Stephens Stephanie L, Cassel J Brian, Noreika Danielle, Del Fabbro Egidio
1 Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, USA.
Am J Hosp Palliat Care. 2019 Apr;36(4):321-325. doi: 10.1177/1049909118811899. Epub 2018 Nov 14.
The US population of inmates continues to increase along with a rapid escalation in the number of elderly prisoners. Previous studies have demonstrated multiple barriers to providing palliative care for seriously ill inmates. The aim of this study was to assess the frequency of palliative care consultation and nature of consultation requests for inmates who died while hospitalized at a large tertiary care hospital. A retrospective chart review of all inmate decedents over a 10-year time period was conducted. The reason and timing of consultation was noted in addition to symptoms identified and interventions recommended by the palliative care team. Characteristics of patients who were transferred to the inpatient palliative care unit were also recorded. Forty-five percent of inmates were seen by palliative care prior to their death. Timing of consultation was close to the day of death. Inmates with cancer were significantly more likely to have a palliative care consultation prior to death. The most frequent intervention recommended was opiates for pain or dyspnea. Delirium was often missed by the primary team but was identified by the palliative care team. Nearly, 5000 prisoners die each year, mostly in community hospitals. These patients exhibit similar symptoms to free-living patients. Given that the inmate population has a higher rate of comorbid conditions, there is a need for more research to identify areas of need for incarcerated patients and where palliative care can best serve these individuals.
美国囚犯的数量持续增加，老年囚犯的数量也在迅速攀升。先前的研究表明，为重病囚犯提供姑息治疗存在多重障碍。本研究的目的是评估在一家大型三级护理医院住院期间死亡的囚犯接受姑息治疗咨询的频率以及咨询请求的性质。对10年间所有囚犯死亡病例进行了回顾性病历审查。记录了咨询的原因和时间，以及姑息治疗团队确定的症状和建议的干预措施。还记录了转入住院姑息治疗病房的患者特征。45%的囚犯在死亡前接受了姑息治疗咨询。咨询时间接近死亡日期。癌症囚犯在死亡前接受姑息治疗咨询的可能性显著更高。最常建议的干预措施是使用阿片类药物治疗疼痛或呼吸困难。初级团队经常漏诊谵妄，但姑息治疗团队能够识别。每年有近5000名囚犯死亡，大多死在社区医院。这些患者表现出与自由生活患者相似的症状。鉴于囚犯群体中合并症的发生率较高，需要开展更多研究，以确定被监禁患者的需求领域以及姑息治疗能够为这些人提供最佳服务的方面。
