在患有晚期、生命有限疾病的患者中，药物滥用、症状负担和生活质量之间的关联。
Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness.
机构信息
Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
Center for Research on Healthcare Data Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
J Gen Intern Med. 2019 Apr;34(4):559-566. doi: 10.1007/s11606-019-04837-7. Epub 2019 Feb 4.
BACKGROUND
Polypharmacy may be particularly burdensome near the end of life, as patients "accumulate" medications to treat and prevent multiple diseases.
OBJECTIVE
To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year).
DESIGN
Secondary analysis of baseline data from a trial of statin discontinuation.
PARTICIPANTS
Adults with advanced, life-limiting illness.
MAIN MEASURES
Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0-90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0-10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL.
KEY RESULTS
Among 372 participants, 47% were age 75 or older and 35% were enrolled in hospice. The mean symptom score was 27.0 (standard deviation (SD) 16.1) and the mean QOL score was 7.0 (SD 1.3). The average number of non-statin medications was 11.6 (SD 5.0); one-third of participants took ≥ 14 medications. In adjusted models, higher polypharmacy was associated with higher symptom burden (coefficient 0.81; p < .001) and lower QOL (coefficient - .06; p = .001). Adjusting for symptom burden weakened the association between polypharmacy and QOL (coefficient - .03; p = .045) without a significant interaction, suggesting that worse quality of life associated with polypharmacy may be related to medication-associated symptoms.
CONCLUSIONS
Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower QOL. Attention to medication-related symptoms and shared decision-making regarding deprescribing are warranted in this setting.
NIH TRIAL REGISTRY NUMBER
ClinicalTrials.gov Identifier for Parent Study - NCT01415934.
背景
在生命末期，多种药物治疗和预防多种疾病可能会给患者带来沉重负担，即所谓的“药物累积”。
目的
评估在晚期、生命有限的疾病患者中（临床医生估计为 1 个月至 1 年），多种药物治疗、症状负担和生活质量（QOL）之间的关联。
设计
他汀类药物停药试验的基线数据的二次分析。
参与者
患有晚期、生命有限的疾病的成年人。
主要措施
通过定期或按需服用的非他汀类药物的数量来评估多种药物治疗。使用埃德蒙顿症状评估量表（范围 0-90；分数越高表示症状负担越大）评估症状负担，使用 McGill QOL 问卷（范围 0-10；分数越高表示 QOL 越好）评估 QOL。线性回归模型评估了多种药物治疗、症状负担和 QOL 之间的关联。
主要结果
在 372 名参与者中，47%的人年龄在 75 岁或以上，35%的人参加了临终关怀。平均症状评分为 27.0（标准差（SD）16.1），平均 QOL 评分为 7.0（SD 1.3）。非他汀类药物的平均数量为 11.6（SD 5.0）；三分之一的参与者服用了≥14 种药物。在调整后的模型中，较高的多种药物治疗与较高的症状负担（系数 0.81；p<0.001）和较低的 QOL（系数 -0.06；p=0.001）相关。调整症状负担后，多种药物治疗与 QOL 之间的关联减弱（系数 -0.03；p=0.045），且无显著交互作用，这表明与多种药物治疗相关的较差的生活质量可能与药物相关的症状有关。
结论
在患有晚期疾病的成年人中，服用更多的药物与更高的症状负担和更低的 QOL 相关。在这种情况下，需要关注与药物相关的症状和减少药物的共同决策。
NIH 试验注册编号：用于父研究的 ClinicalTrials.gov 标识符 - NCT01415934。
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