Third Department of Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Department of Medical Statistics, Biomathematics and Information Processing, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany.
J Cancer Res Clin Oncol. 2022 Mar;148(3):735-742. doi: 10.1007/s00432-021-03652-0. Epub 2021 May 5.
Providing state-of-the-art palliative care is crucial in all areas of in- and outpatient settings. Studies on the implementation of palliative care standards for dying patients are rare.
N = 141 physicians from all internal departments were polled anonymously about the treatment of dying patients using a self-designed questionnaire. Furthermore, we evaluated the terminal care of n = 278 patients who died in internal medicine departments at University Hospital Mannheim between January and June, 2019 based on clinical data of the last 48 h of life. We defined mandatory criteria for good palliative practice both regarding treatment according to patients' records and answers in physicians' survey.
Fifty-six physicians (40%) reported uncertainties in the treatment of dying patients (p < 0.05). Physicians caring for dying patients regularly stated to use sedatives more frequently and to administer less infusions (p < 0.05, respectively). In multivariate analysis, medical specialization was identified as an independent factor for good palliative practice (p < 0.05). Physicians working with cancer patients regularly were seven times more likely to use good palliative practice (p < 0.05) than physicians who did not. Cancer patients received good palliative practice more often than patients dying from non-malignant diseases (p < 0.05).
Guideline-based palliative care for dying patients was found to be implemented more likely and consistent within the oncology department. These results point to a potential lack of training of fellows in non-oncological departments in terms of good end-of-life care.
在门诊和住院环境的各个领域提供最先进的姑息治疗至关重要。关于实施临终患者姑息治疗标准的研究很少。
我们使用自行设计的问卷对所有内科医生进行了匿名调查，以了解他们对临终患者的治疗情况。此外，我们根据 2019 年 1 月至 6 月在曼海姆大学医院内科死亡的 278 名患者的临床数据，评估了他们的临终护理情况。我们根据患者记录和医生调查中的回答，为良好姑息治疗实践定义了强制性标准。
56 名医生（40%）报告说在治疗临终患者时存在不确定性（p<0.05）。照顾临终患者的医生经常表示更频繁地使用镇静剂和减少输液（p<0.05）。多变量分析表明，医学专业是良好姑息治疗的独立因素（p<0.05）。经常与癌症患者一起工作的医生比不与癌症患者一起工作的医生更有可能使用良好的姑息治疗（p<0.05）。癌症患者比非恶性疾病患者更经常接受良好的姑息治疗（p<0.05）。
在肿瘤学部门，基于指南的姑息治疗在临终患者中更有可能得到实施，且更一致。这些结果表明，在非肿瘤学部门，住院医师在良好的临终关怀方面可能缺乏培训。
