指令范围治疗（MOST）的完成情况以及治疗决策。

结果

在 137 名符合条件的患者中，有 62 名（45%）被纳入研究。干预措施证明是可行的，协议完成率从 77%（家庭两周电话）到 93%（初步咨询）不等。住院和急诊就诊没有差异（干预组与对照组每 60 天的就诊次数分别为 0.68 次和 0.53 次，P=0.415）。干预组患者涉及的姑息治疗领域更多，更有可能接受临终关怀（25%对 3%，P<0.019）。干预组家庭更有可能讨论预后（90%对 3%，P<0.001）和护理目标（90%对 25%，P<0.001），并且在 60 天随访时有更多的 MOST（79%对 30%，P<0.001）。更多的干预组家庭做出了避免再次住院的决定（13%对 0%，P=0.033）。