Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan.
Department of Pain and Palliative Care, Kameda General Hospital, Kamogawa, Chiba, Japan.
J Pain Symptom Manage. 2020 Dec;60(6):1163-1169. doi: 10.1016/j.jpainsymman.2020.06.031. Epub 2020 Jun 29.
In end-of-life care, rehabilitation for patients with cancer is considered to be an important means for improving patients' quality of death and dying.
To determine whether the provision of rehabilitation for patients with cancer in palliative care units is associated with the achievement of a good death.
This study involved a cross-sectional, anonymous, and self-report questionnaire survey of families of patients with cancer who died in palliative care units in Japan. We evaluated the short version of Good Death Inventory (GDI) on a seven-point scale. A logistic regression model was used to calculate the propensity score. Covariates included in this model were survey year, patients' characteristics, and families' characteristics. The associations between rehabilitation and GDI were tested using trend tests after propensity score matching adjustment.
Of the 1965 family caregivers who received the questionnaires, available data were obtained from 1008 respondents (51.2%). Among them, 285 (28.2%) cases received rehabilitation in palliative care units. There was no difference in total GDI score between the groups with and without rehabilitation. In exploratory analyses, patients receiving rehabilitation were significantly more likely to feel maintaining hope and pleasure (mean 4.50 [SE 0.10] vs. 4.05 [0.11], respectively; effect size [ES] 0.31; P = 0.003), good relationships with medical staff (mean 5.67 [SE 0.07] vs. 5.43 [0.09], respectively; ES 0.22; P = 0.035), and being respected as an individual (mean 6.08 [SE 0.06] vs. 5.90 [0.07], respectively; ES 0.19; P = 0.049) compared with patients not receiving rehabilitation.
Rehabilitation in palliative care units may contribute to several domains of quality of death and dying, particularly maintaining hope and pleasure. Further research is needed to investigate whether palliative rehabilitation contributes to the achievement of a good death.
在临终关怀中，对癌症患者进行康复治疗被认为是提高患者死亡质量和临终质量的重要手段。
确定姑息治疗病房中为癌症患者提供康复治疗是否与实现善终有关。
本研究采用了一种在日本姑息治疗病房死亡的癌症患者家属的横断面、匿名、自我报告问卷调查。我们使用七点量表评估了善终量表（Good Death Inventory，GDI）的简短版。使用逻辑回归模型计算倾向评分。该模型纳入的协变量包括调查年份、患者特征和家庭特征。在倾向评分匹配调整后，使用趋势检验测试康复与 GDI 之间的关联。
在收到问卷的 1965 名家庭护理人员中，有 1008 名（51.2%）应答者提供了可用数据。其中，285 例（28.2%）患者在姑息治疗病房接受了康复治疗。接受康复治疗组与未接受康复治疗组的总 GDI 评分无差异。在探索性分析中，接受康复治疗的患者更有可能感到保持希望和愉悦（平均值 4.50 [0.10] 与 4.05 [0.11]，分别；效应量 [ES] 0.31；P=0.003），与医务人员保持良好关系（平均值 5.67 [0.07] 与 5.43 [0.09]，分别；ES 0.22；P=0.035），以及被尊重为个体（平均值 6.08 [0.06] 与 5.90 [0.07]，分别；ES 0.19；P=0.049），而不是未接受康复治疗的患者。
姑息治疗病房中的康复治疗可能有助于死亡质量和临终质量的几个方面，特别是保持希望和愉悦。需要进一步研究姑息性康复治疗是否有助于实现善终。
