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姑息治疗咨询对患者满意度的影响:一项单中心观察性研究。

Treatment effects of palliative care consultation and patient contentment: A monocentric observational study.

机构信息

Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinik und Poliklinik für Strahlentherapie.

Institut für Medizinische Epidemiologie, Biometrie und Informatik Universitätsmedizin Halle (Saale), Germany.

出版信息

Medicine (Baltimore). 2021 Mar 26;100(12):e24320. doi: 10.1097/MD.0000000000024320.

DOI:10.1097/MD.0000000000024320
PMID:33761631
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9282054/
Abstract

Palliative care is a central component of the therapy in terminally ill patients. During treatment in non-palliative departments this can be realized by consultation.To analyze the change in symptom burden during palliative care consultation.In this observational study, we enrolled all cancer cases (n = 163) receiving inpatient treatment for 2015 to 2018 at our institution. We used the MDASI-questionnaire (0 = 'not present' and 10 = "as bad as you can imagine") and the FAMCARE-6 (1 = very satisfied, 5 = very dissatisfied) to analyze the treatment effect and patient satisfaction, respectively.We examined the association of symptom burden and patient satisfaction using Spearman-correlation. Comparing mean values, we applied the Wilcoxon-test and one-way ANOVA.An improvement in MDASI-core-items after treatment completion was significant (P < .05) in 14/18 symptoms. The change in perception of pain showed the strongest improvement (median: 5 to 3). Initially the MDASI-items "activity" (median = 8) and emotional distress (median = 5 and 6) were viewed as especially incriminating. There was no evidence for a correlation between patients' age, the type of diagnosis and time since diagnosis.The analysis of FAMCARE-6 patient contentment was lower or equal to two in all of the six items. There was a weak negative association between the change in symptom burden of psycho-emotional items "distress/feeling upset" (P = .006, rSp = -0,226), "sadness" and patient satisfaction in FAMCARE-6.A considerable improvement of the extensive symptom burden particularly of pain relief was achieved by integrating palliative consultation in clinical practice.

摘要

姑息治疗是终末期患者治疗的核心组成部分。在非姑息治疗科室进行治疗时,可以通过咨询来实现这一点。

  • 分析姑息治疗咨询过程中症状负担的变化。

  • 在这项观察性研究中,我们招募了所有在我们机构接受姑息治疗的癌症患者(n=163)。我们使用 MDASI 问卷(0=“不存在”和 10=“无法想象的严重”)和 FAMCARE-6(1=非常满意,5=非常不满意)来分析治疗效果和患者满意度。

  • 我们使用 Spearman 相关分析来研究症状负担与患者满意度之间的关系。通过比较平均值,我们应用了 Wilcoxon 检验和单因素方差分析。

  • 治疗完成后,MDASI 核心项目的改善具有统计学意义(P<0.05),18 项症状中的 14 项均有改善。疼痛感知的变化显示出最强的改善(中位数:5 变为 3)。最初,MDASI 项目“活动”(中位数=8)和情绪困扰(中位数=5 和 6)被认为是特别严重的问题。患者年龄、诊断类型和诊断后时间与症状负担的变化之间没有相关性。

  • 在所有六个项目中,FAMCARE-6 患者满意度分析的结果均低于或等于 2。在心理-情感项目“痛苦/不安”(P=0.006,rSp=-0.226)和“悲伤”的症状负担变化与 FAMCARE-6 患者满意度之间存在弱负相关。

  • 通过将姑息治疗咨询纳入临床实践,广泛的症状负担得到了显著改善,尤其是疼痛缓解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adc1/9282054/774968761b07/medi-100-e24320-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adc1/9282054/dcb4848c046d/medi-100-e24320-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adc1/9282054/056d24d85348/medi-100-e24320-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adc1/9282054/774968761b07/medi-100-e24320-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adc1/9282054/dcb4848c046d/medi-100-e24320-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adc1/9282054/056d24d85348/medi-100-e24320-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adc1/9282054/774968761b07/medi-100-e24320-g003.jpg

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