End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
J Pain Symptom Manage. 2021 Apr;61(4):732-742.e1. doi: 10.1016/j.jpainsymman.2020.09.001. Epub 2020 Sep 8.
Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area.
To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries.
A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life.
We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%).
Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff.
某些治疗方法在生命末期对疗养院居民可能并不适用，应谨慎考虑。对潜在不适当治疗方法的国际比较可以深入了解疗养院临终护理的常见问题和特定于国家的挑战，并有助于指导该领域的医疗保健政策。
估计疗养院居民生命最后一周内潜在不适当治疗方法的流行率，并分析各国之间流行率的差异。
对六个欧洲国家（比利时（佛兰德斯）、英格兰、芬兰、意大利、荷兰和波兰）疗养院中已故居民（2015 年）进行的横断面研究。潜在不适当的治疗方法包括肠内给予营养、肠外给予营养、人工补液、复苏、人工通气、输血、化疗/放疗、透析、手术、抗生素、他汀类药物、降糖药、新型口服抗凝剂。护士被询问这些治疗方法是否在生命的最后一周内给予。
我们纳入了来自 322 家疗养院的 1384 名已故居民。在大多数国家，很少使用潜在不适当的治疗方法，在波兰，最多有 18.3%的居民接受了至少一种治疗。例外情况是所有国家都使用抗生素（比利时为 11.3%，波兰为 45%）、波兰和意大利（54.3%和 41%）的人工营养和水合作用以及波兰的降糖药（19.7%）。
尽管生命最后一周内潜在不适当治疗方法的流行率通常较低，但所有国家都经常开抗生素。在波兰和意大利，生命最后一周内人工给予食物/液体的流行率较高，这可能反映了国家在立法、护理组织和文化以及工作人员的姑息治疗能力方面的差异。
