Department of Oncology and Radiotherapy, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.
Department of Clinical Oncology, University of Turku, Turku, Finland.
BMC Palliat Care. 2018 Dec 17;17(1):128. doi: 10.1186/s12904-018-0383-4.
Until recently, palliative care (PC) resources in Finland have been sparse. To meet the increasing need for PC an end-of-life (EOL) care project has been ongoing in South Western Finland since 2012, and in 2015, a weekday palliative outpatient clinic was established in Turku University Hospital (TUH). The aim of this study was to explore the effect of the project and the PC clinic on the management practices of EOL cancer patients attending the Emergency Department (ED) of TUH from 2013 to 2016.
The medical records of all cancer patients (ICD-10 codes C00-97) admitted to the ED of TUH between August 1-December 31, in 2013 and 2016, were analyzed: n = 529, n = 432 respectively (2013 and 2016). The analysis focused on those patients in EOL care; n = 77, n = 63, respectively. The late palliative patients were defined by PC decision, thus termination of life-prolonging cancer-specific treatments. The EOL patients were in the imminently dying phase of their illness. The site of referral after an ED visit was also verified together with the documentation on advance care plans (ACP), and the impact of palliative outpatient visits.
In 2016, the number of late palliative and EOL patients admitted to the ED has shown a tendency to decrease. The quality of the documentation for treatment goals, do-not-resuscitate (DNR) orders, living wills and connections to primary care providers has improved since 2013. Prior visits to palliative outpatient clinic correlated well with the more comprehensive ACP information: i) DNR order (p = 0.0001); ii) connection to primary care (p = 0.003); iii) documented ICD-10 code Z51.5 (p = 0.0001).
Even modest investments in resources for PC can induce an objective change in the allocation of health care resources, and improve the ACP for the cancer patients at their EOL. A visit to a palliative outpatient clinic may offer one approach for improving the quality and completion of ACP documentation.
直到最近，芬兰的姑息治疗（PC）资源还很匮乏。为了满足对 PC 的日益增长的需求，自 2012 年以来，芬兰西南部一直在进行一项临终关怀项目，2015 年，图尔库大学医院（TUH）开设了一个工作日的姑息治疗门诊。本研究旨在探讨该项目和 PC 门诊对 2013 年至 2016 年 TUH 急诊科收治的终末期癌症患者管理实践的影响。
分析 2013 年 8 月 1 日至 12 月 31 日期间 TUH 急诊科收治的所有癌症患者（ICD-10 编码 C00-97）的病历：n=529，n=432（2013 年和 2016 年）。分析重点是处于 EOL 护理的患者；n=77，n=63，分别。晚期姑息治疗患者由 PC 决定，即终止延长生命的癌症特异性治疗。EOL 患者处于疾病的临终阶段。还验证了急诊科就诊后的转诊地点以及预先护理计划（ACP）的记录，并评估了姑息门诊就诊的影响。
2016 年，急诊科收治的晚期姑息治疗和 EOL 患者数量呈下降趋势。自 2013 年以来，治疗目标、不复苏（DNR）医嘱、生前遗嘱和与初级保健提供者联系的文档质量有所改善。姑息门诊就诊次数与更全面的 ACP 信息相关：i）DNR 医嘱（p=0.0001）；ii）与初级保健的联系（p=0.003）；iii）记录 ICD-10 编码 Z51.5（p=0.0001）。
即使对姑息治疗资源进行适度投资，也能客观地改变卫生保健资源的分配，并改善终末期癌症患者的 ACP。姑息门诊就诊可能是提高 ACP 文档质量和完整性的一种方法。
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