End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Ghent, Belgium.
Department of Geriatric Medicine, Ghent University and Ghent University Hospital, Ghent, Belgium.
Palliat Med. 2020 Jun;34(6):784-794. doi: 10.1177/0269216320910332. Epub 2020 Apr 14.
BACKGROUND/OBJECTIVES: Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death.
In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents' death.
Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis.
Nurses' response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9-27.2) in the Netherlands, 25.2% (18.3-33.6) in Belgium, 29.3% (16.9-45.8) in England, 33.7% (26.2-42.2) in Finland, 64.6% (52.0-75.4) in Italy and 79.1% (71.2-85.3) in Poland ( < 0.001). Opioid underuse was 57.2% (33.0-78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9-63.8) for pain and 37.4% (19.4-59.6) for both symptoms ( = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20-0.54) when pain was assessed.
Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders.
背景/目的：阿片类药物可缓解终末期患者的症状。我们研究了长期护理机构中阿片类药物使用不足的情况，将在死亡前 3 天尽管有疼痛和/或呼吸困难仍未开具阿片类药物处方的患者定义为阿片类药物使用不足。
在 6 个欧盟国家按比例分层随机选择的长期护理机构样本中，护士和长期护理机构管理人员在居民死亡后 3 个月内完成了死亡后结构问卷调查。
护士使用临终痴呆症舒适度评估量表评估疼痛/呼吸困难，并通过病历审查检查阿片类药物处方。我们按国家和症状计算了阿片类药物使用不足的比例，并通过多水平、多变量分析计算了阿片类药物使用不足的相关性。
护士的回复率为 81.6%，管理人员的回复率为 95.7%。在最后一周报告有疼痛/呼吸困难的 901 名死亡患者中，10.6%有呼吸困难，34.4%有疼痛，55.0%有两种症状。荷兰的阿片类药物使用不足率为 19.2%（95%置信区间：12.9-27.2），比利时为 25.2%（18.3-33.6），英格兰为 29.3%（16.9-45.8），芬兰为 33.7%（26.2-42.2），意大利为 64.6%（52.0-75.4），波兰为 79.1%（71.2-85.3）（ < 0.001）。呼吸困难的阿片类药物使用不足率为 57.2%（33.0-78.4），疼痛为 41.2%（95%置信区间：21.9-63.8），两种症状均为 37.4%（19.4-59.6）（ = 0.013）。当评估疼痛时，阿片类药物使用不足的可能性较低（比值比：0.33；95%置信区间：0.20-0.54）。
阿片类药物使用不足在各国之间存在差异。在临终阶段应正式评估疼痛和呼吸困难，并将其纳入医生的医嘱。
